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Baking With Your Little Ones; Safety and Tips to Taking Care of Thermal Burns

This weekend I plan on doing a little baking with my daughter. We are going to make cookies for her friends at playschool. My daughter loves getting involved in the kitchen which usually means I have to be super vigilent about keeping an eye on her.

I think the kitchen is the most dangerous room in the house. It’s the room with the most appliances, utensils and where most of us keep the cleaning materials. For our cookie making masterclass this weekend we will be using the oven for baking and this is why I am going to be talking a little more about thermal burns in children. Of course children can also sustain chemical and electrical burns in the kitchen but for this blog I will only be looking at thermal injuries.

Thermal burns can occur from hot liquids, hot solids or flames. According to the WHO, burns are the “fifth most common cause of non-fatal childhood injuries” worldwide. However in South Africa things are a little more frightening. In children 1 to 4 years of age, thermal injury is the second most common cause of mortality, with toddlers and boys being at highest risk.

CLASSIFICATION  OF BURNS

Burns are no longer classified as first, second or third degree and are currently being described according to the depth of the burn.

  1. Superficial thickness – This burn involves only the epidermis (the outermost layer of the skin). Here you will only notice a reddening of the skin.
  2. Partial thickness – This is further classified into superficial or deep partial thickness. This burn involves the entire epidermis and parts of the dermis.
    1. Superficial partial thickness: appears red with blisters and is very painful.
    2. Deep partial thickness: looks waxy white with some areas of red, wet and blistered. This depth of burn may be less painful.
  3. Full thickness – This burn involves the entire epidermis and the entire dermis. The skin looks white and leathery. There is no pain as the nerve endings in the skin have all been damaged. However, surrounding areas of partial thickness burns will be painful.
  4. Fourth degree – This is the deepest type of burn where there is damage to the structures underlying the skin such as the muscles and bones.

Full thickness and fourth degree burns almost always require surgical intervention and skin grafting. Some deep partial thickness burns may also require surgical management.

HOW TO TREAT A COOKING BURN

Act FAST: A child’s skin will burn much faster than adult skin.

The longer a burn remains open, the more likely it will get infected so get it covered as quickly as possible.

  1. Remove your child from the source of the burn.
  2. Remove any clothing near the affected area to expose the wound. Don’t try to remove anything that is stuck to the burn.
  3. Place affected area under cool running water for up to 20 minutes. Do this as soon as possible to prevent any further thermal injury.
  4. Pat dry gently with a clean cloth or gauze.
  5. You can now apply a burn gel if you have one (if you don’t have this proceed to the next step). This will help cool the wound but should only be used short-term. Remove after a few hours and wash away any excess gel left on the wound with cool running water, then gently pat area dry.
  6. Cover the wound loosely with a dry, sterile non-adherent dressing.

WHAT ABOUT BLISTERS?

It’s important to leave blisters alone. You can apply a burn gel over a blister. Just be careful when you rinse the wound of the gel once you remove it that you don’t rub too hard, as the skin on top is very thin. Cover the blistered wound with a dry dressing.

If the blister has popped the underlying skin is raw and exposed and at increased risk of infection. It is now even more important to keep the wound clean.  There is new evidence to suggest that you can now cover the wound with a wet dressing until it heals provided you regularly wash the area and keep the dressings clean.

You can read more in one of my previous blogs https://www.oneaid.co.za/picking-scabs-popping-blisters/

BUTTER, TOOTHPASTE AND TURMERIC

I have seen patients put all kinds of things on their burns. Superficial burns require nothing more than initial cooling, a dry dressing and some painkillers. If there are blisters you can manage the wound as described above. Applying home remedies can do more harm than good.

Antibiotic ointments for prophylaxis (prevention of infection) are an issue of debate. Many specialists don’t advocate their use as they can cause antibiotic resistance if the wound were to get infected. 

GO TO THE ER!

  • Any burn, regardless of depth, bigger than the palm of your child’s hand;
  • Any burn, regardless of size, deeper than a superficial partial thickness burn;
  • Any burn, regardless of size, involving the head and neck, hands, feet, groin and joints;
  • Circumferential burns of any size around the chest, abdomen or a limb; and/or
  • When there was a risk of inhalation burns

SAFEGUARD YOUR KITCHEN AGAINST BURNS

Burns are preventable!

  • Make sure appliances that contain hot liquids such as kettles and slow cookers as well as hotplates are kept out of reach.
  • Make sure that electrical cords of these appliances are also out of reach. Exploring children can pull on the cords as well as trip over them if they are lying on the floor. I read about an incident where a young child tripped over a cord pulling a slow cooker and all the hot contents over her. She sustained serious full thickness burns over most of her body.
  • Use the furthest burner on the stovetop and keep pot handles turned away towards the back.
  • Don’t mix hot liquids in a blender as the contents can explode out onto whoever is standing nearby.
  • Be careful of long hair and loose clothing, which can catch on fire.
  • Keep paper towels, dishcloths and oven mitts away from the stovetop as they can catch on fire.
  • Keep chemicals and other flammables such as paraffin locked away at all times https://www.oneaid.co.za/10-essential-tips-to-prevent-poisoning-in-your-home/
  • If you have little children running around you should never take your eye off the kitchen if you still have something cooking.

Cooking with your kids can be so much fun. It’s hands on and a great form of ‘messy play’. It’s also a great way to get your children to explore new flavours. I find that if my daughter has been involved in the prepping of her meal she is much more likely to eat it. Next time why don’t you let your toddler better their motor skills by cracking open some eggs or measuring out some flour.

RESOURCES:

https://consumer.healthday.com/general-health-information-16/burn-health-news-87/kitchen-cooking-burns-a-real-danger-for-kids-713976.html

http://www.firechildren.org/index2.asp?include=fireburns.htm&catID=4

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3187951/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3500004/

http://www.who.int/news-room/fact-sheets/detail/burns

https://www.westerncape.gov.za/general-publication/national-burns-week-2016

Does Your Child Need a Tetanus Shot or Not?

I’ve had parents often come into the emergency room after their child has taken a tumble asking for a Tetanus vaccine, which is why I felt the need to write a post explaining what Tetanus is and why we need to vaccinate our kids.

WHAT IS TETANUS?

Tetanus is a disease commonly known as lockjaw. It is caused by the bacteria, Clostridium tetani and can be fatal. The toxin from the bacteria affects the nervous system and causes severe painful muscle spasms, which can interfere with the ability to breathe. Currently there is no cure for Tetanus and treatment is mainly symptomatic until the effects of the toxin wear off. Complete recovery can take up to several months.

WHERE IS THE BACTERIA FOUND?

Clostridial spores can be found everywhere. They are found in soil, dust and animal faeces (including humans). Once the spores enter a wound they grow into mature bacteria, which produce the powerful toxin. Clostridium tetani is found worldwide.

WHAT ARE THE SIGNS AND SYMPTOMS OF TETANUS?

Signs and symptoms of tetanus can appear anytime from a few days to a few weeks from infection:

  • Spasms and stiffness of jaw muscles (hence the name lockjaw);
  • Spasms and stiffness of the neck muscles;
  • Difficulty swallowing;
  • Spasms and stiffness of other body muscles, commonly the abdominal muscles;
  • Other constitutional symptoms such as fever, sweating and palpitations.

TETANUS VACCINATION

I won’t go into too much detail regarding the various combination vaccines as there are many and every country has its own recommendations. A copy of the latest South African immunisation schedule can be downloaded from my resources page. The WHO recommends an initial 6-dose schedule to achieve tetanus immunity.

1. Primary vaccination

Three primary doses of the vaccine are recommended in childhood starting from 6 weeks.

2. Booster vaccination

Three booster doses are recommended prior to adolescence. Booster vaccines are then recommended every 10 years thereafter.

TETANUS-PRONE WOUND

  • This is any wound that has been contaminated with material that could contain tetanus spores;
  • This is any wound that is deep;
  • This is any wound that is dirty;
  • This is any wound that contains a foreign body.

Note: any wound can be tetanus-prone – cuts, scrapes, burns, animal (including human) and insect bites.

WHEN TO SEE A DOCTOR

It is recommended you see a doctor if:

  • Your child has a tetanus-prone wound and has not had a booster vaccine in the last 5 years;
  • Your child has a minor, clean wound and has not had a booster vaccine in the last 10 years;
  • Your child has a wound and you cannot remember when their last booster vaccine was.

RESOURCES

CDC (2018) Tetanus. [online]. Available from: https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html#contraindications [Accessed 30 August 2018].

WHO (2018) Tetanus vaccines: WHO position paper, February 2017 – Recommendations. Vaccine. [online] 36 (25). Available from: http://dx.doi.org/10.1016/j.vaccine.2017.02.034 [Accessed 30 August 2018].

WHO (2018) Tetanus. [online]. http://www.who.int/ith/vaccines/tetanus/en/ [Accessed 30 August 2018].

Picking Scabs & Popping Blisters

I remember my mother telling me when I was a little girl that I shouldn’t pick my scabs because it would cause scarring. Now it is believed that the scabs themselves actually cause more scarring and the recommended treatment of skin wounds has moved away from dry healing towards moist healing.

What is dry healing?

This is when a wound is left open to dry out or it’s simply covered with a dressing. This method allows a hard scab to form over the wound on the outside. It was thought that the scab protected the damaged skin underneath and would eventually fall off once the skin defect had healed. The scab was also meant to protect the wound from infection.

What is moist healing?

This is when an ointment is applied to a wound and it is covered with a dressing. It has been proven that epithelialisation (formation of new skin) happens much faster in a moist environment when compared to dry one. Leaving a wound to dry out allows the new skin cells that are trying to grow and cover the skin defect to dry out and die resulting in more inflammation. This causes further pain, slows down the healing process and leads to more scarring. Previous beliefs that a moist dressing resulted in infection have not been proven.

When should you apply a moist dressing?

You should provide a moist, but not too wet, environment for cuts, scrapes and burns. Small cuts and scrapes that have already scabbed can be left open.

What is a blister?

A blister is a pocket of fluid collection within the superficial layers of the skin. They can develop when the skin is damaged by friction, extreme temperature (hot and cold) or certain chemicals that come in contact with the skin. The fluid acts as a barrier protecting the injured tissue underneath so it can heal.

How to treat a blister

Do not pop a blister! The blister protects the underlying skin from infection. The fluid within the blister also contains proteins that help promote healing. As the skin underneath heals the fluid in the blister disappears and the skin peels off. It is best to keep the blister covered with a dry dressing to avoid it getting scraped or torn open. If the blister does burst open, clean the wound gently without pulling off any skin, and apply a moist dressing.

How to clean a wound and apply a moist dressing

  1. Clean your hands thoroughly with soap and water or a hand disinfectant.
  2. Put on disposable gloves if available.
  3. If the wound is bleeding, stop bleeding by applying pressure with a clean gauze, bandage or cloth.
  4. Rinse the wound under running water for 10 minutes. Use a gauze pad or cloth soaked in water to gently wipe the wound and surrounding skin of any dirt and debris.
  5. Gently pat wound dry using a clean gauze or cloth. Do not use cotton wool as the fluff may stick to the wound.
  6. Apply a topical ointment such as petroleum jelly or equivalent. A thin layer of an antiseptic cream such as Cetrimide can also be used if the wound is at risk of infection.
  7. Cover the wound with a sterile dressing such as a non-adherent pad and bandage or a plaster.
  8. Clean the wound daily with running water and reapply a new moist dressing until the wound has healed.

Moist Healing plasters

Many brands have developed plasters that are designed to keep wounds moist without having to apply a topical ointment. These dressings provide a moist environment by absorbing and retaining fluid from the actual wound. Some of these plasters do not need to be changed daily. Make sure to read the directions on the box before applying your plaster.

As our little ones explore this world there is no doubt you will have to deal with many cuts and scrapes and even though wound healing is individualised most minor wounds will heal well with no complications if looked after from the very beginning.

RESOURCES

Elastoplast, (2018). 4 Reasons for Moist Wound Healing. [online] Available at: https://www.elastoplast.com.au/first-aid/wound-care/moist-wound-healing [Accessed 21 August 2018].

Field, C.K. & Kerstein, M.D. (1994). Overview of wound healing in a moist environment. The American Journal of Surgery, [online] 167 (1), pp. S2-S6. Available at: https://doi.org/10.1016/0002-9610(94)90002-7 [Accessed 21 August 2018].

Junker, J.P.E., Kamel, R.A., Caterson, E.J. & Eriksson, E. (2013). Clinical Impact Upon Wound Healing and Inflammation in Moist, Wet, and Dry Environments. Adv Wound Care, [online] 2 (7), pp. 348-356. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842869/ [Accessed 22 August 2018].

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