How to Treat and Prevent Burns in Babies

Written by Dr. Seran Kim, board-certified Emergency Physician

Here’s something to know: pediatric burns are a leading cause of death in children. Infants and toddlers are most often burned by thermal burns or scalding, such as by tipping hot liquids in the kitchen or being immersed in too-hot bath water.

The latest data reveals that the vast majority of these burns are preventable. And since most burns occur at home, it is even more important to emphasize burn injury prevention and review safety measures.

What is a burn?

A burn is any injury to soft tissue (muscles, fat, blood vessels, nerves, tendons) caused by heat, friction, electricity, radiation or chemicals.

What are the types of burns in babies and kids?

There are many causes of burns, most commonly thermal, electrical, chemical or radiation contact. Thermal burns are the most common in babies and toddlers, but all types can occur.

• Thermal burns are scald burns resulting from direct contact with fire, hot objects or hot liquids. Real-life scenario: Imagine a toddler pulling down a piping hot cup of cocoa and spilling it on themselves.
• Electrical burns are those resulting from a flow of electrical current, carrying temperatures as high as 5000°C. Real-life scenario: Imagine a newly crawling baby discovering Christmas lights and chewing on the cord.
• Chemical burns are caused by direct contact with an alkali or acid (like ammonia, sodium hydroxide, hydrochloric or sulphuric acids). Real-life scenario: Imagine a child spraying cinnamon air freshener into their brother’s eyes.
• Radiation burns are caused by UV radiation, X rays or radiation therapy to treat cancer. Real-life scenario: Imagine your baby with a sunburn after a day at the beach without sunscreen.

What are the burn classifications?

Burns are generally classified and treated by three factors: the depth of skin or soft tissue involved, location on the body and the percent of total body surface involved.

Depth Classifications:

• Superficial burns: the skin is pink or red, and painful (example: sunburn).
• Partial thickness: the skin is red and painful, with blister formation (example: curling iron burn).
• Full thickness: the skin is white, waxy or leathery, without bleeding, and painless since the nerve fibers have been destroyed (example: high voltage electrocution).

Location Classifications:

Burns to the face, hands, feet, groin/genitalia, eyes, ears or areas that cross joints are considered high-risk locations. If not immediately evaluated and properly treated, children can suffer poor cosmetic outcomes and growth complications if they scar down in these high-risk locations.

Percentage of total body surface area (%TBSA):

%TBSA helps predict how much fluid loss occurs. Because they’re small, children have a higher volume surface area compared to adults, so they experience a higher fluid loss from open burn sites.

How to treat thermal burns in babies and children

If your child does suffer from a thermal burn, prompt wound care and further evaluation is key.

Children are at risk for more severe consequences of burns, regardless of the type, because their skin is much thinner than an adult’s and is more likely to result in a deeper burn. This also makes burn depth assessment in a child more difficult, so any thermal burn in a child warrants professional medical evaluation. Before heading to your doctor or the Emergency Department, it’s important to also keep in mind:

• Contrary to popular belief, ice should never be applied to a burn. Instead, the area should be immediately cooled with room temperature or tepid water for 10 minutes after the injury. This helps to prevent ongoing damage to the skin and soft tissue. Extreme cold causes blood vessels to constrict and can worsen the injury by decreasing blood supply.
• When available, the wound should be covered with a wet, sterile dressing. Otherwise, the burn should remain uncovered. Do not apply butter or any other topical ointment or sprays as these can trap heat and cause the burn to go deeper.
• Elevate the burned extremity to minimize swelling. This is extremely important to avoid infection and minimize any long-term complications from wound healing.
• If any blisters form, do not pop them, as these act as a natural barrier.
• Remove any clothing or jewelry near the burn. However, if any clothing gets stuck to the burn, do not remove it. Wait until evaluated by a medical professional.

How to prevent burns in babies and children

Remember, the best approach to all types of burns is prevention. There are many things that you can do to actively protect your child in your own home:

• Reset the water heater to 120 degrees Fahrenheit. Most home water heaters are set at 140-150 degrees. Water at this temperature will result in a full thickness burn within 2 seconds. Also, use a bath water thermometer before placing your baby into the bath.
• Do not leave the stove unattended. Be sure to also turn pot handles backwards, use rear burners, and install stove knob covers when possible.
• Do not hold a baby or child while cooking near a stove. Or better yet, keep children out of the kitchen area while cooking.
• Exercise great caution when drinking hot liquids like hot tea or coffee around children. Make sure to always use a cup with a lid, and keep hot drinks away from the edge of a table or countertop. Never carry hot drinks while children are playing underfoot or while holding children.
• Hide matches and lighters. Most child-caused home fires begin with matches or lighters in a room where children are left unattended. When necessary, use child-resistant lighters.
• Keep chemicals out of reach. The most common cause of chemical burns is from household products such as toilet bowl cleaners, drain cleaners, detergents and bleaches, so be sure these are all locked away.
• Place a fire extinguisher in or near the kitchen. Be sure to read the instructions and know how to use it. Remember the acronym PASS: Pull the pin, Aim low at the base of the fire, Squeeze the handle slowly and Sweep the nozzle side to side.
• Cover all electrical outlets. Electrical outlets are irresistible to babies and toddlers. Use outlet plug covers to prevent your baby from accessing the socket.
• Keep all electrical cords out of reach. These can cause oral electrical burns if a baby chews on the wire.
• Keep hair straighteners and curling irons out of reach. Little hands can easily pull these down, and the tools can be very hot, even as they’re cooling down when unplugged or turned off.
• Cover your fireplace with an appropriate gate. A fireplace gate will help prevent flame injuries as well as protect children from hot glass burns from gas fireplaces.
• Cover all radiators and heating vents. Be sure to also cover any exposed steam pipes with a radiator cover.
• Clean dryer lint traps after each use. Every year, more than 3,000 fires in the U.S. are caused by clogged lint ducts. Lint is highly combustible, and therefore as heat builds up and air blows through the ductwork, the dryer becomes a fire hazard. Don’t forget to also inspect and clean the outdoor vent trap yearly.
• Ensure that all smoke detectors are functional. Smoke alarms play a vital role in reducing fire injuries and deaths, with three of five home fire deaths resulting from a disabled or missing fire alarm. Every bedroom needs a smoke alarm. Check that batteries are fresh, and when in doubt, replace them. The National Fire Protection Association recommends that when you “change your clocks, change your batteries.” Smoke alarms themselves should be changed every 10 years.
• Map out and practice a fire safety evacuation plan for your family. The NFPA website is a great resource for establishing a home fire escape plan, which includes planning two routes of exit from each room, making sure all windows and doors leading to the outside open easily and designating an outside meeting place a safe distance from the house. If there are multiple children, assign someone to assist them in the event of an emergency.
• Wear sunscreen! If your baby is under six months, be sure to cover their skin with hats, long-sleeve shirts and pants, keep them in the shade if you’re out for a walk or at the beach or park and avoid times of intense rays between 10 a.m. and 2 p.m.

Don’t forget, all burns in children, with the exception of minor sunburns, should be evaluated by a physician. But the best safety is prevention, and since most burn injuries occur at home, you can take a lot of precautions to prevent them.

Factually reviewed by Dr. Seran Kim, board-certified Emergency Physician, on May 12, 2021.

Sources:

• International Journal of Critical Illness and Injury Science: Pediatric burn injuries
• Johns Hopkins Medicine: Burns in Children
• US Fire Administration: Clothes Dryer Fire Safety Outreach Materials
• National Fire Protection Association: How to make a home fire escape plan