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When a child presents with a burn, it is important to obtain a detailed account of the circumstances and mechanism of the burn injury from the adult caregiver and the child (when possible). At initial presentation, all burns should be evaluated for anatomic location, size, and depth. The goals of wound care are to remove dead tissue and promote healing while minimizing the risks of infection and scarring.
Basic wound care performed in the outpatient clinic setting should include gentle debridement (use of antimicrobial or mild soap on cotton gauze) as a first step to gently remove loose skin and any existing topical application before wound evaluation. Once the topical agent has been applied, the affected area should be wrapped using a minimal amount of petrolatum emulsion-soaked gauze (eg, Adaptic) or nonstick pads and cotton wrap dressings (eg, Kerlix, Kling) to absorb the exudate while keeping the topical application in contact with the wound and protecting the area.4-6 The parent should be taught this routine and then continue this care twice daily until the follow-up visits when the provider judges the skin to have reepithelialized. As an alternative to a twice-daily wound care regimen, multiday dressings can be used for uncomplicated burn injuries. Newer to the dressing-care market are multiday antimicrobial dressings (such as Mepilex Ag, Aquacel Ag, and Acticoat), which are put onto a clean, superficial to middermal burn wound and left in place to maintain the moist environment, thereby facilitating antimicrobial delivery.
Regardless of the wound care regimen used, patients, families, and providers must be aware that an evaluation by the clinician for a wound check is indicated if signs and symptoms of wound infection occur. Burn wound cellulitis presents with advancing erythema, warmth, and tenderness, which must be distinguished from the initial blanching appearance of burn wound erythema.
More severe forms of burn wound infection are commonly limited to large burns, which FIGURE Lateral left chest of a child with scald injury on day 10 after the burn.
The development of shock and suspected sepsis always requires that the wound be inspected and considered as a possible source.
Areas of healed burns may remain sensitive for months after the initial injury and more prone to traumatic reinjury than areas of uninjured skin. The vast majority of burns sustained by children can be managed by primary care pediatricians. Subscribe to Contemporary Pediatrics to get monthly clinical advice for today's pediatrician.
All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. A speech-language pathologist, Charlie Osborne has published articles related to his field.
Turf burn is a common injury among people who play sports -- especially football and soccer players.
Clean the turf burn abrasion with a saline solution, gently rinsing it to disinfect the wound and remove any dirt and debris that may be adhering to the damaged tissue.
Change the dressing after a day or two to ensure that the turf burn is still moist and shows no signs of infection, such as increasing redness or a foul odor.
If the turf burn causes severe pain or covers a large area of the body, seek medical attention immediately. While training as a physician in Chicago, I have had the opportunity to work with and attend multiple lectures by Dr. This is the most common type of wound we will encounter as weekend warriors, coaches, parents, and players. Abrasions are irritated and scraped skin that is immediately painful with some blood at the site of bleeding. Stop the bleedingUse a clean cloth, cotton ball, or material and apply direct pressure until the bleeding stops. In most sport injury applications, an occlusive dressing like Tegaderm is usually plenty for most superficial wounds. PreparationPrepare the area by using a trimmer and trimming any hair that may hinder adhesion of the dressing as we have in the photo. The benefit of using the Band Aid waterproof band aids is that they are waterproof, you can keep them on all the time, shower with them, swim with them, and they don't come off (we've tried).
The athlete pictured at the right was involved in a tackle football game and was kicked in the back of the leg with a cleat. Proper wound care is never taught in medical school, and most physicians never receive formal training in the most common medical problem; a skinned knee.
A pioneering method for fighting burn infections in children using viruses which destroy disease-causing bacteria has been awarded new funding. The project has now been awarded a grant of £620,000 from the Engineering and Physical Sciences Research Council (EPSRC) to develop a prototype dressing.
Half of all burn injuries occur in children, and most of these are due to scalds from hot tea, coffee and bath water. Isambard suffered 32 per cent burns from a cup of tea - here his body is covered in medical dressings.
Around 10 percent of children who are burnt become infected by disease-causing bacteria which can increase the likelihood of scarring and in some cases even cause death.
In the last year the South West UK Children’s Burn Centre at Frenchay Hospital in Bristol has treated more than 800 children for serious burn injuries. Current treatments for infections use chemical antibiotics but bacteria are rapidly evolving resistance to such drugs.


Bacteriophages have already been shown to be safe and effective in a recent clinical trial in patients with chronic ear infections [1], carried out by AmpliPhi’s wholly-owned subsidiary Biocontrol Ltd. Dr Jenkins’ colleague Dr Tom Arnot is developing large scale methods of producing the nanocapsules, and for incorporating the nanocapsules into a gel formulation for topical application to the skin. The EPSRC funding award will allow the team to develop prototype dressings, undertake microbial analysis and begin preclinical trials, with the aim of commencing clinical trials at the end of the project. However, knowing when to contact a local burn center for assessment and treatment of burn injuries can minimize adverse outcomes and optimize care for the burn-injured child. Important details to note are the etiology of injury, time interval from the injury to medical treatment, steps used to clean and treat the wound before the evaluation, and presence of other injuries. Once dry, the wounds should be inspected for the extent of injury, the development of moisture, and the presence of pain. Blisters should be allowed to remain intact.5 If large or interfering with function, blisters are best treated by unroofing and gentle cleansing. Each dressing should be kept in place for several days according to the manufacturer’s recommendations, barring any suspected complications. Elevated temperature cannot be relied upon as a sole indictor of infection, even among children with minor burns.11 Only sustained fever for more than 48 hours was significantly associated with infectious complications. This painless, benign erythema characteristically occurs 3 to 5 days after the initial injury, surrounds the injury to within 2 cm of the burn edge, and subsides spontaneously.7 Recognition of this entity is important to decrease the unnecessary use of antibiotics and to differentiate it from burn wound cellulitis. The most common organism is Staphylococcus aureus, and appropriate antibiotics should be initiated with close follow-up.7 If the cellulitis does not respond to oral antibiotics or affects a large area, if additional infection is suspected, or if the patient and family are unable to secure follow-up care, the burn-injured child should be transferred to a burn center. Scalloped epithelial edges are characteristic of viral infection.require the monitoring and expertise of a burn center. However, clinicians should keep in mind that in the case of small and moderate burns, the burn wound itself is not the most common source of infection.
To treat the pain associated with minor burns, options include narcotics, acetaminophen, or other nonsteroidal anti-inflammatory agents (barring the possibility of surgery) as needed, especially for use as a premedication before wound care.5,15 As the areas heal, itching becomes extremely common among children.
Rough play or specific activities should be limited to prevent tears of the regenerated tissue.16 Although all areas of the body should be protected from the sun with sunscreen, healed burn sites require vigilant use of sunscreen and ultraviolet protective clothing to prevent permanent scarring of those areas. However, if a pediatrician is unsure about management at any stage, or if the burn is deep or is developing an infection, he or she should contact the local burn center to arrange transfer for the child. Greenhalgh DG, Saffle JR, Holmes JH IV, et al; American Burn Association Consensus Conference on Burn Sepsis and Infection Group. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. He was an associate editor and then editor for the American Speech-Language-Hearing Association Division 4 Perspectives in Fluency and Fluency Disorders. Bleeding from most turf burns generally will stop with a few minutes of pressure, although weeping of clear fluids may continue after bleeding has ceased.
Hydrogel will keep the abrasion moist when it is dressed, a key element of proper healing for turf burns. This is the same solution that is given in an IV format to athletes that are dehydrated and you should have some on your sidelines. During the game, we just cleaned the wound with normal saline and taped it up with our usual medical tape and foam wrap to apply pressure and keep him in the game. There is a certain amount of bacterial load that is found on skin and necessary for healing. Proper wound care can alleviate many skin problems and lead to stronger skin and a faster return to play.
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Should any suspicion of abuse or neglect arise, the patient should be considered for referral to the local child protection authorities.
Children with preexisting medical conditions or burns that will require long-term rehabilitation and social service coordination should be referred to a burn center. It is commonly agreed among burn surgeons that the more exudate is present, the higher the likelihood that the wound is superficial and will heal spontaneously. Burns should then be evaluated for size, depth, presence of infection, and appropriate topical antimicrobial treatment. Such products include Duoderm and Opsite, which cover the wound but do not offer antimicrobial protection.4,5 Clinical experience shows that these dressings are well suited for placement onto a wound that has a border of intact skin to anchor the dressing. In addition, the presence of fever should not automatically mandate an investigation for infection or prescription of an antibiotic. A wound with surrounding cellulitis should not be considered for a multiday dressing; instead, twice-daily wound care with washing and topical ointments is the preferred treatment for these burns. This may last 18 months or longer after the burn and may result in scratching to the point of injury and infection of the regenerating tissue.15 First-line treatments include liberal use of a mild lotion (cocoa butter, Elta, Lubriderm, Nivea) or oatmeal baths. Loose-fitting cotton clothes are preferred to tight-fitting clothes, belts, and elastic-waist pants, which can rub and cause blisters. In many cases, the primary care pediatrician can be assisted by a discussion with a burn surgeon who has reviewed a good-quality photograph of the burn injury.


In vitro studies of toxic shock toxin-1-secreting Staphylococcus aureus and implications for burn care in children. Osborne has a Master of Arts degree in communicative disorders from the University of Central Florida.
Proper treatment of turf burn is essential to speed healing, prevent infection and reduce the potential for scarring. Chemicals such as peroxide, iodine and alcohol can cause unnecessary pain and further damage the wounded skin.
Occlusive dressings are available at pharmacies and range from adhesive films to waterproof bandages. This has given me invaluable experience and insight into the treatment of basic wounds that we encounter on the football field and in every day life. An abrasion is a disruption in the outer few layers of skin, but not completely through the skin.
These are solutions that are toxic to cells and will damage viable tissue and impair proper healing.
This solution does not burn or hurt and does not irritate the wound.  Most physicians have access to normal saline and you can usually buy it over the counter from any pharmacy.
If you have one of those 1 liter normal saline bottles, you can poke three holes in the top with a 18 gauge needle and use that as a squirt bottle to clean the wound.
Later, we cleaned the wound thoroughly with lots of normal saline, debrided and removed small dirt particles, removed some dried blood and areas that appeared to start scabbing, trimmed the hair in the area around the wound, applied the water proof band aid with some normal saline to wet the cotton patch on the inside.
Some burns, however, can be large or associated with infections and long-term sequelae such as scarring. Such cases could include those in which the reported circumstances of injury are unclear, vary when recounted, or are inconsistent with the clinical presentation. However, in daily practice, providers should be aware of common generalized signs of worsening infection, such as mental status changes, tachypnea, decreased oral intake, decreased urine output, increased pain, and changes in the wound as described below. The clinical suspicion of infection should be addressed as soon as possible because inadequate treatment of a burn wound infection can lead to adverse systemic consequences and deepen the wound, thereby increasing the likelihood of scarring and possibly the need for surgery. In addition, children with burns are part of the general pediatric population, and they can develop a second problem such as appendicitis, respiratory infection, or gastroenteritis.
Patients and families should expect that the color of the healed skin will change over time depending on the child’s original pigmentation, injury depth, and other factors. Any product that seals the area and keeps it moist will promote healing and help prevent scabbing and scarring.
If the skin is completely removed and you can see muscle, bone, tendons or other below skin structures, you have more than a simple abrasion and need to see a physician for what will likely be stitches and or a more complex procedure.
Avoid alcohol, peroxide, betadine, iodine, merthiolate, mercurochrome, chlorhexadine, sterile water, and other concoctions. Further, this not only allows the wound to heal in a closed environment, but also allows the wound to heal in a freely movable, soft, and pliable environment and does not interrupt practice and training.
If it is a really nasty wound or there was a lot of initial bleeding of oozing, change it in 3 days.
Of course, if the skin around the wound starts turning red, becomes tender or painful, and if you see puss developing, you need to consider infection, clean the area with saline, and may even need antibiotics. Therefore, all providers should be familiar with the assessment and treatment of burns to minimize the risk of adverse outcomes.
They have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article. As team physicians, coaches, and even as players, we need to know how to best treat these injuries for quick and safe recovery.
For more extensive and deeper wounds you may want to consult a physician and use a different method. Unless you do a wound care fellowship, you will not be formerly trained on how to treat wounds appropriately. If you don't have normal saline use some of the above suggestions; Band Aid wound cleaning solution or you can use saline solution for contact lenses (close enough), or make your own. Sometimes you will need to continue this for another seven days, depending on how it looks. These are membranes that sit over the wound and are 90% water and allow the wound to heal in a moist environment. Hydrocolloids are gelatinous membranes that sit over wounds they absorb juices from the wound.



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