Pediatric Burns

Burns are painful wounds caused by thermal, cold, electrical, chemical or electromagnetic energy. Smoking and open flame are the leading causes of burn injury in adults. Scalding is the leading cause of burn injury in children. Both infants and older adults are at the greatest risk for burn injury.

There are many types of burns caused by thermal, radiation, chemical, or electrical contact.

• Thermal burns. These burns are due to heat sources which raise the temperature of the skin and tissues. They cause tissue cell death or charring. When hot metals, scalding liquids, steam, and flames come into contact with the skin, they can cause thermal burns.
• Cold exposure burns (frostbite). Damage to the skin is caused by exposure to cold.
• Radiation burns. These burns are due to prolonged exposure to ultraviolet rays of the sun, or to other sources of radiation such as X-ray.
• Chemical burns. These burns are due to strong acids, alkalis, detergents or solvents that come into contact with the skin, eyes, mouth or gastrointestinal tract.
• Electrical burns. These burns are from electrical current.

Burns are classified as first-, second-, or third-degree, depending on how deep and severely they penetrate the skin's surface.

• First-degree (superficial) burns. First-degree burns affect only the epidermis, or outer layer of skin. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and usually involves an increase or decrease in the skin color.
• Second-degree (partial thickness) burns. Second-degree burns involve the epidermis and part of the dermis layer of skin. The burn site appears red, blistered and may be swollen and painful.
• Third-degree (full thickness) burns. Third-degree burns destroy the epidermis and dermis. Third-degree burns may also damage the underlying bones, muscles and tendons. When bones, muscles, or tendons are also burned, this may be called a fourth-degree burn. The burn site looks white or charred. There is no feeling in the area because of nerve damage.

Burns that are more severe and widespread need specialized treatment. The age of a burn victim, the location of the burn, and the percentage of the body's surface area affected are the most important factors affecting the outlook of a burn injury. The American Burn Association recommends that those who meet these criteria should be treated at a specialized burn center:

• People with partial-thickness burns over 10% or more of the total body surface area (TBSA)
• Any age with full-thickness burns
• Burns of the face, hands, feet, groin, or genital area, or burns that extend all the way around a part of the body
• Burns that happen along with an inhalation injury that affects the airway or the lungs
• Burns that occur with existing long-term (chronic) conditions that may greatly affect how the burn heals. These conditions include diabetes, high blood pressure, heart disease, kidney disease and multiple sclerosis.
• Suspected child or elder abuse. This person will need social, emotional or rehab help
• Chemical burn
• Electrical injury

A severe burn can be a seriously devastating injury, both physically and emotionally. It can affect the burn victim and their family. People with severe burns may be left with a loss of certain physical abilities. These may include loss of limb(s), disfigurement, loss of mobility, scarring and recurrent infections. Severe burns can also penetrate deep skin layers. This can cause muscle or tissue damage that may affect every system of the body.

Burns can also cause emotional problems such as depression, nightmares or flashbacks from the traumatizing event. The loss of a friend or family member and possessions in the fire may add grief to the emotional impact of a burn.