Burn Injuries in Children's Hand

Burn injuries in children’s hands are relatively common as they use their hands to explore their environment, making them more susceptible to injury. While burns can occur with exposure to electricity, chemicals or heat, thermal burns are most common in children. The hotter the object and the longer it remains in contact with the skin, the deeper the injury. Burns cause skin cells to die. The severity of a burn is determined by the depth of the injury and is classified as 1^st, 2^nd, 3^rd and 4^th degree burns.

• First degree burns (superficial burns) produce redness of the skin.
• Second degree burns (partial thickness of skin) are associated with blisters (fluid collection under burnt skin).
• Third degree burns (full-thickness of skin) lead to white and leathery skin.
• In fourth degree burns, there is usually underlying muscle, tendon and bone injury.

If left untreated, severe burn injuries to the hand can lead to stiffness, deformity and disability.

When you present with your child to the clinic, the burn injury is first gently cleansed. Your doctor will examine the extent and depth of injury, and the range of motion and function of the hand to determine the severity of injury and decide on treatment.

The management of burns in children is complex and usually requires a multidisciplinary approach. Treatment is aimed at preventing hand stiffness and infection. Pain is controlled with medication and the hand is kept elevated to minimize swelling. Tetanus immunization may be administered if necessary. Topical antibiotics and a sterile dressing are applied over the burnt skin, and changed frequently. Blisters are usually left alone, but the outer skin of broken blisters may be trimmed. In order to prevent stiffness, the hand is placed in a splint in its normal position, and occupational therapy and finger movement are encouraged. Healing may occur in 2-4 weeks depending on the severity of the injury.

Surgical intervention is required when the burns do not heal after 7-10 days. A 3^rd degree burn may be associated with tight scarring or for deep burn injuries where pressure develops within the tissues due to fluid accumulation, it can lead to tissue death. Incisions as well as excision of burnt tissue may be required to relieve this pressure. Skin grafts may be used for extensive areas of tissue damage to prevent scarring and stiffness. Further surgery may be necessary to repair underlying tissues and improve hand function. Your child’s emotional and psychological trauma is also addressed.