Burns in Children - Treatment

Michael Cooper MD Burn Expert - Staten Island Hospital Burn Unit

Now just briefly if your child is burnt, how do you treat it? Well number one the soap and water, you should wash the burn, you should not scrub it but you should wash it softly. Give the child pain medication perhaps Tylenol, about a half hour before but you can wash the burn. Number two; we put a topical antibiotic cream. Use the Silverdine which is a antibiotic cream. However if the person has a sulphur allergy we don’t use Silverdine we use something like Bacitracin. So we always ask do you have any allergies? And if the person may say no, when we ask do you have any sulphur allergies? So, if one has a sulphur allergy we don’t use Silverdine, we use Bacitracin or some other and then we use a non stick gauze. You don’t want to put the white gauze directly on the burn because it sticks, especially with children it sticks and it hurts and they won’t let you change the dressing. We use some type of non-stick gauze like a Adaptic or Telfa or Xeroform and then we put the white gauze on and we usually change the dressings twice a day. And here is an example of hand burn, this is at the hospital, washing it and then if there is a loose burnt skin we remove that skin. And then if you are at home sometimes the patients come in, not all patients are admitted, until they go home one thing, I always tell parents is make sure you have everything set up before you start. So here is the Silverdine, here is the non-stick gauze, you want to have your white gauze, have everything set up so that the dressing doesn’t take a long time it and is less painful for the child. There are two ways to apply the Silverdine, some place Silverdine directly on the burn. Here, it's directly on the burn wound here and then they put the non-stick gauze over and then they put the white gauze on. What I like to do is put the Silverdine directly on the non-stick gauze. And then put that combination with the Silverdine and the gauze on the burn. I find that is less painful than if you rub the Silverdine directly on the wound. So again, I put the Silverdine directly on the non-stick gauze and then put that non-stick gauze on and then I put the white gauze on. Either way is fine, it's personal preference. I would like to show this slide here just because it's white it doesn’t mean it's Silverdine. I was rounding in a hospital, I won’t say which one, it wasn't important that but you see that the Silverdine is here and the family has brought in some Maxima, a cold cream and the resident has the tongue depressor in the cold cream. We have seen everything from just two weeks ago, a young girl came into our outpatient clinic, we have our clinic on Tuesday mornings on 20 Allen Avenue and she had been in another hospital. She came in with toothpaste, I have a great slide, I couldn’t show it here, but I have a great slide of this young woman with blue toothpaste all over both legs. So just because it's cream and just because it's white doesn’t mean that it's Silverdine. So don’t put those and I will leave that. So these are a couple of examples. I know it's getting late but this is a gentleman who was cooking, had a seizure, if you have a seizure disorders, don’t cook because invariably, you will get the seizure while you are cooking and this is a second degree burn. We washed it, debrided it and this is at about 10 days, paint and dry and that's healed. This is a third degree burn, this is a gentleman who dropped acid in to his boots. He was working, usually with the third degree burn, I would operate, remove the burn tissue and do a skin graft. He opted not to have a surgery. So over the next six weeks, we put Silverdine on it and it finally did heal. And lastly, we are always asked if my child is burnt, my child has a burn if they are going to be scaring. That’s a major concern and what I always say is that usually if a burn heals within two weeks so less it's not so deep. So the probability or the chance is scaring is less. So two weeks is sort of -- it doesn’t mean exactly two weeks but two weeks is sort of a guideline. So if you come in with a scar burn or