What is the management for a first-degree burn in a pediatric patient?

Management of First-Degree Burns in Pediatric Patients

For first-degree burns in pediatric patients, immediate cooling with cold running water for 20 minutes is the essential first step, followed by application of a greasy emollient (50% white soft paraffin with 50% liquid paraffin) and non-adherent dressings if needed. 1

Initial Assessment and Treatment

1. Immediate Cooling:

   • Apply cold running water to the burned area for 20 minutes
   • This reduces burn depth and decreases the likelihood of hospital admission 1
   • Avoid ice or very cold water which can worsen tissue damage

2. Pain Management:

   • Implement multimodal analgesia based on validated pain assessment scales
   • Use a combination of:
     • Acetaminophen
     • NSAIDs (if not contraindicated)
     • Opioids only if necessary for severe pain 1
   • Assess pain at least once daily using age-appropriate validated pain tools

Wound Care

1. Cleansing:

   • Gently irrigate with warmed sterile water, saline, or dilute chlorhexidine (1/5000) 1

2. Topical Treatment:

   • Apply greasy emollient (50% white soft paraffin with 50% liquid paraffin) over the epidermis 1
   • For first-degree burns, aqueous emulsions with small amounts of well-tolerated lipids (O/W emulsions) are optimal 2
   • Foam sprays and lotions are ideal as they are easy and painless to apply 2

3. Blister Management:

   • Keep blisters intact to maintain a sterile environment and reduce infection risk
   • If necessary, decompress by piercing but leave the blister roof intact to act as a biological dressing 1

4. Dressings:

   • For first-degree burns, dressings are often not required
   • If needed, use non-adherent dressings (e.g., Mepitel™ or Telfa™) 1

Monitoring and Follow-up

1. Infection Prevention:

   • Monitor for signs of infection: increasing pain, redness, swelling, discharge, fever 1
   • Do not administer systemic antibiotics prophylactically

2. When to Seek Medical Attention:

   • Burns involving face, hands, feet, genitalia, or perineum
   • Any full-thickness burns
   • Burns covering >10% TBSA in children 1

Special Considerations for Pediatric Patients

1. Environment:

   • Maintain ambient temperature between 25°C and 28°C to prevent hypothermia 1

2. Pain Assessment:

   • Use age-appropriate pain assessment tools
   • Consider non-pharmacological techniques (distraction, virtual reality) when appropriate 1, 3

3. Anatomical Differences:

   • Children have thinner skin that increases risk for deeper burns 4
   • Monitor burns closely as they may appear superficial initially but can deepen over time

Common Pitfalls to Avoid

1. Do not use topical corticosteroids - superiority to vehicle has not been demonstrated and may impair healing 2

2. Avoid ice or very cold water for cooling as this can cause vasoconstriction and worsen tissue damage

3. Do not underestimate pain in pediatric burn patients - inadequate pain management can lead to non-compliance with treatment and prolonged healing 3

4. Do not neglect follow-up - first-degree burns can still lead to complications if not properly monitored

By following this structured approach to managing first-degree burns in pediatric patients, healthcare providers can optimize healing outcomes while minimizing pain and preventing complications.