Forever Seared Into My Memory

This week’s guest columnist is Dr. Aaron Foster, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

Forever seared into my memory is the image of my friend, running down the dock at summer camp, his body engulfed in flames.  Behind him trailed burning footprints, lighting his path in the night.  All boys are fascinated by fire, and at age 14 we discovered that aerosol bug spray was flammable, and would briefly burn on your skin without causing injury.  This led to the scene of my friend, doused in flaming insect repellent, running down the dock to jump in the lake.  Luckily he survived the ordeal unharmed, minus some hairs on his head and eyebrows.

Many children, though not as foolish as we were, are not as lucky either.  According to National Institutes of Health (NIH) statistics, a quarter of all burns treated in the U.S. involve kids under age 16.  While teenage foolishness may be unavoidable, burns are largely preventable.  The incidence of burns, and most importantly severe burns, has decreased in recent decades.  This is due to improved building codes, education in schools about fire escape planning, and smoke detectors.  Yet burns do still occur, and fortunately most of these are minor.

As a medical student I spent time on a burn ward, and saw many different types and severities of burns.  One thing that stood out for me was the disproportionate number of young children admitted for burns.  According to the NIH, most pediatric burns happen to kids under age 5.  Most of these are scald injuries, and occur in the kitchen.  And given that we adults are in charge of the kitchen, these are avoidable.

Preventing burns includes common sense things like keeping small children out of the kitchen while cooking.  Don’t carry children and hot food at the same time.  Advice that might seem less obvious: turn the pot handles on the stove inward, so they don’t stick out where kids can grab them.  Make sure appliance cords don’t hang over counters either, for the same reason- curious children grab stuff, and if that stuff is hot toasters or pots full of boiling soup, disaster can ensue.

Several times in the past in this blog, Dr. Hamilton has mentioned that most of the burns he sees are when little kids take hot bowls of noodles out of microwaves.  Someone else happens along, bumps that big, in-the-way microwave door, and the bowl spills on the child.  In my time as a medical student on the burn ward, I also saw a lot of kids burned when they pulled on a tablecloth that had a container of hot liquid on top.

As we mentioned above, kitchen burns can be prevented with a little extra care.  Small children should be kept out of the kitchen while hot food is being prepared, and should never operate microwave ovens without an adult hovering.  Pot handles and electric cords should be out of reach.

After age 5, burns happen more with open flames.  This includes campfires and bonfires, and fireworks.  Open fires should be contained within fire pits, with no flammables (extra wood, long dry grasses) close by.  Kids shouldn’t wear loose flowing clothing near fire, or clothes that easily catch fire with a spark (synthetics).  And though it seems obvious (to the sober), don’t throw lighter fluid or gasoline on open flames.  We see too many kids who get engulfed when those fluids become an exploding cloud.

Though we do our best to prevent children from harming themselves, burns happen. Fortunately the vast majority do not require seeing a doctor.  Small burns can be managed at home by remembering the 5 C’s.  Clothing- immediately remove any clothing involved, so that the hot liquid or flaming clothes don’t continue to burn. Cooling- cool water stops the burning process, and feels good too!  Cleaning- soap and water is sufficient, to minimize infection if the skin barrier is compromised.  Cover- put on antibiotic ointment generously and cover with gauze.  This also soothes, and prevents infection. Comfort- pain relief with Tylenol or ibuprofen.

When should kids see a doctor for burns?  Burns that blister, or are larger than the area of the patient’s hand, or involve faces or joints, should get seen.  Kids should have up-to-date tetanus vaccines, since burns increase the risk of tetanus infection. 

Ouch That’s Hot!

This week’s guest columnist is Dr. Matthew Whittington, a third year resident in the Family Practice program at the University Health Center here in Lafayette.  We see a lot of burns in the Pediatric Emergency Department, mostly from spilled hot liquids or kids grabbing hot curling irons or open ovens.  And parents feel terribly guilty when it happens.  Read and heed Dr. Whittington!- SH

The idea of a child getting burned is such a scary subject for parents.  Though it is scary, educating yourself now is the best way to prevent a burn.  You also will know how to best handle a burn situation if it happens.  If a parent has a sound game plan, a frightening situation can be countered with calm quick action.

Prevention is the best way to handle burns, of course.  A weekend project to ready you and your home can go a very long way for peace of mind.  Cover electrical outlets.  Exploratory behavior of young children often leads to them sticking fingers, coins, forks, and keys into these outlets.  Set the water heater to 120 degrees (or less).  Always check the water temperature of running water for baths.

Keep flammable materials, like curtains, at least three feet away from space heaters and candles.  Hide the matches and lighters so they are never in a child’s reach.  Install safety gates around fireplaces.  Install smoke detectors in every bedroom, in main hallways, and everywhere else recommended in the smoke detector instruction booklet.  Watch closely while using appliances that heat up, like curling irons and hair dryers.

Burns commonly happen in the kitchen.  Never hold a child while cooking at the stove. Use high chairs in the kitchen to keep your toddler from reaching hot things, or install gates to keep them out of the kitchen.  Only use back stove burners, with pot handles turned inwards.   Toddlers will reach up and grab pots, just like mom does!   Be very careful with the microwave.  Children often get burned when they are allowed to heat things up in the microwave themselves.  Microwave doors also are big targets for others to bump into when hot things are being taken out, and the hot liquid gets spilled on everyone nearby.

However, if burns occur despite your best prevention measures, appropriate care is essential.  Care of burns depends on what type of burn you are dealing with.  First degree burns affect only the outer layer of the skin.  They are red, and can be slightly swollen. Sunburns are the most common first degree burns.  This type of burn can still be quite painful.  Run cool, clean water over the affected area to halt the burning process.  Do not use ice as this can further damage the skin.  Mild burn creams and ibuprofen or Tylenol can help with the pain.

Worse burns are second and third degree burns.  Second degree burns are when the skin is burned through more than one layer, the skin layers separate with the damage, and blisters form.  Second degree burns are still painful, because the burn does not destroy the nerves.  Third degree burns cook the full thickness of the skin.  The burn area tends to be pale/yellow, and leathery.  They often do not hurt to touch, given that the nerves are damaged.

If dealing with burns beyond minor first degree, still cool the burn with clean water. Remove all jewelry, clothing, bracelets, and rings.  These might constrict the burn area when swelling sets in.  Taking clothes soaked with hot scalding liquid off right away will also help keep the burn from progressing from a first degree burn to worse.

If blisters have formed, don’t pop them!  This increases the risk of infection.  Cover the area with a dressing, preferably one that won’t stick.  If nothing else is available, you can use cling wrap.  This acts like a second skin to prevent infection later.  Then bring the child to a doctor.

Most importantly, begin talking with your children about hot items and fires.  Start at an early age so they always know the importance of safety measures.  With prevention and education, your home can be happy and safe.