What do we do when our children get burn ?
27 September 2007

BURN

The severity of the burn depends on the depth of the burn; the size of the burn; the location of the burn; the age of the child; the source of the burn; and the health of the child prior to the burn injury.
To protect your child, it is important to understand the types of burns and the most common causes of burns. Practice fire safety and burn awareness at all times. Teach your children how to avoid sources of burns and what to do in the case of a fire. Should your child be burned, emergency care may be necessary.
Anatomy of the Skin

Facts about the skin:
The skin is the body's largest organ, covering the entire body. In addition to serving as a protective shield against heat, light, injury, and infection, the skin also:
• regulates body temperature.
• stores water and fat.
• is a sensory organ.
• prevents water loss.
• prevents entry of bacteria.
Throughout the body, the skin's characteristics vary (i.e., thickness, color, texture). For instance, the head contains more hair follicles than anywhere else, while the soles of the feet contain none. In addition, the soles of the feet and the palms of the hands are much thicker.

The skin is made up of the following layers, with each layer performing specific functions:
• epidermis
• dermis
• subcutaneous fat layer
epidermis The epidermis is the thin outer layer of the skin which consists of the following three parts:
• stratum corneum (horny layer)
This layer consists of fully mature keratinocytes which contain fibrous proteins (keratins). The outermost layer is continuously shed. The stratum corneum prevents the entry of most foreign substances as well as the loss of fluid from the body.
• keratinocytes (squamous cells)
This layer, just beneath the stratum corneum, contains living keratinocytes (squamous cells), which mature and form the stratum corneum.
• basal layer
The basal layer is the deepest layer of the epidermis, containing basal cells. Basal cells continually divide, forming new keratinocytes, replacing the old ones that are shed from the skin's surface.
The epidermis also contains melanocytes, which are cells that produce melanin (skin pigment).
dermis The dermis is the middle layer of the skin. The dermis contains the following:
• blood vessels
• lymph vessels
• hair follicles
• sweat glands
• collagen bundles
• fibroblasts
• nerves
The dermis is held together by a protein called collagen, made by fibroblasts. This layer also contains pain and touch receptors.
subcutis The subcutis is the deepest layer of skin. The subcutis, consisting of a network of collagen and fat cells, helps conserve the body's heat and protects the body from injury by acting as a "shock absorber."


What are burns?
Burns are a type of injury caused by thermal, electrical, chemical, or electromagnetic energy. Most burn accidents occur at home. About 75 percent of all burn injuries in children are preventable.
An open flame is the leading cause of burn injury for adults, while scalding is the leading cause of burn injury for children. Both infants and the elderly are at the greatest risk for burn injury.
What are the different types of burns?
A burn injury usually results from an energy transfer to the body. There are many types of burns caused by thermal, radiation, chemical, or electrical contact.
thermal burns - burns due to external heat sources which raise the temperature of the skin and tissues and cause tissue cell death or charring. Hot metals, scalding liquids, steam, and flames, when coming in contact with the skin, can cause thermal burns.
radiation burns - burns due to prolonged exposure to ultraviolet rays of the sun, or to other sources of radiation such as x-ray.
chemical burns - burns due to strong acids, alkalies, detergents, or solvents coming into contact with the skin and/or eyes.
electrical burns - burns from electrical current, either alternating current (AC) or direct current (DC).
Age Most Common Injury Type Risk Factors
< 5 Years Flame Playing with matches, cigarette lighters, fires in fireplaces, barbecue pits, and trash fires.
Scald Kitchen injury from tipping scalding liquids.

Bathtub scalds often associated with lack of supervision or child abuse. Greatest number of pediatric burn patients are infants and toddlers younger than 3 years of age burned by scalding liquids.
5 to 10 Years Flame Male children are at an increased risk often due to fire play and risk-taking behaviors.
Scald Female children are at increased risk, with most burns occurring in the kitchen or bathroom.
Adolescent Flame Injury associated with male peer-group activities involving gasoline or other flammable products, such as fireworks.
Electrical Occurs most often in male adolescents involved in dare-type behaviors, such as climbing utility poles or antennas. In rural areas, burns may be caused by moving irrigation pipes that touch an electrical source.
• During the last 30 years, burn injuries have decreased for the following reasons:
o Increased use of smoke detectors.
o The flammability of consumer products, such as toys and pajamas, is federally regulated.
o The US government monitors safety in the workplace.
o A greater national emphasis is placed on burn injury prevention and fire safety.
o A decrease in smoking helps prevent burn injuries.
o New water heaters in homes and in public areas are now preset at lower temperatures to reduce scald injuries.
o There are fewer open fires.
Facts About Sunburn
What is sunburn?
Sunburn is a visible reaction of the skin's exposure to ultraviolet (UV) radiation, the invisible rays that are part of sunlight. Ultraviolet rays can also cause invisible damage to the skin. Excessive and/or multiple sunburns cause premature aging of the skin and lead to skin cancer. Skin cancer is the most common type of cancer in the US and exposure to the sun is the leading cause of skin cancer.
Children often spend a good part of their day playing outdoors in the sun, especially during the summer. Children who have fair skin, moles, or freckles, or who have a family history of skin cancer, are more likely to develop skin cancer in later years.
UV rays are strongest during summer months when the sun is directly overhead (normally between 10:00 a.m. and 3:00 p.m.).

What are the symptoms of sunburn?
The following are the most common symptoms of sunburn. However, each child may experience symptoms differently. Symptoms may include:
• redness
• swelling of the skin
• pain
• blisters
• fever
• chills
• weakness
• dry, itching, and peeling skin days after the burn

The symptoms of sunburn may resemble other skin conditions. Always consult your child's physician for a diagnosis.
First-aid for sunburn:
• Have your child take a cool bath or use cool compresses on the sunburned area.
• Give your child acetaminophen or ibuprofen for discomfort. Be sure to follow the directions on the container.
• Apply a topical moisturizer, aloe gel, hydrocortisone cream, or a topical pain reliever to sunburned skin. Avoid commercial products that contain Benadryl or benzocaine, because of the possibility of skin irritation or allergy.
• If blisters are present, do not break them open, as infection can occur.
• Keep your child out of the sun until the burn is healed.
When should I call my child's physician?
Specific treatment for sunburn will be determined by your child's physician and may depend on the severity of the sunburn. In general, call your child's physician if:
• the sunburn is severe or forms blisters.
• your child has symptoms of heat stress such as fever, chills, nausea, vomiting, or feeling faint.
Preventing sunburn:
Protection from the sun should start at birth and continue throughout your child's life. It is estimated that 60 to 80 percent of total lifetime sun exposure occurs in the first 18 years of life.
The best way to prevent sunburn in children over 6 months of age is to follow the A, B, Cs recommended by The American Academy of Dermatology:
Away Stay away from the sun in the middle of the day. This is when the sun's rays are the most damaging.
Block Block the sun's rays using a SPF 15 or higher sunscreen. Apply the lotion 30 minutes before going outside and reapply it often during the day. Sunscreens should not be used on infants under 6 months of age.
Cover-up Cover up using protective clothing, such as a long sleeve shirt and hat when in the sun. Use clothing with a tight weave to keep out as much sunlight as possible. Keep babies less than 6 months old out of direct sunlight at all times. Hats with brims are important.
What are sunscreens?
Sunscreens protect the skin against sunburns and play an important role in blocking the penetration of ultraviolet (UV) radiation. However, no sunscreen blocks UV radiation 100 percent.
Terms used on sunscreen labels can be confusing. The protection provided by a sunscreen is indicated by the sun protection factor (SPF) listed on the product label. A product with an SPF higher than 15 is called a sunblock.
How to use sunscreens:
A sunscreen protects from sunburn and minimizes suntan by absorbing UV rays. Using sunscreens correctly is important in protecting the skin. Consider the following recommendations:
• Choose a sunscreen for children and test it on your child's wrist before using. If your child develops skin or eye irritation, choose another brand. Apply the sunscreen very carefully around the eyes
• Choose a broad-spectrum sunscreen that filters out both ultraviolet A (UVA) and ultraviolet B (UVB) rays.
• Apply sunscreens to all exposed areas of skin, including those easily overlooked areas, such as the rims of the ears, the lips, the back of the neck, and tops of the feet.
• Use sunscreens for all children over 6 months of age, regardless of skin or complexion type, because all skin types need protection from UV rays. Even dark-skinned children can have painful sunburns.
• Apply sunscreens 30 minutes before going out into the sun to give it time to work. Use it liberally and reapply it every two hours after being in the water or after exercising or sweating. Sunscreens are not just for the beach - use them when your child is playing outdoors in the yard or participating in sports.
• Use a waterproof or water-resistant sunscreen.
• Use of a sunscreen with SPF of 20 to 30 offers substantial protection from sunburn and prevents tanning. High SPF sunscreens protect from burning for longer periods of time than do sunscreens with lower a SPF. Talk with your older child or teenager about using sunscreen and why it's important. Set a good example for them by using sunscreen yourself.
• Teach your teenager to avoid tanning beds and salons. Most tanning beds and salons use ultraviolet-A bulbs. Research has shown that UVA rays may contribute to premature aging of the skin and skin cancer.
Pain Management and Itching
Pain management and burn care:
Most children with burns have pain. The amount of pain depends on the severity and location of the burn. Severe pain can make your child's stay in the hospital very scary. Your child will be given pain medication through an intravenous (IV) line or by mouth before wound care and as needed. Many parents worry that their child may become addicted to pain medication. This is very rare, because children are given such small amounts of pain medication for short time periods. If you have more questions about pain medication, please ask your child's nurse or physician.
If old enough, your child can help control the pain by rating it with a scoring tool. This will help the healthcare team know when and how much pain medication to give so that your child can be more comfortable. The nurses and child life therapist can help your child control the pain. The nurse and child life therapist can help you find ways to comfort and distract your child to decrease his/her anxiety.
Itching and burn care:
Most children who have suffered from a burn injury usually experience itching at some point during the healing process. Sometimes, it begins right away, but it may also occur several weeks or months into the healing process. Itching can range from a minor irritation to severe discomfort that can interfere with daily activities. While there is no "cure" for itching, the condition diminishes over time. In the meantime, there are things that you can do for your child to lessen his/her discomfort:
• Keep the area moist with creams. Try to avoid lotions, as they may contain alcohol, which can dry the skin.
• Avoid creams that contain perfumes, which may cause more irritation to the area.
• Topical corticosteroids (such as hydrocortisone) may be recommended by your child's physician.
• Hemorrhoidal creams contain local anesthetics that are safe to use on the skin.
• Cool or cold compresses may help provide relief.
• There are other medications that your child's physician may prescribe such as antihistamines and/or oral steroids.
Specific treatment will be determined by your child's physician based on the following:
• your child's age, overall health, and medical history
• extent of the pain or discomfort
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the healing
• your opinion or preference
Preventing Burn Injuries
Tips for preventing burn injuries:
During the last 20 years, fatalities and injuries from burns and fires have decreased significantly. This decrease can be attributed to heightened public awareness of fire prevention, as well as safer manufacturing of many consumer products.
The following tips can increase burn awareness and promote fire safety:
• Periodically, check electrical plugs and cords for dirt or fraying.
• Keep appliances unplugged when not in use.
• When working with a hot liquid, keep your child safely away from the source.
• If you have a toddler or small child at home, avoid using a tablecloth. The child may pull on the corner of the tablecloth causing potentially hot objects to fall on them.
• Teach your child what to do in case of a house fire. Practice your exit strategy and teach them how to put out a fire.
• When cooking with hot oil or a deep fryer, keep your child a safe distance from the source.
• When cooking, keep pot handles turned inward on the stove top and away from the edge of the stove.
• If you use a microwave to heat your child's food, test the temperature before giving it to your child.
• Heating formula or milk in a microwave can be dangerous, as the liquid does not heat uniformly. Some portions may be hotter than others. Use a bottle warmer as a safer means to warm infant formula and milk.
• If you are cooking on the stove or in the microwave, do not hold your child as you remove items from these appliances.
• Teach your child to stay away from lighters and matches. Keep these items out of a child's reach.
• Before placing a child or infant in a bathtub, check the water temperature with your hand.
• Train your children to identify exits in public places, theatres, concert halls, and hotels.
• Turn down your water heater to 120° F.
• Check alternative heating devices for safe operation (electric space heaters or kerosene heaters).
• Check smoke detector batteries and clean your smoke detector often.
• Smoke detector batteries should be changed twice a year. Choose two dates that are easy to remember such as when you change your clocks, or on a summer or winter holiday.
• Before using barbecues or grills, clean them of grease buildup and use lighter fluid sparingly.
• Make sure your child uses a sunblock whenever he/she is in the sun.
• Supervise children near fireworks.
• Encourage children to wear shoes in the summer and avoid walking on hot asphalt or hot sand.
• When traveling, know hotel and motel exits in case of a fire.
• Store harmful chemicals and cleaners in an area that children will not be able to access them.
• Before using a chimney or fireplace during the winter months, have them cleaned.
• Always discard smoking materials in a deep or wet receptacle.
• Do not overload electrical outlets.
• During a power outage, use flashlights instead of candles.
• During Halloween, assure that your child is wearing a flame-retardant costume.
• Use the following tips for Christmas tree safety:
o Check tree lights and decorations.
o Keep trees well-watered.
o Unplug all lights when leaving home for any length of time.
o Do not block an exit with Christmas decorations

Nutrition and Burns
Nutritional needs for a child who has been burned:
A child who has been burned needs a diet higher in calories and proteins to help him/her heal and grow. Your child may have an intravenous (IV) for extra fluids when he/she first comes to the hospital. When your child is more alert and is feeling better, he/she can start to eat.
Most children do not eat as well when they are feeling sick or when they are in the hospital. There are many ways parents can help encourage their to children eat, including the following:
• Bring your child's favorite foods from home.
• Serve your child small frequent meals.
• Praise your child after eating, even if it was only a small amount eaten.
• Offer your child high-calorie shakes and snacks (ice creams, puddings, and custards). Avoid candy and soda, as they do not contain any nutritional value. The dietitian will help you to set up snacks for your child.
• Let older children help choose their own meals by filling out their own menus. Also let them help set up their tray.
• Serve drinks with fun straws in fun cups.
What foods should I give my child?
Give your child a variety of foods that have good nutrients to help the skin heal. Vitamins A and C are important vitamins for the skin. Some foods that have Vitamin A and C are oranges, grapefruits, tomatoes, strawberries, broccoli, and carrots. Many enriched cereals also contain vitamins. Foods that contain protein such as meat, fish, eggs, peanut butter, chicken, and milk are also important to skin healing.
Consult the child's dietitian for diet and nutritional information.

Chemical Burns
Chemical burns can occur when strong acids or alkalies come in contact with the skin and/or the eyes.
Caring for chemical burns:
• Rinse exposed area with running water for 20 minutes; a hose is preferable but you may use a shower or faucet.
• Carefully remove the contaminated clothing, making sure not to touch the unaffected skin with the contaminated clothing. Cut clothing away, if necessary.
• If the chemical has splashed into your child's eyes, begin rinsing his/her eyes immediately and continue doing so until medical help has arrived. If your child wears contact lenses, try to remove them.
• Cover the burned area loosely with a dry, clean cloth.
• If the chemical your child has been exposed to is a dry or powdered chemical, it may not be necessary to rinse the area with water. Instead of rinsing, gingerly wipe the powder from the skin and check the package enclosure for emergency advice.
• Seek medical attention or dial 0361 265165 for emergency medical attention.
Heat or Thermal Burns
A heat-induced or thermal burn can occur when the skin comes in contact with any heat source, such as a cooking pan, an iron, a fire, a hot surface or a hot, scalding liquid.
Caring for a heat-induced or thermal burn:
• Remove the child from the heat source.
• Cool the affected area with cold water or cold compresses until pain is reduced or alleviated.
• If a blister has formed, do not break it.
• Protect the burn with a dry, sterile, gauze bandage or with a clean bed sheet or cloth.
• If your child's clothing is stuck to the burned area, do not attempt to remove it. Instead, cut around the clothing leaving the burn intact.
• Do not apply any ointments, oils, or sprays to the burned area.
• If the burn is serious, seek medical attention or dial 0361 265165 for emergency medical attention.
Electrical Burns
Electrical burns occur when there is contact with an electricity, either alternating current (AC) or direct current (DC).
Caring for an electrical burn:
• Call or send someone to call 911 for emergency medical assistance. Significant electrical injuries will need medical care.
• Unplug the appliance or device that has caused the injury or turn off the electrical current.
• If the child is in contact with the electrical current do not touch them until you turn off the source or the circuit breaker.
• Determine that the child is still breathing. If the child is not breathing, begin cardiopulmonary resuscitation (CPR).
• Cover the burned area with a sterile gauze bandage or clean bed sheet.
• Maintain your child's normal body temperature, and take the child to an emergency center.
• Be aware that a child may experience "shock" after an electrical burn. If your child is showing signs of shock, send someone to call 0361 265165 immediately.
• Do not give your child anything to eat or drink.
• Place the child on his/her back, unless a neck or back injury is suspected.
• If the child has vomited or has a serious injury to the face or mouth area, you may lay the child on his/her side.
• Keep your child warm with blankets or extra clothing, but do not use a heat source to warm them.
• Elevate your child's feet and legs, using a prop or pillow.
What are the symptoms of shock?
The following are the most common symptoms of shock. However, each child may experience symptoms differently. Symptoms of shock may include:
• cold sweat
• weakness
• irregular breathing
• chills
• pale or blue-colored lips
• pale or blue-colored fingernails
• a fast, but weak pulse
• nausea
The symptoms may resemble other conditions or medical problems. Consult your child's physician immediately for diagnosis and treatment.
Returning Home After a Burn Injury
Returning home after a burn injury requires an adjustment period for both your child and your family. You will probably experience a variety of feelings and emotions that are normal. You may feel scared, nervous, or uneasy about leaving the hospital (as well as your child's appearance around friends and loved ones). Your mixed feelings are normal and it may help to have someone to talk with. Remember, there are plenty of support persons who were involved in your child's care, and they are usually available after discharge. However, your emotions can affect the physical recovery of your child. You may want to consider contacting your resources from the hospital, such as a social worker, to find out what services and support are available for you.
Listed in the directory below are some things to consider as you return home with your child following a burn injury.
Preventing Scars and Contractures
Preventing scars after a burn:
Scars are thickened marks left after a burn has healed. Most second and third degree burns cause some degree of scarring. Physical therapists will work with your child to prevent or reduce scarring.
Wearing pressure garments can minimize scarring. Children with deeper burns need pressure garments. Pressure garments are tight-fitting clothes to be worn over burned areas to prevent scarring. These must be worn 23 hours per day (taken off only for bathing) for up to two years after the burn.
Your child should have at least two sets of pressure garments, so one can be worn at all times while the other pair is being washed. You should hand wash the pressure garment, rinse, squeeze gently on a towel, and hang to dry. Do not use bleach or put the pressure garment in the dryer, because this will damage the garment. As your child grows, he/she many need to have new, larger garments.
Preventing contractures after a burn:
Contractures occur when the burn scar matures, thickens, and tightens, preventing movement. A contracture is a serious complication of a burn. If your child gets a contracture, he/she will not be able to move the scarred area normally. For example, your child may have difficulty doing normal things like dressing, walking, eating, or playing - depending on where the scar contracture is located. It is important that you let your child do things for himself/herself regardless of how long or hard it might be for them. This will help prevent contractures and help your child become independent and confident.
Most second and third-degree burns do cause some degree of scarring, but there are several things that can be done to minimize scarring and to prevent contractures, including the following:
• wearing a splint
Sometimes, after a child has been burned, he/she will need to wear a splint on the joint to keep it straight and to help prevent a contracture. Splints should be worn on top of the pressure garment.
• practicing range of motion exercises
Range of motion (ROM) exercises help keep the muscles and joints of the burned limbs flexible. A physical therapist (PT) will teach you and your child how to do ROM, so you can help in the healing process.
• exercising
Do the special exercises given by your child's physical therapist with your child faithfully. Exercises are very important to keep the scar area stretched and prevent a thick, hard, tight contracture. Exercises must be done even if your child does not like them. You may want to reward your child for doing a good job at the end of the exercises.
• promoting independence
Have your child do daily activities for himself/herself, as much as possible. For example, let your child eat, brush teeth, brush hair, and dress. Even if it is a little difficult for your child, let him/her do these activities and overcome the temptation to help. The movement that occurs during daily activities will help keep the scar area stretched. Your child should perform daily range of motion exercises as directed by the physical therapist or your child's physician.
Home Wound Care
Healing skin can be dry

The burn damages the glands in the skin that make oils. Until the glands work again, you can put lotion on your child's dry skin. Cocoa butter is often recommended. Do not use products on the skin that contain alcohol. Alcohol dries the skin. You will need to read the labels on different lotions to see if they contain alcohol and then avoid that lotion. Also consult your child's physician regarding skin products.
Providing wound care for your child at home:
Your child may come home with unhealed areas that still require dressing changes. You will be instructed on how to change dressings before you leave the hospital. It is not necessary to maintain a sterile environment for home dressing changes, but they should take place in as clean an area as possible. Whoever is doing the dressing change should:
• wash hands well before and after changing the dressings.
• set out and open the new dressing before removing the old ones.
• use lukewarm water when bathing your child (be sure your hot water tank temperature is set below 120°F so that very hot water cannot be turned on accidentally).
• be gentle when bathing burned skin.
If it appears that the dressing changes are extremely painful for your child, you may want to discuss pain medication with your child's physician.
The new skin over the burn area is more sensitive than the skin over the rest of the body. To protect your child's skin, make sure your child takes the following steps:
• Put on comfortable clothes.
• Try to avoid physical trauma.
• Avoid going out in the sun as much as possible. Wear clothes, hats, and sun screen (with a sun protection factor [SPF] of 15 or higher) on your child when in the sun. Even for a for a short period of time, your child's healing skin can become sunburned easily.
• Do not stay out in cold weather. Healing burn areas are also sensitive to cold.
If Your Child Has Difficulty Adjusting
Symptoms that your child may be having difficulty adjusting:
It is extremely difficult to cope with stressful situations that last for a long time. Children have less ability to cope with stress because of their limited life experiences. Some symptoms that your child may be having difficulty adjusting include:
• agitated behavior, such as crying, thumb sucking
• disturbed bodily functions, such as eating, sleeping, or elimination
• separation anxiety, such as clinging, refusing to sleep alone, wanting to be held constantly
• sleep disturbances and nightmares
• regression in toilet training, dressing, or self-feeding
• withdrawal
• decreased self-confidence
• makes deprecating comments about self
• aggression, both verbal and physical
• repeated episodes of sadness
• compulsive re-enactment of traumatic events in play
• concentration difficulties
• behavior changes (the quiet may become frantic and the energetic may become lethargic)
• physical ailment, such as headaches, stomach aches, or dizziness
• increased dependence
• resentment of unfairness of situation, blaming
• difficulty with peers
• unrealistic expectations of self and others
• concern with body image
• frustration, producing rebellion
• avoidance and denial to avoid addressing issue
• reluctance to trust or open self to others
• feelings of hopelessness, meaningless of life
• depression
• lowered impulse control, easily frustrated
• drug and alcohol abuse
Any unusual, persistent behavior should be evaluated by a qualified mental health professional. It is often very beneficial to seek professional care when you are concerned or unsure about what do next. If one or more of these behaviors persist over a long period of time, and to a marked degree, professional help may be needed.
Coping Emotionally
Coping with changes following a burn:
Your child will be very happy to once again be with his/her toys, friends, school, and family. However, your child's burn care and emotional recovery will continue when you leave the hospital. Along with the excitement, you and your child may also feel uneasy about what will happen next.
Your entire family has experienced a crisis as a result of the burn, hospitalization, and the disruption of home life. Children are affected not only by how a crisis impacts their own lives, but also by their parents' reactions to the situation. Below are some important strategies for helping children and parents cope with the stress of the child's injury, the hospitalization, medical treatment, and now returning home:
• Try to set up a daily routine that includes some of the daily activities that you did before your child's injury.
• Take one day at a time. Make simple goals every day; be proud of your child's daily achievements.
• Take care of yourself, as a caregiver of your child.
• Remember, the way your child comes through this situation will largely be determined by the way you handle it. Your child can be stronger as a result of this experience.
• Understand your child's level of development. Be on the lookout for symptoms. Do not punish your child for symptomatic behavior.
• Expect regression, changes, problems, and anger.
• Talk with your child often. Do not assume that if he/she has not mentioned it, it is not on his/her mind. Tell the truth. Tell your child how you feel, but be careful not to overwhelm your child if you are having difficulty coping.
• Encourage your child to express opinions, suggestions, and solutions.
• Reassure your child of the normalcy of their feelings. Expose your child to other children of the same age with the same problems.
• Encourage your child's development of competence and independence.
• Inform the school. Talk with your child's teachers.
• Inquire about support groups.
• Let others help you. Seek professional help, if necessary.
• Reassure your child of parental love, support, and constancy.
When to Call Your Child's Physician
It is important to contact your child's physician in the following situations:
• if your child is not eating or drinking well
• if there is antisocial or disruptive behavior at home or school
• if there are signs of infection (healing burn areas change and become red, warm, swollen, extremely tender, and have foul odor)
• if there is uncontrollable itching
• if the scar cracks open or splits
• if a contracture occurs
• if your child's temperature is greater than 37,5 O C rectally or by mouth
• if it appears that the dressing changes are painful for your child (you may want to discuss pain medication with your physician