What is the treatment for a second-degree burn in a 3-year-old child?

From the Guidelines

For a second degree burn in a 3-year-old, immediately cool the burn with cool (not cold) running water for 10-15 minutes to stop the burning process and reduce pain, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. This approach is crucial in minimizing tissue damage and reducing the risk of infection.

• Do not use ice, as it can worsen tissue damage.
• After cooling, gently clean the area with mild soap and water.
• Apply a thin layer of petroleum jelly (like Vaseline) or an antibiotic ointment such as bacitracin, as these have been shown to improve healing time in patients with partial-thickness burns 1.
• Cover with a non-stick sterile dressing like Telfa and secure with gauze or medical tape.
• Change the dressing daily or when soiled. For pain management, give weight-appropriate doses of acetaminophen (Tylenol) at 10-15 mg/kg every 4-6 hours or ibuprofen (Motrin) at 5-10 mg/kg every 6-8 hours, as over-the-counter analgesics such as these are well tolerated and generally recommended for burn pain 1. Seek immediate medical attention if the burn is larger than 3 inches, involves the face, hands, feet, genitals, or major joints, appears white or charred, or if the child develops fever or increasing pain, as these may require specialized treatment, including surgical intervention and intravenous fluid resuscitation 1. Second degree burns involve both the epidermis and part of the dermis, causing blistering, redness, and pain, and proper wound care is essential in preventing infection and promoting healing, which typically takes 2-3 weeks in children 1. Keep the burn area elevated when possible to reduce swelling and protect blisters from breaking to prevent infection. It is also important to remove any jewelry before the onset of swelling to prevent constriction and vascular ischemia, as burned tissue swells 1.

From the FDA Drug Label

Silver sulfadiazine cream, USP 1% is a topical antimicrobial drug indicated as an adjunct for the prevention and treatment of wound sepsis in patients with second and third degree burns. The burn wounds are then cleansed and debrided; silver sulfadiazine cream, USP 1% is then applied under sterile conditions. The cream should be applied once to twice daily to a thickness of approximately one sixteenth of an inch.

For the treatment of a second-degree burn in a 3-year-old, silver sulfadiazine cream, USP 1% can be used as an adjunct for the prevention and treatment of wound sepsis. The treatment should include:

• Cleansing and debriding the burn wound
• Applying silver sulfadiazine cream, USP 1% under sterile conditions
• Covering the burn area with the cream at all times
• Applying the cream once to twice daily to a thickness of approximately one sixteenth of an inch
• Reapplying the cream after hydrotherapy or whenever necessary 2, 2

From the Research

Treatment of Second-Degree Burns in Children

The treatment of second-degree burns in children is crucial for promoting wound healing and preventing infection. Several studies have investigated the effectiveness of different topical antimicrobial agents and dressings in managing second-degree burns.

Topical Antimicrobial Agents

• Silver sulfadiazine is an effective agent with low toxicity and few side effects, as reported in a study published in 1984 3.
• A study published in 2020 found that compounded preparations of silver sulfadiazine and other antimicrobials were effective against a broad spectrum of microorganisms 4.
• International guidelines recommend the use of silver-containing dressings, including silver sulfadiazine, for the prevention of burn-wound infection 5.

Dressings for Second-Degree Burns

• A study published in 2015 compared the use of a topical antibiotic ointment and a silver-containing foam dressing for second-degree burns in a porcine model, and found that the antibiotic ointment resulted in faster reepithelialization and less scarring 6.
• A randomized controlled study published in 2019 compared the use of an antibiotic ointment and a silver-based dressing for children with extremity burns, and found that the antibiotic ointment significantly increased the rate of wound healing 7.

Considerations for Treatment

• The choice of topical antimicrobial agent and dressing should be based on the individual patient's needs and the severity of the burn.
• The development of topical antimicrobial resistance is a concern, and further study is needed to address this issue 4.
• International guidelines recommend the use of silver-containing dressings, but also acknowledge that there is no ideal topical antimicrobial agent that can be recommended for all clinical scenarios 5.