Burns in Babies and Children: First Aid and When to See a Doctor

The tea tray is on the coffee table, the teapot is still steaming, and a small hand grabs it before anyone has time to react. A baby burn almost always happens like this: in a second, in a familiar scene. The first few minutes matter enormously, and what you do (or avoid doing) changes how the skin heals.

Here are the steps to take straight away, the old home remedies to forget, the burns that must be seen in the emergency room, and prevention that suits our homes.

What is the first step with a burn?

Cool it, right away, under cool running tap water. It is the only step that limits how deep the burn goes, and it is recommended everywhere.

1. Move your child away from the source of heat and protect yourself (turn off the gas or electricity if needed).
2. Hold the burned area under cool running water, not ice-cold, as quickly as you can.
3. Remove clothing and jewellery around the burn, except anything stuck to the skin: leave that in place and head to the emergency room.
4. Keep the rest of the body warm in a towel or blanket.
5. Then cover the burn with cling film laid flat, without wrapping it around an arm or leg, or with a clean, damp cloth.

If clothing catches fire, lay your child down and smother the flames with a blanket, keeping the head clear, as the Quebec guide Mieux vivre describes.

How long should you cool it, and at what temperature?

Plan on 15 to 20 minutes of cool water. On the exact duration, recommendations vary from country to country, and it is useful to know that:

Why the differences? They all look for the same balance: cool for long enough to stop the burn, without dropping the body's temperature. The WHO warns against prolonged cooling, which can cause hypothermia, and the Brussels hospital sums up the rule in one sentence: you cool the burn, not the child. With an infant, whose body cools quickly, run water only over the burned area, never the whole body under a cold shower, and watch that they do not shiver.

Ice, toothpaste, oil, egg: why these remedies should be avoided

This is often where relatives step in with good intentions. Yet health authorities are unanimous:

• Ice makes the injury worse by deepening it, according to the WHO. A cold pack never goes directly on the skin.
• Toothpaste, butter, oil and vinegar can make the burn worse, warn the NHS and the INSPQ.
• Egg, honey, henna, coffee grounds, turmeric: the WHO advises against any paste or preparation placed on the wound. They trap heat, dirty the wound, encourage infection and stop the doctor judging the depth.
• Blisters are not to be popped: they protect the skin underneath.
• Adhesive plasters stick to the wound: the NHS advises against using them to cover a burn.

For pain, ask the pharmacist or doctor which pain reliever to give and at what dose for your child's weight. For a small, superficial burn, they can also suggest suitable care. Keep sterile gauze and cling film in your baby's medicine kit.

Which burns need the emergency room?

A burn in a toddler is always taken seriously, because their skin is thinner than an adult's. The NHS advises getting medical advice for any burned child under 5.

Emergency room or 141, without waiting, if the burn:

• is large or deep (white, leathery or brownish skin, little pain);
• affects the face, neck, mouth, hands, feet, a joint, the genitals or the buttocks;
• goes all the way around an arm, a leg or a finger;
• is electrical or chemical;
• comes with clothing stuck to the skin;
• involves a child who is breathing badly, is drowsy or was caught in smoke.

See a doctor the same day for a burn with blisters, even a small one, and for any burn where the redness or pain lasts more than a few hours, as the American Academy of Pediatrics recommends.

In the following days, see a doctor if the burn does not heal or shows signs of infection: spreading redness, swelling, yellow or green discharge, a bad smell, fever, or if your child refuses to drink and eat.

A chemical burn is rinsed for a long time with plenty of water: 30 to 60 minutes according to the Brussels hospital, removing any soaked clothing. For an electrical burn, cut the power before touching your child.

Where do toddlers' burns come from?

Mostly from hot liquids. The WHO reminds us that children are most often burned at home, in the kitchen, by hot liquids or flames. In our homes, the risky scenes are well known:

• tea, served scalding hot, often on a coffee table at child height;
• the kitchen: pots, pressure cookers, frying, soup and the Ramadan harira;
• the bath, when the water has not been checked;
• the hammam, with its buckets of very hot water and scorching floors;
• braziers, ovens and gas cylinders, which add flame burns.

Tap water is more dangerous than people think. The INSPQ reminds us that at 60 °C, water can give a child a second-degree or even third-degree burn in one second.

How can you prevent burns at home?

A few habits are enough to avoid most accidents:

• Never hold a hot drink when your baby is on your lap, or while carrying them. Belgian, Quebec and American sources all insist on this.
• Keep the tea tray away from the edge and out of reach; no hanging tablecloth that a child could pull.
• Pan handles turned inward, with your child kept away from the stove and the oven door.
• Check the bathwater with your elbow or a bath thermometer: it should be lukewarm, at body temperature. Never leave a child alone in the tub, as they could turn on the hot tap.
• Set the water heater sensibly: the American Academy of Pediatrics recommends tap water no hotter than 48.9 °C, the INSPQ a temperature limiter at 49 °C at most.
• Protect sockets with socket covers and unplug extension leads.
• Keep matches, lighters and candles out of reach.

In the sun, sunburns are burns too: our advice is in keeping your baby safe at the beach. The full checklist is in making your home safe for your baby, and our guide to household accidents covers the other risks at home.