Cool, call, cover
Three steps, in that order, and the first one is the one that changes the outcome.
Cool. Cold or lukewarm running water over the burn for a full twenty minutes, starting as soon as possible. Twenty minutes is much longer than it feels, and the common mistake is stopping at two or three because the crying has settled. Cooling reduces pain, limits how deep the burn goes and reduces scarring, and it is still worth doing up to a few hours later if it was not done at the time.
A tap, a shower head at low pressure or a jug refilled repeatedly all work. The water is aimed at the burn only — a small child must not go under a cold shower or into a cold bath whole-body, because they lose heat fast and hypothermia is a genuine risk while a burn is being cooled. The rest of the child is kept warm with a blanket or clothing held clear of the burn. If there is no running water, any cold harmless liquid is better than nothing.
Call. 999 if the burn looks serious or if there is any doubt at all. For a baby or young child, medical advice is sought for every burn, including the ones that look trivial — 111 at the least. Cooling continues while the call is made, and continues until help arrives.
Cover. After cooling, cling film laid over the burn in a single layer, not wrapped round a limb, because swelling follows a burn and a wrap becomes a tourniquet. A clean plastic bag suits a hand or a foot. No plasters and no adhesive dressings, which stick to damaged skin and hurt coming off.
Clothing and nappies near the burn come off, along with anything tight, because swelling starts quickly. Anything stuck to the burn stays where it is and is dealt with at hospital.
For pain, paracetamol or ibuprofen at the dose on the packet. Not aspirin, which is not given to anyone under sixteen.
What does not go on a burn
All of the following are still in circulation and all of them make things worse.
- Ice or iced water. Cold enough to damage already injured skin and to deepen the burn.
- Butter, margarine, oil or any grease. These hold the heat in, which is the exact opposite of the intention.
- Creams, ointments and antiseptics. They have to be cleaned off before the burn can be assessed, which is painful and pointless.
- Toothpaste. A persistent piece of folklore with nothing behind it.
- Bursting blisters. The blister is a sterile dressing the body has provided. It is left alone.
When it is a hospital
Straight to A&E, or 999, for:
- Any burn on a child under five that is more than trivial, and any burn at all on a baby
- A burn larger than the child's own hand, or any deep burn
- White, brown, black, charred, leathery or waxy skin, or a burn that is not painful — painlessness means the nerve endings have gone and is a sign of a worse burn, not a better one
- Blistering on the face, hands, feet, genitals, or across a joint
- Any chemical or electrical burn, however small it looks
- Smoke or fumes breathed in — coughing, a sore throat, a hoarse voice, singed nose hair or soot around the mouth, even with no obvious burn, and even if symptoms take hours to appear
- A burn that goes all the way round a limb, a finger or a toe
And 999 for signs of shock: cold clammy skin, sweating, fast shallow breathing, weakness or dizziness. The child is laid down with the legs raised if their injuries allow, kept warm, and given nothing to eat or drink.
Hot drinks
The single commonest cause of scalds in the under-fives, and the one most often dismissed because the tea has been sitting there for a while. A hot drink can still scald a baby fifteen minutes after it was made.
- Mugs go at the back of a worktop or on a high surface, never on a low table, an arm of a chair, or the floor beside one.
- The child gets put down before the drink gets picked up. A wriggle at the wrong moment accounts for a great many of these injuries.
- No passing a drink over a child's head, which also applies in cafés and at other people's houses, where the furniture is the wrong height and nobody is thinking about it.
- Tablecloths come off while there is a toddler in the house, because a cloth is a handle for everything standing on it.
Bath water
Hot bath water causes more of the severe and fatal burns in young children than anything else, and the mechanism is usually a child getting in or being put in before the water was mixed, or turning the hot tap while playing.
- Cold water in first, hot added afterwards, and the taps turned off and the water stirred before anyone gets in. Running the hot first leaves a layer of scalding water that a stir does not reliably disperse.
- The elbow test. An elbow or the back of a hand put in the water, which should feel neither hot nor cold. A hand that has been in cold water, or in washing-up water, is not a reliable judge.
- Nobody leaves the room, and nobody leaves an older child in charge of the taps.
- A thermostatic blending valve is the proper fix. Building regulations require new and replacement baths to be supplied at no more than 48°C, achieved by a valve that blends the hot supply before it reaches the tap. Older installations usually have nothing of the kind, and a plumber can fit one; in rented housing it is a reasonable thing to ask a landlord for.
- Even with a valve fitted, 48°C is still too hot for a child to sit in, so the mixing and testing still happen.
Water safety in the bath, which is a different hazard with the same furniture, is covered under water safety for children.
Hair straighteners, irons and everything that stays hot
Hair straighteners run at around 235°C — hotter than an oven — and stay dangerous for up to about forty minutes after being unplugged. Left on a bed or a bedroom floor to cool, they are at exactly the height and in exactly the place a toddler will find them, and the burn is usually to a palm, which is a bad place to have one.
The same applies to anything with residual heat, and residual heat is the theme of most contact burns:
- Straighteners and curling tongs — a heatproof pouch, and then out of reach rather than on the floor.
- Irons — put away immediately after use, and the flex kept off the edge of the board. An ironing board is easy to pull over.
- Hobs and oven doors, which stay hot long after cooking. A glass oven door at child height is a common contact burn.
- Radiators and heated towel rails — cots and beds moved away, so an arm or a leg cannot end up trapped against one.
- Barbecues, which stay hot for hours after the food has gone. A disposable one goes into a bucket of water rather than being left on the grass.
- Hot water bottles, which should be in date, in a cover, and not used in a child's bed.
The kitchen
Half of these injuries happen here, and the fixes are mundane.
- Back rings, handles turned inward.
- A short or coiled kettle flex, pushed to the back of the worktop. A dangling flex is a rope attached to two pints of boiling water.
- No bottles warmed in a microwave, because the heating is uneven and leaves scalding pockets even when the outside feels fine. A bottle warmer or a jug of hot water, then shaken well and tested.
- A safety gate on the kitchen door while cooking is going on, which solves most of the above at once.
- Steam from a kettle, a pan or a steamer burns as readily as water, and a child reaching up into it is not watching for it.
Fires, candles and sparklers
- Fireguards on any open fire or heater, to the current British standard and fixed to the wall rather than freestanding, which a child can pull over or lean on.
- Candles out of reach, never left burning in an empty room, and fully extinguished. Battery versions remove the problem entirely, though the ones with button batteries bring a different one.
- Matches and lighters in a high and ideally locked cupboard. Lighters are not child-resistant in any meaningful sense.
- Sparklers are not for under-fives, and burn at a temperature far above what their appearance suggests. Gloves, held at arm's length, one at a time, and into a bucket of water afterwards.
- Dressing-up clothes are often made of fabric that catches fire readily and are not covered by the flammability rules that apply to children's nightwear. Worth keeping well away from candles and a hob.
Working smoke alarms sit behind all of this and are a separate subject, but the one-line version is one on every floor, tested monthly.
Sunburn, chemicals and electricity
Sunburn is a burn and is prevented rather than treated; the detail is under summer safety for children. The short version for a child already burnt is shade, cool water, plenty to drink, an unscented aftersun rather than anything greasy, and paracetamol or ibuprofen. Blistering, a fever, or a baby under a year old means medical advice.
Chemical burns — oven cleaner, drain cleaner, dishwasher powder, descaler, laundry capsules — are rinsed with plenty of running water and then taken to A&E regardless of how they look, with the container brought along. Where a chemical has been swallowed as well as spilt, the response is different again and is covered under poisoning in children.
Electrical burns always need assessment, even when the mark on the skin is tiny, because the damage follows the current through the body and the entry wound reveals nothing about it. The power goes off before anyone touches the child.
Worth being honest about
Nearly all of these accidents happen with an adult a few feet away, during the ordinary distraction of a day. The useful response to that is not more vigilance, which is already at its limit, but a handful of permanent changes — the mug at the back of the worktop, the coiled kettle flex, the straighteners in a pouch on a high shelf, the blending valve on the bath — that keep working on the day attention runs out.