Professor Andrew Holland Professor of paediatric surgery and senior clinical academic , Burns Research Institute , department of paediatric surgery , The Children ’ s Hospital at Westmead , The University of Sydney , Sydney , NSW .

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This information was correct at the time of publication : 4 August 2023

INTRODUCTION

BURNS are a common mechanism of

injury in children . This is especially so in toddlers and , to a lesser extent , in teenagers , with the incidence featuring a bimodal age distribution .

Burn injuries may be due to a variety of mechanisms , with scalds and contact and flame burns consistently the most common . Typically dramatic and painful injuries , any burn greater than 10 % of the total body surface area ( TBSA ) is considered serious and requires admission to a burns unit , with the potential for long-term sequelae . 1

Even minor burns that do not require skin grafting may have important consequences , including disruption of schooling and temporary loss of function or limitations on physical activity . Burns that do not heal within 7-10 days or that require grafting have an increased risk of hypertrophic scarring , which requires prolonged , expensive scar management that may have an impact on the child ’ s social and academic achievement .

More major burns cause whole-ofbody inflammation and impact both growth and physical development , with long-term physical , social and

mental health effects that extend into adult life . 2

Treatment of the acute burn and subsequent scarring has evolved , with increasing evidence to support the benefits of optimal burns first-aid treatment ( BFAT ), prompt cleaning of the acute burn wound and a dressing that reduces the risk of infection while promoting burn wound healing . Despite these improvements , some children , families and their friends will continue to dislike the appearance of their scars .

This How to treat covers the common presentations of burns in children , optimal first aid and the initial management in a primary care setting , together with details of when to refer . It aims to ensure that family practitioners can supervise and co-ordinate care of children with burns independently or in conjunction with a burns unit .

AETIOLOGY

BURNS may be caused by heat or friction . The most common mechanism of injury ( MOI ) in children remains a scald ( see figure 1 ) — generally either from hot water in the bathroom or kitchen or from knocking

over a hot drink . 1 , 3 , 4 These children will most often be toddlers — between 10 months and two years of age — who are keen to explore their environment while , at the same time , unsteady and lacking co-ordination . Scald burns are typically mixed depth , with epidermal , superficial and deep dermal elements .

The prevalence of flame burn injuries has fallen over the past 20-30 years , with contact burns ( see figure 2 ) now the next most common in children . Like most burn injuries , these most commonly occur in the home and result from direct physical contact with a hot surface , such as a heater , iron or saucepan . As children have thinner skin , a deeper burn is more likely when compared with a similar duration of contact or exposure in an adult . These burns most commonly involve the limbs .

Flame burns ( see figure 3 ) are generally more serious as they are usually deeper — with most full thickness or deep dermal — and , if sustained in a confined space , such as a house fire , may be associated with an inhalational injury . Electrical ( see figure 4 ) and chemical burns remain much less common in children , with

occupational exposure highly unlikely . In general , electrical burns in children are much less serious than those in adults ; domestic low-voltage injuries predominate .

Friction burns — most commonly from home treadmills but also seen from bicycle and scooter tyres — are often surprisingly severe injuries . This is because , in addition to the heat generated at the time of the injury , there is a mechanical injury to the skin and subdermal tissues ; this compromises the local circulation and may also lead to direct nerve or tendon damage .

FIRST AID

DESPITE the simplicity and effectiveness

of appropriate BFAT , it continues to be inconsistently used or not optimally applied in at least one-third of patients . 5 While ensuring their own safety , bystanders should ‘ stop , drop and roll ’ anyone who is alight . Once any flames have been extinguished , optimal BFAT involves the application of cool running water for at least 20 minutes to the burnt area . For this to be maximally effective , remove any clothing or jewellery from the patient and take steps to avoid the risk of hypothermia . In addition