Examination and treatment Burns in children

The team

For the treatment of burns, we work together from different disciplines to provide the best care. Our multidisciplinary team consists of:

• Nurses
• Pediatricians
• Pediatric intensivists
• Pediatric anesthesiologists
• Surgeons (pediatric, trauma, plastic)
• Child psychologists
• Educational caregivers
• Social workers
• Physiotherapists
• Occupational therapists
• Rehabilitation physicians
• Gastrointestinal specialist and dietitian
• Microbiologist

Acute admission

At the Emergency Room, we check your child's airways and breathing. If necessary, your child will receive oxygen through a mask. We will also measure their blood pressure and pulse, and take blood samples. To prevent hypothermia, we will cover them with warm blankets. Your child will also be given medication to reduce pain. We will then examine your child for burns and any other injuries. For major burns, we will give your child additional fluids through an IV.

To get a good idea of the cause and severity of the burns, we will ask you how the accident happened, when and exactly what happened, whether the burn was cooled, whether your child is taking any medication, whether your child has been hospitalized before, and whether they are vaccinated.

Examination

We assess the extent and depth of the burns and take photographs for the medical record. We also take wound cultures to assess bacterial growth. Initially, your child will receive an ointment treatment, and we will formulate an initial treatment plan.

Risks

The severity of the burn depends on its depth, size, location, your child's age, and any additional injuries. The skin is the body's largest organ and has a protective function. Skin burns cause the skin to lose some of its important functions. This may lead to moisture loss and infection risk from bacteria. The body loses heat and cannot maintain its temperature.

What is inhalation injury?

In case of a fire or explosion, your child may have inhaled smoke particles or hot air. As a result, their airways may be damaged. We call this inhalation injury.

Damage to the upper airways

Damage to the upper airways is often caused by inhaling hot gases. The upper airways consist of the nose and sinuses, the mouth, and the throat. Indications of upper airway damage are shortness of breath, a weak voice, a hoarse-sounding cough and soot in the nose or mouth.

Damage to the lower airways

Damage to the lower airways occurs from inhaling smoke constituents. The lower airways consist of the trachea and lungs. Smoke constituents cause inflammation of the trachea. This can cause bronchospasms (cramps in the trachea) or pulmonary edema (accumulation of fluid in the lungs).

Examination

To assess the severity of the injuries, the doctor examines the burns. To determine the depth of the burn, the doctor looks at the color of the wound, whether there are blisters, whether the capillaries are refilling, and whether the wound is painful or sensitive. The doctor also asks some questions about the cause of the injury and whether the injuries have already been cooled down.

Types of burns

We categorize burns based on the depth of the wound. The skin consists of two layers. These are the epidermis and the dermis. The skin also contains hair, sebum, and sweat glands.

Burns can be divided into superficial second-degree, deep second-degree, mixed, and third-degree burns. A first-degree burn only involves redness of the skin.

• First-degree burns

  A first-degree burn is not a wound, although it can still be painful. Consider sunburn, for example.

• Superficial second-degree burns

  In superficial second-degree burns, blisters often develop. Wounds usually heal within two weeks, often without scarring. We clean these burns and cover them with a temporary wound dressing.

• Deep second-degree burns

  For a deep second-degree burn, healing can take up to three weeks. Scars are likely to appear. These are often red, stiff, thick, and bumpy. These scars are called hypertrophic scars. If these scars run across a joint, your child may not be able to freely move the joint in question.

  To prevent hypertrophic scars as a result of second-degree burns, we perform skin grafting.

• Mixed burns

  A mixed burn is a combination of a superficial, and a deep second-degree burn. Mixed burns are often caused by hot water, such as hot tea. It is not always immediately clear whether surgery is necessary. We therefore examine the wound several times.

• Third-degree burns

  A burn in which both layers of skin are completely burned is called a third-degree burn. With a third-degree burn, we perform skin grafting. A third-degree burn is usually caused by a flame. The burn is often stiff, but comparatively less painful.

Size of burn

If much of the body is severely burned, your child may become ill with symptoms such as rapid heartbeat, rapid breathing, decreased appetite, and fatigue. The body may swell due to fluid in the tissue (edema).

The burns can lead to a loss of moisture. We supplement this through an IV. We keep a close eye on your child and check how much your child pees, among other things. If they pee too little, they are suffering from dehydration.

Temporary wound dressing

Superficial second-degree burns that are too large to treat in the Emergency Room are cleaned in the operating room. Blisters are also removed. This is done under anesthesia. The wound is then covered with a wound dressing. This is a type of bandage. The wound dressing remains in place until the wound heals.

The wound dressing is removed at the outpatient clinic once the skin underneath is completely healed.

Going home or to another institution

If your child's condition allows it and you are able to care for the wound yourself, your child will be allowed to go home. In some cases you may receive help from home care for wound care. Wetting the wound dressings makes it possible to soak them off the wound. In most cases, your child will be able to take a shower or bath. If so, you can use regular shower gel and/or shampoo.

Rehabilitation Center

If your child has severe burns and needs rehabilitation, long-term admission to a rehabilitation center may be required.

Healing

Deep burns produce scars. These scars are often bumpy, red, thickened and usually itchy (hypertrophic scars). A scar is most active three to four months after surgery. It may take months for the scar to calm down. To speed up this process, your child will be prescribed pressure garments, silicone patches, or silicone gel.

Pigment loss

Pigment loss may also occur. This usually recovers within a few months, but in some cases, it may be permanent. It can help to reacclimatize the skin to sunlight slowly. Use sunscreen with a high factor and avoid the hot sun hours (from 12 noon to 3 p.m.). There is no need to apply sunblock.

Discolorations, wounds and blisters

Deep burns on the legs can turn purple after standing for a long time. This can also occur with temperature changes and emotions. Even if the wounds are already closed, new blisters and wounds can sometimes still form. That is normal and can come from bumping, rubbing, or moving. In addition, even if the wounds are already closed, pimples may still appear. These disappear on their own.

Care

Lubricate the scar daily with a neutral body lotion or a prescribed scar cream. This helps against itching. When wearing the pressure garment, it is better not to apply petroleum jelly, as this corrodes the fabric and reduces the performance of the pressure garment.

Pressure garment

Children with deep second-degree burns and third-degree burns will be issued pressure garments as soon as the wounds close.

Your child will have to wear the pressure garment almost 24 hours a day for one year. The pressure garment makes the scar flatter, smoother, and less red. It also reduces itching. The pressure garment allows the scar to ‘mature’ faster.

A pressure garment is similar to a surf suit. Your child will receive two suits that you can wash in the washing machine. Your child should not wear the pressure garment when showering.

Care

Wound care

The areas that have not yet healed should be treated with ointment at home.

You should change the bandages on these areas every day. The bandages may look dirty and covered in pus because of the ointment; this is no cause for alarm. You should ideally wash your child under the shower, or else in the bathtub. In any case, the bandages should be wet when removed so that they stick less to the wound. Once the skin is clean and dried with a clean towel, new ointment and bandages can be applied.

Sun protection

Scars recover in daylight. However, it is important to protect the skin from too much sun. Apply waterproof sunscreen of at least factor 20 to the skin. Avoid bright sunlight in summer (between 12 noon and 2 p.m.).

Pressure garment

If your child has been prescribed pressure garments, make sure they wear them 23 hours a day.

Preventing itching

Itching can be very annoying after burns, especially at night. Itching is often caused by heat. Dress your child in airy and not too warm clothes. Make sure heir the bath/shower water is not too hot. Use a comforter that is not too warm, and make sure the temperature in the house is not too high.

Use skin moisturizers: body lotion or cream. If the scar remains very dry, use white petroleum jelly or vegetable oil.

If the itching is so severe that your child has trouble sleeping, you can consult the doctor at the hospital or your GP.

Massaging scars

Massaging scars is good for recovery. It reduces itching and stiffness, makes the scar softer and smoother, and improves circulation. Do not massage open wounds. Do not rub the skin (this may cause blisters), but use deep pressure in circular motions. Do this once or twice a day, about 1-2 minutes in each spot.

Exercise, play and swimming

It is important to resume normal activities as soon as possible. Being in motion will keep your child's fitness levels up. Your child will also learn how to deal with their damaged skin. Your child can resume activities in which they get dirty (sandbox, painting) as soon as the wounds are closed.

Your child should not swim until all wounds are completely healed. Once all wounds are closed, swimming may resume. Swimming is good for the muscles and joints and the mobility of the arms and legs.

Care of wounds, blisters and pimples

Shortly after a burn, the skin is vulnerable. As a result, wounds from scratching or bumping are more likely to occur. These wounds heal again quickly.

Large blisters should be covered with a bandage or plaster, small ones can be left uncovered.

White, black or red pimples may appear. Those are clogged sebaceous glands. Keeping the skin clean and rinsing off any soap and ointment residue is enough to ensure that these pimples go away over time.

Check-up

Your child will be invited for a check-up after 6 weeks, after 12 weeks, after 6 months and after 12 months.

The plastic surgeon will ask if your child is in pain and if the wound is itchy. During check-ups, the doctor will take pictures of the wound to see how it is healing. The doctor will also assess the scar. The doctor will also want to know if your child can do everything they did before. If your child is unable to move freely due to scarring, surgical repair surgery may be required.