Burns and scalds are among the most common injuries in young children. The peak age is 1-3 years, when children are mobile and inquisitive but lack the cognitive capacity to understand the danger of hot liquids, hot surfaces, and flames. Most childhood burns are accidental and preventable, but when they do happen, fast and correct first aid reduces the severity of injury significantly.
Healthbooq (healthbooq.com/apps/healthbooq-kids) covers first aid and safety for babies and children.
Types of Burns in Children
Scalds (from hot liquids and steam) are the most common type of burn injury in young children, accounting for the majority of paediatric burns seen in UK emergency departments. The most common scalding incidents involve hot drinks (tea, coffee), reaching up to pull on a mug or cup, or spilling from a kettle or saucepan. Hot bath water is a significant cause in infants.
Contact burns from touching hot objects (oven doors, radiators, irons, hobs) are also common in toddlers.
Flame burns are less common in young children but occur from candles, open fireplaces, and garden fires.
Chemical and electrical burns are less common but more serious and always require emergency assessment.
First Aid: The Priority
The first and most important action for any burn is cool running water – immediately, for 20 minutes. This is the single intervention with the strongest evidence for reducing burn depth and injury severity. Research by Heather Cleland at The Alfred hospital in Melbourne and others has documented that adequate cooling reduces the metabolic and inflammatory processes that cause burn progression into deeper tissue layers.
Cool, not cold. The water should be cool but not iced. In young children particularly, prolonged cooling with very cold water or ice can cause hypothermia, which is itself dangerous. The correct temperature is approximately 15°C – comfortably cool, like a cool tap.
Start immediately. The effectiveness of cooling decreases significantly with time. If cooling cannot begin within 30 minutes of the burn, it is unlikely to reduce depth significantly, though it still reduces pain.
Remove clothing and jewellery from the burned area, unless stuck to the skin (do not pull off clothing adhered to a burn). Remove nappies from scald areas.
What Not to Do
Do not apply toothpaste, butter, oil, cream, flour, or any other home remedy to a burn. These substances do not cool effectively, can introduce infection, and make clinical assessment more difficult. Do not apply ice or iced water – risk of hypothermia and potential frostbite injury.
Do not burst blisters. Blisters form as a protective response; breaking them increases infection risk. Do not cover with fluffy materials (cotton wool, towels) that can stick to the burn.
After Cooling
After 20 minutes of cooling, cover the burn loosely with cling film (applied lengthways, not wrapped around a digit, which could restrict circulation as swelling develops) or a clean non-fluffy dressing. Do not use bandages that could adhere to the wound.
If the child is in pain, age-appropriate paracetamol or ibuprofen can be given while waiting for assessment.
When to Go to A&E
Urgent assessment at A&E (or call 999) is required for: any burn larger than approximately the child's own hand; burns on the face, hands, feet, genitals, or across a joint; any full-thickness burn (white, waxy, leathery, or charred appearance, often less painful because nerve endings are destroyed); burns from chemicals or electricity; circumferential burns (going all the way around a limb); and any burn in an infant under 12 months. The St John Ambulance and British Red Cross guidelines use the "rule of the hand" as an approximate guide: if a burn is larger than the child's hand, go to A&E.
Key Takeaways
Burns in children require prompt first aid: cool running water for at least 20 minutes is the single most important first aid measure and should begin immediately. The water should be cool (not cold or iced) to avoid hypothermia, particularly in young children. Burns larger than the size of the child's hand, on the face, hands, feet, genitals, or joints, or full-thickness burns (white, waxy, or charred) require urgent A&E assessment. Do not apply toothpaste, butter, or any other substances to a burn. Do not burst blisters. Wrap loosely in cling film after cooling if waiting for medical review.
