What is the appropriate treatment for a hand scald burn in a child?

Treatment of Hand Scald Burns in Children

For hand scald burns in children, immediately cool the burn with cold (15-25°C) running tap water until pain is relieved, followed by cleaning, debridement, and application of a thin layer of 1% silver sulfadiazine cream covered with a sterile, non-adherent dressing. 1

Initial Management

First Aid

• Immediate cooling with running water:
  • Cool the burn with cold (15-25°C) running tap water until pain is relieved 1
  • While the optimal duration of cooling remains debated, cooling should be continued for at least 10-20 minutes 2, 3
  • Monitor young children for signs of hypothermia during cooling, especially if cooling large areas 2
  • Avoid using ice directly on burns as this can worsen tissue damage 1

Assessment

• Evaluate the depth and extent of the burn
• Hand burns in children require special attention due to risk of functional impairment 4
• Consider referral to a burn specialist if:
  • Burns involve hands (which is the case here)
  • Burns are full-thickness
  • Burns exceed 10% Total Body Surface Area (TBSA) in children 1, 3

Wound Management

Cleaning and Debridement

• Gently clean the wound after cooling
• Leave burn blisters intact as this improves healing and reduces pain 1
• Remove any jewelry from the affected hand to prevent complications from swelling

Topical Treatment

• Apply a thin layer (approximately 1/16 inch) of 1% silver sulfadiazine cream 1, 5
• Reapply once to twice daily or whenever the cream has been removed by patient activity 5
• Cover with a sterile, non-adherent dressing applied loosely 1
• Reapply silver sulfadiazine immediately after hydrotherapy 5

Pain Management

• Pain control is crucial for compliance with treatment and to prevent prolonged healing 6
• Use a multimodal approach:
  • First-line: Acetaminophen (15mg/kg every 4-6 hours)
  • Second-line: Add NSAIDs for inflammatory pain if no contraindications
  • For severe pain: Consider opioids as needed 1
• Ensure adequate pain control before dressing changes

Follow-up Care and Rehabilitation

• Regular wound assessment for signs of healing or complications
• Begin early range of motion exercises to prevent contractures 1
• For hand burns specifically:
  • Consider splinting in functional position when not performing exercises
  • Implement regular follow-up consultations including splint and compression treatments
  • Provide physiotherapy and occupational therapy to maintain hand function 4

Monitoring for Complications

• Watch for signs of infection (increased pain, redness extending beyond burn margins, purulent discharge)
• Monitor for contracture development, especially in hand burns
• Assess healing progress - burns not healing appropriately within 10-14 days may require specialist evaluation

Common Pitfalls to Avoid

1. Inadequate cooling: Many parents (65%) do not cool burns for the recommended duration 7
2. Inappropriate home remedies: Avoid butter, milk, cooking oil, toothpaste or other home remedies that can impair healing and increase infection risk 7
3. Overlooking tetanus prophylaxis: Burns are tetanus-prone wounds, so check immunization status 3
4. Unnecessary antibiotics: Avoid routine oral antibiotics unless signs of infection are present 3
5. Underestimating pain: Burn pain is often undertreated in children, leading to poor compliance with treatment 6

Early cooling with running water has been shown to reduce the progression of superficial burns to deep burns by approximately 32%, potentially eliminating the need for skin grafting 8. For hand burns specifically, specialized care is crucial to ensure optimal functional and aesthetic outcomes 4.