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Condition/Treatment

Burns


Resources for Families

To schedule a prevention education program, contact Sally Wilson, RN: 202-476-4090




What are burns?
Burns are injuries or damage to the skin or tissue caused by thermal, electrical, chemical, or electromagnetic energy. Most burn accidents occur at home.

An open flame is the leading cause of burn injury for adults, while scalding is the leading cause of burns in children. Both infants and the elderly are at the greatest risk for burns.

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What are the different types of burns?
A burn injury usually results from an energy transfer to the body. There are many types of burns, including the following:
  • Thermal burns are burns from external heat sources, which raise the temperature of the skin and tissue, in turn causing tissue cell death or charring. Hot metals, scalding liquids, steam, or flames can cause thermal burns when they come into contact with the skin.
  • Radiation burns are caused by prolonged exposure to the ultraviolet rays of the sun, or to other sources of radiation, such as x-rays.
  • Chemical burns are caused when strong acids, detergents, or solvents come into contact with the skin and/or eyes.
  • Electrical burns are burns resulting from electrical current.


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How are burns classified?
Burns are classified as first-, second-, or third-degree, depending on how deep and severely they penetrate and/or damage the skin's surface.
  • First-degree (superficial) burns affect only the epidermis, or outer layer of skin. The burn site is red, painful, dry, but there are no blisters. Long-term tissue damage is rare, although the skin may change color.
  • Second-degree (partial thickness) burns penetrate the epidermis and affect part of the dermis layer of skin. The burn site appears red and blistered, and it may be swollen and painful.
  • Third-degree (full thickness) burns destroy the epidermis and the underlying dermis. Third-degree burns may also damage the underlying bones, muscles, and tendons. The burn site appears white or charred, and lacks sensation, since the nerve endings have been destroyed.


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Burn Definitions
  • Burns can be superficial (1st degree), partial thickness (2nd degree) or full thickness (3rd degree).
  • A superficial (1st degree) burn heals in 3-5 day with no scarring. It causes minor damage to the skin, resulting from sunburn or mild scalds. The skin is pink to red, painful and dry. There are no blisters.
  • Partial thickness burns (2nd degree) occur when the tissue is damaged through the epidermis (top layer of the skin) and into the dermis (second layer of skin). Partial thickness burns cause blistering and are painful. Under the blister, burns are red and moist. The skin appears beefy red at first and within a few days turns white and pale as eschar (scab or dry crust) develops. These burns heal within 3 weeks, usually with no scarring, but may cause a permanent change in skin color.
  • Deep partial thickness burns affect the dermis, damaging the hair follicle. These burns may or may not have blisters and may appear ivory or pearly white. They require more than 3 weeks to heal and will cause scarring.
  • Full thickness (3rd degree) burns affect the entire dermis. The hair follicle is not intact. There is minimal pain due to damaged nerve endings. They take 3-6 weeks to heal and a skin graft may be needed.


Burn definitions


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Caring for Burns

Initial Treatment of Burns

Initial Burn Treatment

  • Bacitracin® Topical antibiotic
    Apply after washing 2 - 3 times per day.
  • Silvadene Cream 1%® Anti-microbial burn cream
    Apply ?” layer of gauze directly to burn area.
  • Splints - Made out of orthoplast. Provides comfort and protects dressings.
  • Sulfamylon® Topical anti-microbial cream
    Used on ear burns.  Can sting when applied.

Moisturizers
  • Aquaphor® Moisturizer Healing ointment
    Apply a thin layer twice a day to healed skin
  • Aveeno® Moisturizing cream
    Apply a thin layer twice a day to healed skin

Pain may be treated with acetaminophen or ibuprofen (Tylenol® or Tempra®, Motrin® or Advil®). Read instructions for proper dosage. Consult your child’s care team for proper dosage and questions.

Itching may be treated with diphenhydramine (Benadryl®/antihistamine). Read instructions for proper dosage. Consult your child’s care team for proper dosage and questions.


Cleaning Burn Wounds


Cleaning the Wound:
  • If Silvadene®, Bacitracin® or Sulfamylon® ointments are prescribed, clean the wound twice a day.
  • Give your child something for discomfort (such as acetaminophen or ibuprofen) 30 minutes before you clean the wound.
  • Soak your child’s burn wound in warm, soapy water for about 10 minutes. This will remove all of the medication from the wound. Younger children may soak in a tub and play while older children may prefer to take a shower.
  • Use a mild soap, such as Dove® or Johnson & Johnson® Baby Soap with a clean wet washcloth to gently wash the burn wound. This will remove all of the medication from the wound. Be sure to wash away any eschar (dead skin). The burn wound may bleed. This is OK. If bleeding occurs, apply pressure to the wound.  Frequently the Silvadene dressings have a yellow/green color to the drainage – this is normal.
  • Gently pat the burn wound with a clean towel or gauze pad until it is dry.
  • Put a thin layer of medication on the gauze dressing using a tongue blade or clean fingers and apply the dressing to the burn wounds.
  • Cover the burn wound with gauze dressing such as Kling®. Use tape to secure the dressing.


Helpful Information

  • Some wounds need to be cleaned once a day, unless otherwise directed by your medical provider, to help new healthy skin grow back.
  • Each cleaning procedure will help the healing.
  • Healing skin will look pink and shiny.


Long-Term Management of Burns

Deep partial thickness and small full thickness burns that take longer than 3 weeks to heal may develop hypertrophic scarring (raised thickened red tissue).
  • Avoid sun exposure between 10 am—2 pm.
  • Compression garments - Help to decrease scar growth by providing pressure on the burn.
  • Cica-Care®- Silicone gel sheet used for hypertrophic scar therapy.
  • Massage Therapy - Helps to decrease scar growth by providing pressure on the burn.
  • Use Sunscreen with an SPF of at least 25—Apply 30 minutes prior to sun exposure.
  • Wear a hat - help protect your child if he/she has facial or neck burns.


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Burns - Departments & Programs - Children's National Medical Center