Burn Information for Families What you need to know Contents Healthy skin 1 What is a burn? 1 How hot is too hot? 2 This booklet has been designed to Burn classification 2 provide parents and children with a The places you’ll go and people you’ll meet 3 basic understanding of a burn injury, Specific treatments for burns 5 common treatments depending on Pain control 6 severity and the hospitalization Nutrition: Eating for healing 6 process when required. The staff at Going home 8 Kosair Children’s Hospital works as Preventing future burns 10 a team to provide your child with Minor burn care 11 specialized care and expertise in the Major burn care 11 event of a burn injury. The doctors, Burn support and resources 12 nurses, therapists and other caregivers Notes 13 you will meet during your visit work together to get your child well as quickly as possible while including you in your child’s care every step of the way. We hope the information in this booklet will help you understand the steps and services needed to ensure your child heals and knows how to avoid burns in the future. Every burn is different, so if you have questions that are not covered in this booklet, please feel free to ask us. 1 Healthy skin Believe it or not, skin is considered an organ. It is the largest organ in the body, making up 15 percent of your total body weight. The skin has numerous functions: It protects you from injury and infection, prevents the loss of body fluids, helps regulate your body’s temperature and provides sensory contact with the environment. Children, being smaller than adults, have a larger body surface area per pound of weight and their skin is much thinner than adults, which can lead to deeper injuries. The diagram below shows what normal skin looks like. The skin is made up of three layers, and each layer has a specific function. The outermost layer is the epidermis, which is very thin. It contains the pigment that gives your skin color. The middle layer is the dermis, which contains the blood vessels, lymph vessels, hair follicles, sweat glands, collagen and nerves. This layer has pain and touch receptors. The innermost and deepest layer of the skin is the subcutaneous layer. It contains the collagen and fat cells that maintain temperature and are the shock absorbers to prevent injury. Burn facts • Burns are one of the leading causes of accidental injury. • Most burn injuries are scald burns. • Approximately 116,600 children are treated for fire or burn injuries each year in the United States. • The majority of burns are preventable. • Burns are one of the most expensive catastrophic injuries to treat. Types of burns Burns occur when energy or heat is transferred from an object to the body. There are many types of burns with different levels of severity. Types of burns include thermal burns, radiation burns, chemical burns and electrical burns. Thermal burns Thermal burns are from an external heat source, like a stove. The heat source raises the temperature of the skin and tissue, which causes the tissue cells to die. Sometimes the tissue is charred. Examples of thermal burns include hot metal (curling irons, oven doors, lids and pots), scalding liquids (boiling water, soup, ramen noodles, coffee, tea), steam (from boiling liquids, steam irons, steamers) and flames (candles, fires, matches, lighters). Radiation burns These types of burns are caused by prolonged exposure to the ultraviolet (UV) rays of the sun or other sources of radiation (such as X-rays). This type of burn includes sunburn. Sunburn is painful redness or blistering of the skin caused by overexposure to the UV rays of the sun or a sunlamp. Symptoms usually do not begin until 2 to 4 hours after the damage has been done. Pain is controlled by ibuprofen for 48 hours. Aloe gel may be used for comfort and moisture. Almost all people have experienced sunburn at some point in their life. Chemical burns Chemical burns are caused by strong acids, detergents or solvents that come into contact with the skin, eyes or throat. Examples include toilet bowl cleaner, drain cleaners, car battery acid and bleach. What is a burn? A burn is damage to your body’s skin and sometimes deeper tissues caused by heat, chemicals, electricity, sunlight or radiation. Most burn accidents occur in the home. Thermal burns, especially scald burns, are the most common cause of burns in children. Electrical burns Electrical burns result from contact with an electrical current or lightning. After an electrical burn occurs, make sure contact to the source of electricity is broken and the electrical source is turned off. This type of burn may cause damage to the heart because of the electrical changes it induces on the heart. Always call 911 if this type of burn occurs. 2 How hot is too hot? Burn classification Most cooking activities Burns are classified as superficial, partial thickness or full thickness. The level of classification depends on how deeply and severely the burn penetrates the skin and damages underlying tissue. Deep frying 500 degrees Superficial burns Baking 400 degrees A superficial burn affects only the epidermis, or the outer layer of skin. Frying 300 degrees Crock pot 200 degrees Boiling water 170 degrees Scald burns Appearance: It appears as a red, painful and dry area without blisters. Common causes: Mild sunburn or a “flash burn” (sudden, brief burst of heat). Average healing time: Usually heals within one week. Tissue damage is minimal or rare, but it may cause discoloration of the skin. Common treatment: Ointments or lotions, such as Aquaphor or cocoa butter, and acetaminophen. This type of burn usually is not bandaged. Partial-thickness burns This type of burn is deeper, penetrating the epidermis and affecting the second layer of skin, or dermis. Appearance: It appears as red with blisters and may be swollen and painful. Under the blisters, the burn is red and moist. The skin appears beefy red at first and within a few days turns white and pale as an eschar, or scab, develops. Common causes: Hot liquid (scald), flame or contact with hot surface. Average healing time: Within 3 weeks usually without much scarring, but may cause a permanent change in skin color. Common treatment: This type of burn is usually bandaged. Treatments include Silvadene cream (silver sulfadiazine), antibiotic ointment and dressing changes twice daily. U N I V E R S I T Y P E D I AT R I C S U R G E R Y A S S O C I AT E S P S C 3 Full-thickness burns “Just for Kids” Critical Care Center This type of burn damages every layer of skin, including hair follicles and nerves. Due to the deepness of damage, there may not be any pain associated with this type of burn. This is a special unit that cares for children who are very sick or have very serious injuries. With a burn injury, your child may be placed here so he/she can be closely monitored or because he/she may require artificial ventilation. Each nurse in this unit cares for only one or two patients at a time and can provide close monitoring. Appearance: Usually does not have blisters and may appear ivory or pearly white and very dry and leathery. Common causes: Scalding liquids, skin in contact with a hot object for an extended period of time, flames from a fire or from an electrical or chemical source. Average healing time: Requires more than 3 weeks to heal, and most have scarring associated. This burn may also need skin grafting to cover it. Common treatment: Early cleaning and debriding (removing the dead skin). Debridement may be done in the operating room, in the tub or in the hospital room with sedation. Patients may have an IV inserted to give fluids, nutrition and antibiotics. Twice daily dressing changes are done with Silvadene (silver sulfadiazine) or similar ointment. The wound will be examined daily to monitor healing and growth of new skin. A high-protein diet is given to promote healing. Patients are given medicine for pain and monitored closely for pain control. Physical and occupational therapy is usually necessary to maintain function and motion in the area affected by the burn. The burn may need grafting, or replacing dead skin with skin taken from another area of the body. 4 West Burn Unit The Burn Unit at Kosair Children’s Hospital is Kentucky’s first and only burn unit exclusively for children. We care for major and minor burn injuries, electrical injuries and patients undergoing reconstructive plastic surgery after a burn. The Burn Unit is close to the “Just for Kids” Critical Care Center. This unit of the hospital has a large tub and other equipment specifically designed to assist your child in the event of a burn injury. Specialty doctors In addition to a primary attending physician, a specialty doctor may be asked to see your child to evaluate the treatment plan or assist because of where the burn injury is located. These types of doctors include plastic surgeons or hand doctors, and their expertise may be needed to obtain the best cosmetic result after healing. The places you’ll go and people you’ll meet In the event of a major burn, there are two areas of Kosair Children’s Hospital your child may go: the “Just for Kids” Critical Care Center or the Burn Unit on 4 West. Both areas are fully equipped to manage your child’s injury and have specially trained nurses and physical therapists who will care for your child as well as help you understand and cope with what has happened. You will meet many doctors, nurses and therapists who will work as a team to help your child heal. K O S A I R C H I L D R E N ’ S H O S P I TA L 4 Therapy Pharmacy A burn injury may have emotional effects in addition to physical effects. Psychological evaluation and treatment may be necessary to help your child deal with the stress and anxiety associated with a burn. This team will help determine if your child will need additional therapy once he/she goes home. In addition, the team will work with you and your child to teach you wound care techniques and exercises to continue once you return home. The Trauma/Burn Team has a pharmacist on staff who will monitor your child’s medication needs while in the hospital. The pharmacist will make sure your child’s pain is controlled, anxiety is managed and side effects are minimized. We do our best to ensure your child is comfortable and not overmedicated. If you have questions, let your nurse know you’d like to speak with the pharmacist regarding your child’s medications and care. Physical therapists Physical therapists assist your child with activities that encourage movement and stretching. After a burn your child may need assistance to keep the injured part of the body flexible and moving freely. The physical therapists will report daily on how your child is doing with therapy. Home health services Occupational therapists Occupational therapists assist your child in activities of daily living, such as dressing, writing and eating. Through activities and exercises, occupational therapists will work to restore or improve these functions. They will teach exercises for home so that you can help your child too. Occupational therapists will report daily on how your child is doing with therapy. Child life services Child life therapists will visit your child to assist with play time, provide distraction activities to assist with dressing changes and help your child manage stress or anxiety. Because burn injuries are very difficult on children, child life therapists are available to help your child cope with the injury. Pastoral care At any point during your child’s hospital stay you may meet a chaplain. It could be upon admission, during your stay or even at discharge. You may also request to meet with a chaplain at any time. They are available for support, prayers and other spiritual needs while at the hospital. Nutritionist Your child will be evaluated by a nutritionist to help develop a high-protein diet that aids in the burn injury healing process. The nutritionist is a specially trained individual who will monitor your child’s eating habits from admission to discharge. The nutritionist will track weight, all food and drinks your child consumes and will advise on changes needed. The nutritionist also will give you a plan for eating at home. If you have questions about your child’s nutrition, ask your nurse to contact the nutritionist to come by for a visit with you. Home health services are contacted as needed should you need help caring for your child at home. Home health services usually include nursing care, physical therapy, medical supplies, education and monitoring while you are adjusting to home care. The specific service depends on insurance and where you live. There are times when there is not a service available in your area and you may need services provided at your local hospital. Social services Social services consist of hospital social workers who are available from admission to discharge to provide assistance when challenges arise. Areas that they can assist with are school absence, housing, work leave papers for parents and help with obtaining medication if unable to afford. They will visit you while your child is in the hospital, explain their role and how they can assist you during your child’s hospital stay. Hearts and Hands Palliative Care Team Depending on how severely your child was burned, the Hearts and Hands Palliative Care Team may offer help to you and your family. Pediatric palliative care is medical care that focuses on treating the pain, symptoms and stress of children and families facing complex medical conditions. Their services include assistance with symptom control; decision making among the patient, family members and medical team; transition support; grief and bereavement support; and education about palliative care principles. U N I V E R S I T Y P E D I AT R I C S U R G E R Y A S S O C I AT E S P S C 5 Specific treatments for burns Silvadene Silvadene (silver sulfadiazine) is a 1 percent silver-based cream that has antimicrobial properties. It is an ointment applied in a thin layer on the burned skin. It is then covered and wrapped with gauze. This type of treatment is usually done twice a day until the skin heals. Your child will get medication before Silvadene treatment, as it can be uncomfortable, especially when the burn is new. Sometimes this makes it difficult for parents to endure as well. To change the dressings, the gauze is removed and the burn is cleaned with water to remove dead skin and the Silvadene. As your child heals, these treatments will become easier. Bacitracin Bacitracin is a topical antibiotic ointment used primarily on the face, because the skin on the face is very tender. Bacitracin is applied after washing the face, usually two to three times a day. It also may be used after the burn has healed but still needs to be kept moist. Acticoat Acticoat is a silver-based dressing that is placed over the burn, allowing the wound to heal much like Silvadene does. The difference is that this type of dressing may stay on for up to seven days. Acticoat dressings can be less painful than Silvadene dressing changes. Biobrane Biobrane is another type of dressing that covers the wound so it can heal. It is usually put on in the operating room after the burn has been debrided and cleaned. It also may be used to cover a skin graft donor site to protect it and allow it to heal. Biobrane is usually stapled in place to protect the burn or graft site. The staples are removed later. Cadaver skin This is human tissue removed from a cadaver, treated and cleaned. It is then available for use in skin grafts to replace skin that is lost. It is the most common material used in skin grafts of burn patients who may not have enough skin available for a graft. As the burn heals and makes its own new skin, the cadaver skin eventually falls off. Donor site This is an area of the body that the physician chooses to take skin from for grafting. The area usually is the upper thigh or buttocks. The patient is taken to the operating room to remove the donor skin. A clear dressing is applied over the donor site to protect it. Usually this area heals very quickly as new skin grows to cover the donor site. K O S A I R C H I L D R E N ’ S H O S P I TA L 6 Pain control Burn injuries can be very painful. We understand this and begin giving pain medication as soon as your child is admitted in the hospital. Your child has probably never had to experience anything like this before. You will need to help your child cope with the pain. Pain feels different to every child, and every child responds differently to it and to pain medication. Pain is always there, we just use medications to lessen it and make it manageable. We have a lot of experience in pain management, and we will do everything to help your child remain comfortable. Many parents worry that their child could become addicted to pain medication. Your child will be given small amounts of medication, just enough to control pain, and will not be taking it for a long enough period to become addicted. If you have questions or concerns about pain medicines, please ask your child’s nurse or doctor. IV pain medications Morphine sulfate and fentanyl are given through an IV for severe burns to help control pain during a dressing change. They are used at the beginning of the hospitalization and weaned throughout the child’s hospital stay until the child is able to tolerate dressing changes on oral medications. All pain medications cause drowsiness, nausea and/or vomiting. Oral pain medications Hydrocodone Hydrocodone and acetaminophen (Lortab) is an oral medication that is started when your child is eating normal food and ready to be transitioned to oral medication. This long-acting drug controls pain for about 3 to 4 hours. It needs to be given with something in the stomach to prevent nausea. This medication takes longer to work after it is given because it needs to be digested by the stomach first. It comes in pill and liquid forms. Acetaminophen Acetaminophen (Tylenol) is used for burn pain. It relieves most mild pain without difficulty. It often works in conjunction with other medications to help them be more effective. It also may be given if your child has a fever. Diphenhydramine or hydroxine Itching is something that your child may complain of after being burned. Sometimes it happens right away and other times it may be months into healing. It can range from minor irritation to something that interferes with daily activities. There is no cure for the itching, but some medications can help lessen it, like diphenhydramine (Benadryl) or hydroxine (Atarax). Both of these medications make it easier to tolerate but both also cause drowsiness. The best way to lessen itch is with creams applied directly to the skin. Cold compresses also may help. Nutrition: Eating for healing When a burn occurs, the body uses more calories to heal and fight infection. Your child will need additional calories, protein and vitamins to help strengthen the body and speed recovery. Your child will be put on a diet of two to three times more calories and protein than normal. Good nutrition lays the foundation for your child to go home sooner. Protein Protein plays a major role in rebuilding muscle and skin tissues. Protein is needed to produce extra energy for healing. If the body doesn’t get enough protein, it will begin breaking down muscle to produce energy. The best sources of protein are lean meat, seafood, beans and dairy foods. Your child will need one to two extra servings per day for healing. Carbohydrates Carbohydrates provide the majority of calories, or energy, the body uses. Calories are turned into glucose, which will be a source of energy for healing your child’s burns. Your child will need to consume two to three times more calories than normal. Fat Fat provides essential amino acids. However, adding too much fat can actually weaken the immune system. Fat is found in most fast food, chips and junk food. Your child will be given the appropriate amount of fat while in the hospital. After your child goes home, he/she needs to follow a balanced diet. Vitamins Your child will be given additional vitamins to assist the body with healing. Vitamins reduce the damage burns cause and work to promote wound healing. The most beneficial vitamins for wound healing include a multivitamin, vitamin C, zinc and vitamin E. U N I V E R S I T Y P E D I AT R I C S U R G E R Y A S S O C I AT E S P S C 7 During this time it may be difficult to get your child to eat. This is a normal response to a burn. We will pay close attention to what your child is eating to monitor his/her needs. This may be done with a calorie count by writing down everything the child eats or drinks during the day. The calorie count will then be reviewed by a dietitian and adjustments may be made. Your child may require supplemental food to increase calories. Ways to encourage your child to eat and drink 1. Offer small amounts of healthy foods frequently throughout the day, every 2 to 3 hours. Aim for five to six small meals or snacks each day. 2. Encourage foods you feel your child can manage. 3. Offer familiar foods your child likes, but avoid less nutritious foods like candy, burgers, fries and chips. Best drinks for your child • The best drinks to offer are those high in calories and protein, like milk. • If your child is younger than 1 year old, formula or breast milk is best. • For children older than 1 year offer: ¶¶ Milk drinks 4. Favorite foods and home-cooked meals can be supplied from home. 5. Drinks, such as milk, are important when your child is not eating much. Offer milk drinks regularly throughout the day and at meal times and snack times. –– Plain or flavored milk 6. Stay positive when offering food and drinks. –– Whole milk –– High-energy milk 7. Offer praise when your child eats or drinks, no matter how small. –– Milkshakes 8. Avoid battles and fights over food. –– Soy milk 9. It is normal for your child not to eat much at this time. ¶¶ Fruit juices ¶¶ High-energy drinks (Gatorade or Powerade) Best foods for your child The best foods to offer are full of energy, protein and nutrients. These include: Dairy products milk, yogurt, custard, ice cream, cheese and soy products red lean meats, chicken, fish, eggs, Meats/proteins baked beans, lentils, chick peas, hummus Fruits all types of fresh, canned or dried fruit Vegetables all types, potatoes, pumpkin, carrots, broccoli and peas Grains all types of breads, cereals, rice and pasta Reasons why your child may not be able to eat enough 1. The shock and trauma of the burn 2. Drowsiness from the drugs, pain and fear related to dressing changes 3. Fasting periods awaiting surgical procedures 4. Stress of being in the hospital; unfamiliar surroundings, people and food If your child is not eating or drinking enough, he/she may require a nasogastric tube, which is inserted through the nose into the stomach to provide supplemental nutrition. A nasogastric tube (or NG tube) does not interfere with normal eating. When the child begins to eat enough, the tube can be easily removed. K O S A I R C H I L D R E N ’ S H O S P I TA L 8 Suggestions to make the transition home easier: • Set up a daily routine that includes some of the things you did with your child before the injury. • Take one day at a time. Make simple goals each day and celebrate when they are reached. • Take care of yourself as the caregiver of your child. You are an important part of your child fully recovering. • The way your child comes through this situation will largely be determined by the way in which you handle it. In other words, your child will become stronger based on your strength. • Understand your child’s level of development and make allowances based on it. • Expect regression, anger and impatience as your child adjusts to recovery. • Talk with your child often. Be truthful in response to questions. Tell your child how you feel about what has happened. If your child is having trouble coping, sleeping or is having nightmares, contact you pediatrician for help and a referral. Going home When your child suffers a burn, it creates a major change in your normal life. You will need to learn how to care for your child while he/she is healing. We will teach you how and when to change dressings. It is important that you learn how to do this on your own. We understand this can be difficult because you don’t want to cause your child any pain. Sometimes you may get emotional and have difficulty staying focused and in charge. The nursing staff understands what you are feeling but will push you to do what needs to be done for your child’s health. If you just cannot change the dressings, you will need to find someone who can be available twice a day to do it for you. Prior to discharge, you will learn how to care for your child at home. You will need to make sure your home is ready for your child’s return. You should have a plan for managing the dressing changes, a place to keep your supplies, a safe place for the medications and activities to keep your child entertained. The most important thing to remember is to keep the burn clean so it does not become infected. • Be sure to inform your child’s school and teacher. This way they can inform you of any behavior problems, homework issues or other problems occurring during the school day. Your child may need to be seen by the school counselor. Signs your child may not be adjusting: • Agitated behavior (thumb sucking, increased crying, screaming) • Increased or decreased eating, sleeping, urinating or having bowel movements • Separation anxiety, clinging behavior, refusing to sleep alone or wanting to be held all the time • Withdrawing from social situations • Decreased self-confidence • Insulting him-/herself • Verbal or physical aggressiveness • Repeated episodes of sadness Adjusting to home • Re-enacting traumatic events while playing Returning home after a burn requires a period of adjustment for you, your child and other family members. It is normal for you and your child to experience a variety of feelings and emotions. These include feeling scared, nervous or uneasy leaving the hospital and the staff that has helped you. • Difficulty concentrating Remember, if you have questions or need assistance feel free to call the hospital and ask to speak to someone. The phone number is (502) 629-6000. • Resentment and complaints of unfairness or blaming in situations • Behavior changes • Complaints of physical ailments • Increased dependence • Difficulty with friends • Unrealistic expectations of self and others U N I V E R S I T Y P E D I AT R I C S U R G E R Y A S S O C I AT E S P S C 9 • Concern with body image Preventing contractures • Frustration leading to rebellion Contractures occur when the burn scar matures, thickens and tightens, causing a drawing up of the tissue. This interferes with movement and is a serious complication of a burn. Contractures can be prevented by making sure your child is moving and doing things independently. It is important to encourage your child to perform daily activities, like dressing and brushing his/her teeth, as much as possible. Even if it is difficult and takes a long time to do them, allow your child to keep trying to do them. Avoid the temptation to help or take over. Celebrate when your child is able to complete an activity. • Avoidance and denial to avoid addressing issues that arise • Reluctance to trust or open self to others • Feelings of hopelessness and meaningless of life • Depression • Low impulse control with easy frustration • Drug and alcohol abuse Any unusual or persistent behavior listed above should be evaluated by a qualified mental health professional. For assistance, contact the Bingham Child Guidance Center at (502) 852-6941. Wound care at home After leaving the hospital, you will continue the same dressing changes and burn care until you see the doctor during a follow-up appointment. A burn needs close follow-up starting with weekly visits to the doctor. As the burns heal, the time between visits will become longer. The number of times dressings need to be changed also will decrease as the burn heals. Any dressing changes, further surgeries or therapies will be guided by your doctor. The follow-up appointment number is (502) 583-7337. Preventing scars Scars are thickened areas of tissue left after the burn has healed. Most partial-thickness or full-thickness burns have some scarring associated with healing. To prevent and reduce scar formation your child may need to wear a pressure (Jobst) garment. This is a tight-fitting garment worn over the burn area to help reduce or prevent scarring. Your child is measured by a physical therapist once the burn has healed completely. Once the garments are made, you will be contacted to come to the hospital for a fitting. At this visit you will learn how to put on the garment and will be given a spare garment to be worn when laundering the other one. These garments must be hand washed, toweled dried and then hung up to dry completely. It is very important that your child wears the garment 23 hours a day. It is only to be taken off for bathing. Your child’s doctor will advise you on how long the garment must be worn based on how the wound is healing. K O S A I R C H I L D R E N ’ S H O S P I TA L Another way to prevent contractures is for your child to wear a splint that holds the limb in flexion or a stretched position. A splint should be worn on top of the pressure garment. Range of motion exercises also help prevent contractures. These exercises keep the muscles and joints flexible. A physical therapist will teach you and your child specific exercises prior to you leaving the hospital so that you can continue them at home. These special exercises help keep the scar area stretched. It’s important to do the exercises even if your child does not like to do them or does not want to do them. They will help prevent problems in the future. 10 Preventing future burns Families who experience a burn injury are affected physically, emotionally and economically. The pain, disruption in routine and separation affect every family member’s life. Such an injury doesn’t go away; it can last a lifetime. Consider these facts: • Every day across the U.S., hundreds of children are taken to emergency rooms with scald burns caused by contact with hot liquids, steam or foods. • Approximately 65 percent of children under age 4 hospitalized for burn injuries were scalded by hot liquids. • Ninety-five percent of scald burns occur in homes. • Fire kills more than 600 children ages 14 and under each year, and injures about 3,000 more. • Nearly 50 percent of children injured in fires or fire-related incidents are under age 5. • More than 60 percent of residential fires that cause the death of a child occur in homes without smoke detectors. Cooking safety tips • Young children are at high risk for being burned by hot food and liquids. Keep children away from cooking areas by enforcing a “child-free zone” of 3 feet around the stove and microwave. • When young children are present, use the stove’s back burners whenever possible. • Never hold a child while cooking, drinking or carrying hot foods or liquids. Tips for keeping your home safe • Keep young children at least 3 feet away from any place where hot food or drink is being prepared or carried, such as around the microwave. Heating safety tips • Never use your oven to heat your home. • Keep hot foods and liquids away from the edges of tables and counters. • Never allow children to play near a fireplace, wood-burning stove, space heater or other heating source. Establish a 3-foot safety zone around all heat sources. • Have your chimney or wood stove inspected and cleaned annually by a certified chimney specialist, and use a metal mesh screen when burning a fire in your fireplace. • Teach children that hot things can burn them, and when old enough teach them to cook safely. Supervise them closely. Bathroom safety tips • Never leave an infant or child alone in a bathtub or sink. Take the child out of the water and with you if you need to leave the room for any reason. • Follow manufacturer instructions when alternative heat sources, such as wood stoves and kerosene heaters, are used. Kerosene heaters may be prohibited by local fire marshals. • Check the temperature of a child’s bath water. Use a bathtub thermometer to help you make sure the water is no warmer than 100 degrees Fahrenheit. Water that seems cool enough to you may be too hot for a child. • Use fire-resistant materials on walls around wood stoves. Store fuels in proper containers, and keep them out of the reach of children and away from combustible materials. • Turn the water on in the sink for your child to brush his/her teeth or wash hands to help prevent accidental scalding. U N I V E R S I T Y P E D I AT R I C S U R G E R Y A S S O C I AT E S P S C 11 Be prepared • Keep your family safe by installing smoke and carbon monoxide alarms on every level of your home and inside and outside sleeping areas. In at least 23 percent of all fatal residential fires, no smoke alarms were present. • Test smoke alarm batteries every month and change them at least once a year. • Make an escape plan with your family and agree on a common meeting place outside; practice a home fire drill on a regular basis. • If there is a fire, call 911 once you are safely outside. Minor burn care If a minor burn occurs at home, follow these steps: • If the skin is unbroken, run cool water over the burn or soak it in a cool water bath (not ice water). Keep the area submerged for at least 5 minutes. • Calm and reassure the person. • After rinsing or soaking, cover the burn with a dry, sterile bandage or clean dressing. • Protect the burn from pressure and friction. • Families can further reduce their risk of injury or death by installing residential sprinkler systems. • Over-the-counter ibuprofen or acetaminophen can help relieve pain and swelling. Do not give aspirin to children under age 12. • Practice safe fire behaviors and know what to do in an emergency to give your family extra seconds to escape. • Apply a clean, cold wet towel to reduce pain. • Turn down the temperature of your water heater or install a hot water control on your faucets. Set your water heater to no higher than 120 degrees Fahrenheit. • Talk to your child’s care provider about practicing safety during bathing and preparing food. • Keep children away from radiators, wood stoves and ovens. • Keep a fire extinguisher in the kitchen and check it yearly. • Be careful using candles, space heaters and curling irons. Teach your children these important safety tips to prevent scald burns: • Do not touch handles of pots and pans on the kitchen stove, countertop or table. • Once the skin has cooled, moisturizing lotion can aid in healing. Minor burns will usually heal without further treatment. However, if a partial-thickness burn is more than 2 to 3 inches in diameter or is located on the hands, feet or face or over a joint, seek medical attention for further treatment. The person also may need a tetanus booster. Major burn care If someone is on fire: • Have the person stop, drop and roll to put out the flames. If necessary, wrap the person in a blanket or other thick material to smother the flames. • Douse the person with water. • Do not touch any sink or bathtub faucet. • Call 911 immediately. • Tell your parent or baby sitter if bathtub water is too hot or if food or liquids are too hot. • Make sure the person is no longer in contact with smoldering materials. • Do not play in the kitchen while someone is cooking. • Do not remove burned clothing that is stuck to the skin. • Make sure the person is breathing. If the person is not breathing, open the airway and start rescue breathing. • Cover the burned area with dry, sterile bandages or a clean cloth. A sheet will do if the burn is large. Do not apply any ointments and avoid breaking any blisters. • Elevate the body part that is burned above the level of the heart. Continue to monitor heart rate and breathing until EMS arrives. K O S A I R C H I L D R E N ’ S H O S P I TA L 12 Burn support and resources Medical care Kosair Children’s Hospital 231 E. Chestnut St. Louisville, KY 40202 (502) 629-6000 University Pediatric Surgery Associates PSC (502) 583-7337 Need a pediatrician? Call (502) 629-1234 for a free referral. Behavioral care Bingham Child Guidance Center (502) 852-6941 Websites Kosair Children’s Hospital KosairChildrens.com Kosair Children’s Hospital Coping Club www.copingclub.com Burn Survivor Resource Center www. burnsurvivor.com National Institutes of Health www.nih.gov Burn Resource Centre www.burnresource.com Phoenix Society for Burn Survivors www.phoenix-society.org Prevention 1st www.prevention1st.org U N I V E R S I T Y P E D I AT R I C S U R G E R Y A S S O C I AT E S P S C 13 Notes K O S A I R C H I L D R E N ’ S H O S P I TA L 231 E. Chestnut St. • Louisville, KY 40202 • KosairChildrens.com ©Norton Healthcare 3/12 KCH-4944
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