Transcription:
The ABC’s of Pediatric Burn Care

Melanie Cole (Host): There's no handbook for your child's health, but we do have a podcast, featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. This is Kid's HealthCast by Weill Cornell Medicine. I'm Melanie Cole and I invite you to listen in, as we discuss the ABCs of pediatric burns. This is an important show. Please don't miss it. Joining me is Dr. Philip Chang. He's an Assistant Professor of Surgery in the Division of Trauma, Burns, Critical Care and Acute Care Surgery at Weill Cornell Medicine. And he's an Assistant Attending Surgeon at New York Presbyterian Hospital, Weill Cornell Medical Center.

Dr. Chang, I'm so glad to have you join us. As I said at the beginning, this is really so important. And as a mother myself, it's very scary for parents to think about their children getting burned. So, why are burns so common? How are they so common?

Philip Chang, MD (Guest): Thank you Melanie, for having me on to talk about burn injuries. Burn injuries affect almost half a million patients each year who require going to a medical facility for treatment. One of the reasons this injury is so common is danger abounds in home at the workplace and in between when we're traveling between home and work. There are for example, at home opportunities to get burned in the kitchen, lighting candles at the holiday time, or the various chemicals that we use to clean the house.

Host: Well, then why don't you tell us a little bit about the kinds of burns? You just mentioned a few, but kind of go over that for us and tell us what each of these burns, what, where we would find those things?

Dr. Chang: We classify burn injuries by the source or the mechanism of injury; thermal, chemical, electrical. And at this time of year, we also include cold injury as well. Thermal injuries relates to any source of heat that gets transmitted, and this can be anything from a scald burn where one could be accidentally burned by hot water to contact burns where a patient can be contact with a radiator for example, or a hot heating pipe. This could also include burns that have happen in the kitchen when you're actually touching an oven or a pot handle. Finally, other ways that you can also have thermal injuries is through steam pipes or through steam where the superheated steam can make direct contact with the skin causing very deep injuries.

Chemical injuries can happen through direct contact with various either chemical powders or solutions. And the average American home has over 50 plus dangerous chemicals and danger abounds, both at home and at the workplace when it comes to these chemicals. Electrical injuries, fortunately are less common in our country, but there are a number of third electrical burns do happen in the United States, especially with the proliferation of cell phones. And then this time of year with the cold injuries obviously, as the weather gets colder and if we step outside without adequate clothing or protection, it just takes a few minutes of exposure to cold temperatures to lead to severe cold injury to the skin.

Host: Wow. Yikes. As a parent, you know, there's so many dangers out there and thank you for telling us the most common ways for these types of burns to occur. So, aside from skin damage, and we think of things like you've mentioned frostbite, and obviously kitchen burns, but there's more serious complications, right? I mean, this can go deeper than just the skin.

Dr. Chang: Absolutely. So, we commonly will use a degree system to describe burn injuries. First degree is a skin injury that affects just the top layer of skin. A second degree burn gets down to the second layer of skin what we call the dermis. A third degree burn extends through all the layers of skin down to the underlying subcutaneous tissues. And fortunately, rarely, but unfortunately very serious are the fourth degree burns that can extend down to the underlying bone, tendons or even deeper organs.

Host: So, then God forbid, what happens if a child gets burned? If a child gets burned, it's as we've said, pretty common, quite scary. How do we know the severity of it and whether it requires a visit to our pediatrician or to the ER? How's a parent to know Dr. Chang?

Dr. Chang: Absolutely. So, when I think the safest thing to say is whenever in doubt, it's always wise to seek out expert medical care for that burn injury, but some of the specific signs that you would see after a burn injury can inform you and let you know that this is the one that needs immediate medical attention, perhaps the easiest signs to see would be the presence of blisters.

Blistering let's you know, that the injury has extended through the epidermis, into the dermis and is at the very least a second degree burn injury. So, that's a burn injury, especially if it's over sensitive areas, such as the face, the hands or joints that is an injury that would require medical, attention sooner than later.

Third degree burns can present as injuries in which the skin has changed in color to a brownish, blackish, leathery appearance. And those are also injuries that require immediate attention medically. In addition, besides the depth of injury, the size of injury can also mandate immediate medical attention, especially if it's a burn over an entire leg, an arm or say if a child, for example, reaches up and actually pours a cup of coffee onto them and burns their entire chest, that is clearly an injury in which the child should be brought immediately to the emergency department.

Host: So if it's a smaller injury and even injuries can occur, burn injuries with like, if you're cutting hot peppers, right? If your, if your child touches those and gets blisters on their hands from those, tell us what we do when there's a burn. They used to tell us to put stuff on it. Old wives tales said butter on it, but that's not what we're supposed to do, right? What do we do?

Dr. Chang: Absolutely. So, excellent research that came out of Australia a few years ago, looked at what was the best initial step right after the injury occurred. And what they found in their study was that running the injured area of the body under cool running water, not cold, but cool running water for at least 15 minutes would greatly decrease the risk of progression to a more serious injury. It's a common reaction to sometimes apply ice to the wound, but the ice can actually worsen the depth of injury because the ice will actually slow down and clamp down on the blood flow to the burn injury, and that's the last thing you want to do. Your body is trying to deliver important nutrients to that area.

So, ice is not the best first reaction. Cool, running water for 15 minutes. Now, some of the other folk remedies that we've seen patients apply to burns include toothpaste, honey, ketchup, mayonnaise, eggs. We do not medically recommend any of those. Simple cool, running water by far is the best initial treatment for anything burn injury.

Host: Ketchup. Really? I would think the citrus would, would be very painful.

Dr. Chang: Yes. We can tell, we can tell you firsthand from talking to patients, who've had salsa and ketchup on their wounds that it's, it's excruciating. So, we definitely do not recommend anything that you would eat to put on your burn injuries.

Host: No kidding. So then what do you do for our children? Certainly, severe burns are just devastating. They're painful. What do you do for them? Tell us about acute care and what you do for children in the emergency room in the case of a burn.

Dr. Chang: So, we are blessed that medical research has given us great tools for helping us take care of these burn injuries in a way that decreases the pain, decreases the anxiety and helps improve the outcomes, especially in regards to scarring for these burn injuries. One of the biggest advancements in our field has been the development of these special bandages that we can put on a burn injury that can stay on a burn wound for one to two weeks without needing to be changed.

These special dressings, what we call multi-day dressings have really revolutionized our care, and that used to be very common to have to hospitalize a child with a burn injury for two to three weeks. Thanks to these multi-day burn dressings, we're able to see these children in the emergency department for smaller burns and place these multi-day dressings on, and they're able to go home without having to spend the night in the hospital.

Now, for larger burn injuries, say approximately larger than 5% of the body surface area, we still will admit the children for observation and pain control overnight. But we can greatly shorten the hospital course compared to what it was 20 years ago, by using these multi-day dressings. These dressings are also great for decreasing the anxiety and pain. And this in turn leads to children who are able to return to their normal functioning at home, much more quickly with less, much less, of the emotional trauma that used to be the case.

Host: Well, thank you for telling us. That's really exciting technology. And as you're using 21st century technology with an old fashioned personal touch, tell us what follow-up care is like for burn patients, because we really want the best possible outcomes for children. Tell us a little bit about what happens after the fact, and the multidisciplinary approach that you use.

Dr. Chang: So, burn care in the 21st century in the United States really has evolved into a team-based approach. We rely on the expertise and specialty knowledge of multiple experts every time we see a patient. For example, at a clinic visit for one of our burn patients, they'll be seen by one of our expert burn nurses who has full knowledge of the various dressings we can apply, a burn surgeon or a burn specialist who can then make the decisions in terms of what the best therapy is as well as helping manage the pain control. For our children, we have Child Life Specialists who help engage the children, help decrease some of the emotional anxiety they may be having, and also help distract them while the necessary medical care is being applied.

There can also be Child Psychiatrists and Child Psychologist who can help further for those children who are having more anxiety or having a more difficult time adjusting to the injury. Physical Therapists and Occupational Therapists and Hand Therapists also help the child restore function after a burn injury like this.

And finally, Social Workers are incredibly helpful for helping the parents navigate some of the support systems available through government and our other institutions to help, especially if the parents have to miss work for prolonged period of time in order to take care of the child. It's this multidisciplinary team approach that really distinguishes, I think, burn care from other fields of medicine where perhaps the full expertise is not as easily available during these visits.

Host: Well, it certainly is vital and I'm glad you brought up emotional or psychosocial because for children while they're so resilient, I'm just amazed at what I hear about kids and how they deal with devastating injuries. Burns are something that can be seen, they can affect the rest of a child's life. Tell us a little bit about what you've seen as far as resilience and outcomes, and really how that team works with a child on that emotional aspect of something that's so devastating.

Dr. Chang: Children are amazingly resilient at baseline. They want to get better. They want to resume their usual play. They want to go back to school and be with their friends. And that's one thing that really distinguishes children who get burns compared to adults. The children really have that desire to get better. Now they can face significant challenges however, when that burn injury is either a devastating in terms of affecting a large part of their body, or if it's a burn on a visible areas, such as the face or the hand. Those are the patients that will need extra support from the burn team, especially child psychologists and child psychiatrists in terms of the psychological aspects, the burn surgeons, as well as reconstruction specialist in terms of the scar management and other specialists to really help the child as they grow. One of the challenges, especially for the child, who's suffered a burn injury to a joint, especially if it's a third degree burn injury is that the scars can often lead to scar contractures that can limit function of the affected joint. And then it becomes important for physical therapy as well as burn surgery to work together, to help restore function if the scar contracture becomes serious enough.

Host: As we wrap up Dr. Chang this very important episode, tell us what we can do as parents to prevent those burns at home. You've given us some great information about the way that they happen so that we are aware and National Burn Awareness Week is observed on February 7th, that week of 2021. So, tell us what you want us to know about preventing burns in the first place. Every parent needs to hear this.

Dr. Chang: In the spirit of Burn Awareness Week, there are a number of things you can do around the household to really decrease the chances of an accidental injury. The most common cause of burn injury in children is scald burns. And that can happen while bathing. So, one simple test is that every time you're about to bathe your child or have a shower your child, double check the temperature of the water coming out and never leave the child unattended in the bathtub. We oftentimes will see children who are left alone for a few moments and they will turn on the hot water thinking that's the cool water. And unfortunately that can lead to a burn injury.

In the kitchen, microwave safety is very important. Oftentimes young children want to copy their adults in terms of reaching and grabbing something hot from the microwave and if they're not tall enough, they can accidentally spill that cup of ramen noodles or hot drink onto themselves. When it comes time to having that coffee on the table for yourself, make sure that the mug is away from the edge so that your toddler can't reach up and actually pull it down on themselves. One specific thing in the Smartphone age, we've noticed the increase in the number of electrical burn accidents from frayed power charging cables, and especially for children who are using that Smartphone in bed, or even in the bathtub, heaven forbid, connected to the power cable.

So, A take away those power cables for those dangerous areas and periodically check those cables to make sure there are no frayed wires. If you do all these things that will greatly reduce the chances of needing a visit to a burn center.

Host: Thank you so much, Dr. Chang for joining us today. What great information. So, important for parents to hear, and parents listening, share this show with your friends and family on your social channels. We are learning from the experts at Weill Cornell Medicine together. And this was such an important episode and Weill Cornell Medicine continues to see our patients in-person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. Thank you so much to our listeners. And that concludes today's episode of Kid's HealthCast. Please remember to subscribe, rate and review this podcast and all the other Weill Cornell Medicine podcasts. For more health tips like this and updates, please follow us on your social channels. I'm Melanie Cole.