Delayed Labial Artery Bleeding
The most common complication of perioral electrical burns in young children is delayed labial artery bleeding, which typically occurs 5-14 days after the initial injury when necrotic tissue separates from healthy tissue. 1, 2
Understanding the Injury Pattern
Perioral electrical burns in toddlers occur when children bite electrical cords, creating a characteristic injury pattern involving:
- The lower lip (most commonly affected)
- Oral commissure
- Tongue and floor of mouth
- Adjacent perioral tissues 1
The injury creates a zone of necrotic tissue that undergoes delayed separation, exposing underlying vascular structures. 1
Timeline and Mechanism of Delayed Bleeding
The labial artery bleeding occurs on average around day 8 post-injury (range 5-14 days) when the eschar separates from viable tissue. 1, 2 This is not immediate bleeding but rather a predictable delayed complication that occurs during the natural wound healing process as necrotic tissue demarcates and sloughs. 1
The high incidence of this complication has historically influenced treatment approaches, with some centers favoring early excision specifically to prevent this bleeding risk. 2
Why Other Options Are Less Common
Cardiac arrest is the primary cause of immediate death from high-voltage electrocution but is exceedingly rare with low-voltage household cord injuries (110-120V) that cause perioral burns in toddlers. 3 The question specifies a "minor" burn with an awake, alert child—cardiac complications would have manifested immediately at the scene. 3
Cataract formation is a recognized late complication of electrical injuries but occurs primarily with high-voltage injuries or when current passes through or near the eye. 4 Perioral burns from biting cords do not typically involve current pathways through ocular structures.
Rhabdomyolysis occurs with extensive electrical injuries involving muscle tissue, particularly in high-voltage injuries with significant tissue destruction. 5, 4 Minor perioral burns involve primarily mucosal and skin tissue without the deep muscle involvement necessary to cause clinically significant rhabdomyolysis.
Critical Management Implications
Close monitoring for 2 weeks post-injury is essential, with specific parent education about the risk of sudden bleeding from the mouth. 1, 2 Parents should be instructed to:
- Apply direct pressure if bleeding occurs
- Seek immediate emergency care
- Avoid disturbing the wound during the eschar separation phase 1
Any electrical burn in a child automatically qualifies as a severe burn requiring burn center referral or consultation. 6, 3 Even seemingly "minor" perioral burns warrant specialist evaluation due to the high risk of delayed complications and need for potential reconstructive surgery. 6, 1