A burn is an injury to the skin caused when the skin has contact with hot fluid, flame or chemicals. Burns are classified by how deeply they injure or burn the skin:

1. Superficial
2. Partial thickness
3. Deep full thickness

Treatment for burns includes applying special ‘wet dressings’. Good nutrition is also very important to help the body heal. Regular pain relief and physiotherapy may also be very helpful.

Burns are treated by placing slightly wet dressings over the actual wounds. Most burns dressings used at The Royal Children’s Hospital involve a ‘closed dressing technique’. This means the wound is covered with a dressing and not left open to the air.

The ‘closed dressing technique’ is used for protection and absorption and also reduces stress on the patient and their family. By having the dressing closed, the wound does not need daily care. It just needs checking that it stays on and is intact. The fact the wound is covered also means that neither the child nor their family have to look at the wound.

The level of moisture, and the size, depth and area of the burn need to be taken into consideration when choosing the type of dressing. For example, burns dressings for the face and perineum (the area between the anus and the scrotum in the male and between the anus and the vulva in the female) are different to other parts of the body (see Kids Health Info factsheet: Burns on the face).

The aim of the burn dressing is to keep the wound clean and dry and to prevent infection. Although the dressing is designed to keep the wound dry, a ‘wet dressing’ contains silver which releases for up to seven days. Silver is an antimicrobial – a substance that kills or prevents the growth of microbes such as bacteria. It is important not to have a bath or to play in the sandpit as these activities will contaminate the dressing.

In the beginning, it can be very difficult to tell how deep a burn is.  It takes from 10-14 days or more for a burn area to fully develop. This does not mean that your child needs to stay in hospital for all of that time. Once your child is eating and drinking enough and their condition is stable, you may be able to take your child home. Your child will have their dressings on and will need to come back to either Specialist Clinics or Platypus Ward for dressing changes and to review the healing progress.  Sometimes children need to go to theatre to have the dressing changed under a general anaesthetic (GA).

Dressing changes can be, but are not always, painful. However, the burns dressing changes can be emotionally and psychologically upsetting for both your child and you. As an inpatient, we try to minimise this with a combination of medications and techniques for play and distraction. This is where you, as a parent, can really help. See the Kids Health Info factsheet:  Reduce children’s pain during tests and procedures.

Please feel free to discuss any ideas you have to reduce your child’s fear with the ward nurse. There is also a burns social worker on hand if you would like to talk about coping strategies for dressing changes as well as how to talk to your child about their burns.

Burns usually heal on their own with time.  However, they sometimes don’t heal and need skin grafting. Some burns can scar. The physiotherapist aims to reduce this as much as possible. (see the Kids Health Inof factsheet: Burns & physiotherapy).

Good nutrition is needed to help burns heal. Your child needs a diet high in protein and calories and plenty to drink. Talk to staff for advice and examples of good foods to eat.

Children with burns are treated by a team of different specialists who work together to help your child get better. This team is called the Burns Team and includes:

• doctors (consultant – senior doctor, registrar – middle doctor and resident – junior doctor)
• nurses (ward, outpatients, theatre)
• ward care coordinator (nurse who coordinates your child’s care)
• physiotherapist (works to maintain and restore mobility and range of movement and minimise scarring)
• occupational therapist (services related to rehabilitation of hand injuries)
• social worker (can assist with home, family or transport problems; help you work with welfare organisations such as Centrelink; provide counselling and coping mechanisms)
• dietitian (makes sure your child gets the best food for healing – in hospital and at home)
• education advisor (who acts as a liaison between hospital and school)
• play therapist (provides educational play and distraction during distressing treatment)

Your child may also see other experts as needed.