Great Balls of Fire: Burn Basics

People do a lot of crazy stuff to try to treat their burns: everything from covering them with toothpaste to cracking an egg over top of them. (Not making this up.) Burns are a thermal injury to the skin and are fairly common; the CDC reports that about 300 children in the US age 0-19 years old are seen DAILY in emergency departments with this type of injury. Take that number and imagine how many are managed at home without medical intervention or are seen by their primary care pediatrician or in urgent care settings, and that’s a lot of burns all in one day.

If you look around your house for about 30 seconds it’s pretty easy to see the many potential sources of burns: the oven, teapot, hair styling tools, etc. Curious younger children are easy burn victims, but accidents happen at any age, so it’s reasonable to take a quick walk-through of your house to see where the next burn source just might be located, and take some simple actions to try to reduce the chance of injury. A few ideas are:

1. The stove top. Pot handles facing outward in an easy to reach position just ask toddlers to grab them. Same thing if they are on the front burner. So cook on the back burner with the handles pointed towards the side or back of the stove top.
2. Hair styling tools are one of the most common culprits. Even when they are out of reach of small children on the countertops the cord will hang low and be easy to pull. Don’t just turn OFF the appliance when you are finished using it; unplug it and place the cord out of reach.
3. In the winter, those fireplace tools get hot, and kids like to touch them since they are such a cool shape (especially the poker). Put them behind the screen. I also know of some children who have fallen through the screen and into the fireplace, so be aware of that as well.
4. Keep matches, lighters, and candles away from kids; not stored in one of your “junk drawers” in the kitchen (I’m side-eyeing myself here.)

But even the most well intended of us accidentally get burned every now and then, when the pot holder slips out of position as we pull out a hot pan from the oven, so let’s talk a little bit about burns themselves.

Most people are familiar with the first, second, and third degree classification of burns, but the nomenclature has been updated. In the interest of making you all sound like you are part of the regional level 1 trauma/burn team, let use the most recent terminology:

Superficial burns: the old first degree. These look red and are painful and affect the top layer of skin.

Partial thickness burns: the old second degree, this is a deeper burn. The skin is red and painful but it blisters as well.

Full thickness burns: the old third degree. Deeper layers of the skin are involved, and this burn is often grey appearing and painless because the nerve fibers have been damaged.

My overarching recommendation to EVERYONE is to get burns seen right away by a medical professional if there’s ever a doubt about their extent or depth. Some burns can be surprisingly more serious than people think. The kinds of burns that definitely need immediate evaluation are:

• Large burns over a few centimeters in length
• Any burn on the face, hands, or in the genital area (cosmetics and function are very important for these body parts)
• Burns that cross over a joint (healing skin can contract, decreasing mobility at the joint so careful splinting of the extremity is important)
• Blistering burns
• Burns that are painless (partial and full thickness burns should be evaluated by a clinician familiar with burn care)

When a body part gets burned, the first order of business is to run the burned area under cool water. This arrests the damage pattern of thermal injury. It can also help to wash out any dirt fragments that may have come in contact with the skin. Next, pat the burn dry with a soft, clean cloth and then cover with a clean, dry bandage. Do not add any creams, liquids, foods, butter, or anything on top. Greasy ointments (like butter or cocoa butter) on top of a burn will retain the heat of the burn, slowing down the healing process. This is why we recommend immediately running a burn under cool water. Additives in these substances, such as fragrances in cocoa butter, can also be irritating to the skin.  Administer some pain reducer medicine like acetaminophen (Tylenol and others) or ibuprofen (Motrin, Advil or others) and call your doctor for direction, or proceed to nearby emergency or urgent care for further assessment. Depending on the size or location of the burn, your child may be referred to a regional burn center for further evaluation and management, or you may be asked to follow up in a specialty burn clinic. These are both important resources to take advantage of if suggested to you. Much of burn healing is a marathon, not a sprint, and so getting plugged into a follow up clinic can be critical for a good outcome. Some burns require specific dressing changes and splints, which may change over time as the burn heals.

If you read this entry and come away only with the message that “I’d better not put butter or cocoa butter or toothpaste” on a burn, then I will feel satisfied that I have done my job based on the number of times I have seen strange home remedies come into acute care.

If you now have a new burn classification system you can share in casual conversation, I will have some more pep in my step. And if you burn-proof your house, make sure your hot water heater thermostat is set no higher than 120F, and know how to give first aid to a burn then you will near about make my day and inspire me to learn yet another of those groovy Fortnite dances all the kids are doing. Your call.