What is the emergency management for a 3-year-old with a burn to the hand?

Emergency Management of Burns in a 3-Year-Old Child

The immediate management for a 3-year-old with a hand burn should include cooling the burn with clean running water for 5-20 minutes, followed by covering with a clean, non-adherent dressing while monitoring for hypothermia. 1, 2

Initial First Aid Steps

• Immediately cool the burn with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 3
• Remove any jewelry from the affected area before swelling occurs to prevent constriction and vascular compromise 3, 2
• Monitor closely for signs of hypothermia during cooling, as young children (especially those under 4 years) are at higher risk 1
• Avoid whole-body cooling (such as showers) in young children, as this significantly increases hypothermia risk 1

Pain Management

• Administer weight-appropriate doses of acetaminophen or ibuprofen for pain control 3, 2
• For severe pain, titrated intravenous ketamine combined with other analgesics may be necessary 1, 2
• Use validated pain assessment scales appropriate for the child's age to guide analgesic titration 2

Wound Care After Cooling

• After cooling, gently clean the wound with tap water or isotonic saline 2
• Apply a thin layer of petrolatum or petrolatum-based antibiotic ointment 3, 2
• Cover with a clean, non-adherent dressing such as Xeroform or Mepitel 2, 4
• Ensure dressings on the hand do not cause constriction or impair circulation 2

Burn Assessment

• Determine the burn depth (superficial, partial-thickness, or full-thickness) 5, 6
• Estimate the total body surface area (TBSA) affected using age-appropriate methods 5
• For hand burns in children, the palm is the most commonly affected area, followed by fingers 4

When to Seek Higher Level of Care

• All hand burns in children should be evaluated by a healthcare provider due to functional concerns 2, 5
• Immediate transfer to a burn center is indicated for:
  • Partial-thickness burns >5% TBSA in children 2, 5
  • Full-thickness burns of any size 2, 5
  • Burns involving the hand (regardless of size) due to functional concerns 3, 5
  • Any suspicion of non-accidental injury (present in up to 10% of pediatric burns) 7

Common Pitfalls to Avoid

• Do not apply ice directly to the burn as this can cause further tissue damage 3, 2
• Do not apply butter, oil, or other home remedies to burns 3, 2
• Do not break blisters, as this increases infection risk 2, 8
• Avoid prolonged cooling in young children, especially those under 4 years of age, due to hypothermia risk 1
• Do not delay seeking medical attention for burns involving the hand, as this may lead to functional impairment 2, 4

Follow-up Care

• Most pediatric hand burns heal with conservative management within approximately 10 days 4
• Regular follow-up is essential to monitor for proper healing and prevent complications 4
• Surgical intervention (debridement or grafting) may be necessary in approximately 13.5% of pediatric hand burns 4