Brush up on your burn prevention and first aid knowledge

Charlotte Young from & Breathe First Aid talks treatment and prevention of household burns.

Burns are unfortunately a very common injury in young children, and the vast majority of these happen at home and are preventable. Winter months can pose extra burn risks for children, with families having more hot drinks, hot food and heating the home – so now is a great time to refresh your burns prevention and first aid knowledge. 

77% of all hospitalisations from burns are little ones under four years old. When we asked our community, 30% of parents said at least one of their children suffered a burn of some degree. A burn can be a devastating injury, physically and emotionally. They can have a long, painful recovery time and nearly all burns are preventable, creating significant guilt and emotional distress for parents. Around 30% of New Zealand children don't receive correct burns first aid. For these little ones, recovery time and overall healing is even more difficult.

WHY CHILDREN HAVE SUCH A HIGH RISK OF BURNS

Little ones are inquisitive and grow quickly. They pull things down to have a look, without realising the dangers, and as parents, we’re often unprepared for their rapid development and growth. One day your little one can't reach the bench and then next they are pulling things down! Children are also small with thin, sensitive skin that burns faster, deeper and at lower temperatures. It only takes a small amount of hot liquid to cause a severe burn (a small cup of hot tea is equivalent to a bucket of boiling water for an adult). Children can suffer 3rd degree burns in only 1-3 seconds from a 60°C hot drink.

HOW CAN YOU PREVENT BURNS IN YOUR HOME?

Nearly all burns are preventable, if you take the right steps. The vast majority of all burns to children are caused by hot liquids and food, with a third of these happening in the kitchen. The other common cause is hot tap water, when children are placed in a bath that is too hot or they accidentally turn on the hot tap.

Kitchen and living areas

+  Always keep hot drinks out of arm's reach or save hot drinks for when little ones are sleeping

+  Don't have hot drinks while holding your baby or baby wearing

+  Don't use tablecloths or large placemats, these can be pulled down easily by little ones

+  Keep the kettle cord out of reach

+  Turn pot handles away from the edge of the stove

+  Keep children out of the kitchen when cooking by using baby gates or set up a safe activity away from the kitchen

In the bathroom

+  Set your household hot water to 50-55°C

+  Fill the bath with cold water first

+  When you finish running a bath, run cold water for a few moments once the bath is full

+  Always check the bath temperature before putting children in

In the bedroom

The most common cause of burns in the bedroom is from heaters. If your child has a heater they can access:

+  Choose a heater that doesn't get hot to touch, such as a convection heater

+  If you're not sure if a heater needs a safety guard do the 10-second test. If you can't keep your hand on the heater for 10 seconds, it's a burns risk and needs a guard

WHAT ABOUT FIRE-RELATED BURNS?

Although fire-related burns only account for 6% of hospital admissions, they are the leading cause of burns-related death in children. Fire-related burns are most commonly caused by fireplaces and stoves.

+  Make sure children are always 1 metre from a fire

+  Ensure every fireplace has a safety guard and there are working fire alarms in every bedroom

+  Keep little ones out of the kitchen when you are cooking

+  Use safety guards on your gas knobs

HELPING RECOVERY AT HOME

Burns can be upsetting for children and parents. Give your child lots of cuddles and reassurance. Keep burnt areas covered, clean and dry and give your little one paracetamol for pain. Burns can make children dehydrated, and healing uses a lot of energy so make sure children drink lots of water and eat well during the recovery period (which is usually around 1-2 weeks). Check for the signs below for when to seek further medical help.

HOW TO KNOW IF A BURN NEEDS MEDICAL ATTENTION?

When to see a doctor urgently or head to ED/A&E:

+  Burnt area is larger than 3 cm

+  Burn to the groin (perineum) area

+  A blistering burn

+  Your child is still in pain after having paracetamol

+  You are worried about them – take them to a doctor or call Healthline  (0800 611 116) 

Burns can be painful with a high risk of infection. Children may need strong painkillers even for seemingly small burns. Medical professionals can put on a secure dressing for home or a special burns dressing.

WHEN TO CALL AN AMBULANCE

+  If the burned area is larger than half your child's arm in size

+  Burns involving the eyes

+  Your child is in significant pain

While you wait for the ambulance, start burns first aid. For eyes, continuously flush eyes with water – be careful to keep little ones' nose and mouth out of the water. Knowing burns first aid is vital, but knowing how to prevent burns from happening is even more important. Keep your little one safe and make sure everyone who looks after them knows how to prevent burns and manage them correctly.

THREE KEY STEPS TO BURNS FIRST AID

Around 30% of New Zealand children don't receive correct burns first aid, which means the skin will continue to burn and cause further damage. Correct burns first aid steps are something all parents should know and be able to remember in an emergency.

1. Stop the burn

+  Remove the hot item quickly

+  Remove clothes saturated with the hot liquid

+  Don't forget to remove your baby's nappy! 

The severity of a burn is related to how hot the item is and how long it is in contact with the child’s skin. Two common mistakes are parents not removing clothes first or not removing the nappy.

2. Cool the burn

+  Run the burn area under cool running water for 20 minutes

+  Place your child in the shower or bath if the burn area is on their chest, back or to a large area – use lukewarm water for small babies

+  If using the bath or shower method, don’t cool them for the full 20 minutes, remove them from the water if they start becoming pale or mottled 

Your child will be crying and not want to have the burned area cooled, but we cannot stress enough the importance of continuing to cool the burn even when they become upset.

20 minutes is the time it takes for the burning process to completely stop. All burns must be cooled for 20 minutes within the first 3 hours, but the sooner the better! 'Cool running water' is around 15°C. Most cold settings on household taps are 10-15°C on an average/temperate day. If you don't have running water on hand, any cool clear liquid will do (such as beer or lemonade) and any amount of time is better than none at all.

3. Cover the burn

+  Cover the burnt area with a loose, non-stick dressing (cling film works well)

+  If using cling film, discard a few centimeters first to make sure it’s clean and free of bacteria. Don't wrap it around their limb (you don't want to constrict any swelling that might happen) or over your child's face.

Covering the burn reduces pain by keeping air off the skin and protects against infection. Change the dressing after 48 hours or if the dressing becomes saturated. For young children, cling film can be a choking risk so these little ones will need a different non-adherent (non-stick) dressing, but cling film can be used as an initial cover. Having non-adherent dressings in your home first aid kit is very important.

WHAT NOT TO DO!

+  Never use ice – this can cause further damage as well as prevent healing

+  Don't remove clothes that are stuck to the skin

+  Don't pop or peel any blisters, these protect the burnt area

+  Don't apply creams, lotion, oil, butter or toothpaste 

Charlotte is a senior clinical paediatric ICU nurse and a mum to a busy two-year-old. She runs & Breathe, teaching immersive baby and child first aid courses to families. Motivated by seeing poor outcomes and preventable injuries in the PICU, she has a passion for helping families learn effective CPR and how to keep their little ones safe. Visit andbreathefirstaid.co.nz to book a course.