What is Second Degree Burn in Children

A second-degree burn, also called a partial thickness wound, is a serious injury that affects the first two layers of skin. A second-degree burn may be minor or major, depending on the size of the burn and which parts of the skin are burned.

What are the causes?

This condition may be caused by:

• Heat. Burns caused by heat happen when skin comes in contact with something very hot, such as a flame or hot liquid.
• Electricity. Burns caused by electricity happen when electricity passes through the body from lightning, wiring, electrical outlets, appliances, or power lines.
• Certain chemicals, such as acids that come in contact with the skin or eyes. Some chemicals can go through clothing.
• Radiation. Sources of radiation include sunlight, radiation used to heat food, and radiation treatments.

What increases the risk?

Certain kinds of burns are more likely to happen in children of certain ages. For example:

• Toddlers are at higher risk for burns from hot liquids because they are curious and unaware of what happens if they touch a hot object.
• School-aged children are at higher risk for burns from flames because they are more likely to play with matches.
• Adolescents are at an increased risk for burns caused by gasoline and playing with matches.

Children who have cancer and are receiving radiation treatments also have a higher risk of burns.

What are the signs or symptoms?

Symptoms of this condition include:

• Severe pain.
• Skin that is deep red, blistered, tender, and swollen.
• Skin that has changed color.
• Skin that looks blotchy, wet, or shiny.

How is this diagnosed?

This condition is usually diagnosed with an exam of the wounded area. To get a better look at the wound, your child’s health care provider may remove any blistered skin.

It may take several days to find out if your child has a second-degree burn because the signs of this kind of burn can take time to develop. You may need to watch the wound for changes at home. You may also need to take your child to visit his or her health care provider repeatedly to have the wound checked for changes. If the wound is large, your child may need to stay in the hospital so a health care team can examine the wound for a few days.

How is this treated?

Treatment depends on the cause of the burn and how severe it is. Healing may take several weeks. Some second-degree burns, including major burns, electrical burns, and chemical burns, may need to be treated in a hospital. Treatment may involve:

• Cooling the burn with cool, germ-free (sterile) water.
• Giving or applying medicines, such as:
  • Medicines to relieve pain or itching.
  • Ointments to treat or prevent infection.
  • Antibiotic medicine to treat or prevent infection.
• Giving a tetanus shot.
• Covering the burn with a bandage (dressing). If your child’s fingers or toes were burned, each of them may be bandaged separately.
• Compression dressings to prevent scarring and to help the burned body part stay movable (mobile).
• Removing dead skin. This is done by a health care provider. Do not try to remove dead skin yourself.

Deep burns can cause skin tissue to die, and a scab (eschar) may form where the skin used to be. If your child has a deep burn and an eschar forms, your child may need surgery to remove the eschar so the skin can heal properly. If your child’s wound is deep and large (meaning that it covers more than 15% of your child’s skin), treatment may also involve:

• Giving fluids and nutrition.
• Close monitoring of blood flow near the wound.
• Giving oxygen through a mask or a machine (ventilator). This may be needed if a burn causes fluid shifts in the body that make it hard to breathe.

Follow these instructions at home:

Wound care

• Follow instructions from your child’s health care provider about how to take care of the wound. Make sure you:
  • Wash your hands with soap and water before you change your child’s dressing. If soap and water are not available, use hand sanitizer.
  • Change the dressing as directed.
  • If your child removes the dressing, reapply it as soon as possible.
  • If your child has a compression dressing, have him or her wear it as directed.
• If your child is very young or a toddler, try covering the dressing with gauze, a stocking, a sock, or fitted clothing so that your child is not tempted to remove it. If your child is so young that he or she cannot control finger movements, try putting mittens on your child.
• Clean your child’s wound 2–3 times a day or as often as directed.
  • Wash the wound with mild soap and water.
  • Rinse the wound with water to remove all soap.
  • Pat the wound dry with a clean towel. Do not rub it.
• Do not let your child scratch or pick at the wound, break any blisters, or peel any skin.
  • If you think your child’s wound is itchy, tell your child’s health care provider. He or she may be able to prescribe medicine to help with itching.
• Avoid exposing your child’s wound to the sun.
• Check your child’s wound every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.
  • Yellow or green fluid.

Medicine

• Apply any creams or ointments only as directed.
• Give your child over-the-counter and prescription medicines only as directed.
• Give or apply antibiotic medicine as told by your child’s health care provider. Do not stop using the antibiotic even if your child starts to feel better.

Eating and drinking

• Have your child drink enough fluid to keep his or her urine pale yellow.
• Have your child eat a nutritious diet that is high in protein. This will help the wound to heal.

General instructions

• If possible, raise (elevate) the injured area above the level of your child’s heart while he or she is sitting or lying down.
• Have your child rest as directed. Do not let your child exercise until his or her health care provider approves.
• Do not let your child take baths, swim, or use a hot tub until his or her health care provider approves. Ask your child’s health care provider if your child can take showers. Your child may only be allowed to have sponge baths.
• Do not put ice on your child’s burn. This can cause more damage. Try cooling the burn with:
  • Cool water.
  • A cool, wet, clean cloth (cool compress).
• Keep all follow-up visits as directed. This is important.

How is this prevented?

• Make sure your water heaters are set to 120°F (49°C) or lower.
• Make sure children know how to get out of your home in case of a fire.
• Install smoke alarms in your home. Check them regularly to make sure they are working. Teach your child what to do if an alarm goes off.
• Keep younger children out of the kitchen when meals are being prepared.
• Supervise older children when they use the oven and stove, and restrict when they can use them.
• Do not allow children to microwave liquids, including soup, without supervision.
• Teach your child to never play with matches or lighters and to tell an adult if he or she finds some.

Contact a health care provider if:

• Your child’s symptoms do not improve with treatment.
• Your child’s pain is not controlled with medicine.
• Your child has more redness, swelling, or pain around the wound.
• Your child has more fluid or blood coming from the wound.
• There is yellow or green fluid, pus, or a bad smell coming from your child’s wound.
• Your child’s wound changes in appearance.
• Your child’s wound feels warm to the touch.
• Your child has a fever.

Get help right away if:

• You notice more redness or red streaks around the wound that feel warm to the touch.
• Your child develops severe pain.
• Your child develops a fever or chills.
• Your child stops urinating.
• Your child is much more thirsty than normal.

Summary

• A second-degree burn, also called a partial thickness wound, is a serious injury that affects the first two layers of skin.
• Clean your child’s wound 2–3 times a day or as often as directed. Check the wound every day for signs of infection.
• Do not let your child scratch or pick at the wound, break blisters, or peel skin.