Burns and scalds are among the most common serious injuries in young children, and the few minutes immediately after the injury happen at home, before any professional is involved. What is done in those minutes affects healing outcome significantly. Correctly applied first aid – specifically, cool running water for 20 minutes – reduces depth of burn injury by limiting the ongoing tissue damage caused by retained heat. It also reduces pain and improves healing outcomes.
The most important things parents can do for a burn or scald are: start cool water immediately, keep it running for 20 minutes, and then assess whether the child needs hospital care. The things that don't help – and actively harm – include ice, butter, cream, and any attempt to cover the burn before the cooling is complete.
Healthbooq (healthbooq.com) covers child safety and first aid.
Types of Burns in Children
Scalds (burns from hot liquids) are the most common burn injury in children under 5. A cup of tea or coffee can be hot enough to cause a serious scald for up to 15 minutes after brewing. Bath water at 50 degrees causes a full-thickness burn in 2 minutes; at 60 degrees in 5 seconds. Young children cannot reliably avoid or escape hot liquid, making scald prevention as important as first aid.
Flame burns occur when clothing or objects catch fire. Contact burns result from touching hot objects – ovens, irons, barbeque grills, cigarettes. Chemical burns from household chemicals (bleach, drain cleaners, oven cleaners) are less common but particularly serious because the chemical continues to damage tissue until completely removed.
Electrical burns from household sockets or cables may have a deceptively small skin wound with extensive deeper tissue damage along the path of the current.
Correct First Aid
Cool the burn immediately with cool (not cold, not iced) running water. The temperature of the water should be comfortable on healthy skin. Run water continuously over the affected area for 20 minutes. This is the single most effective first aid measure and its effect on reducing burn depth is well-established in both experimental and clinical literature (Cuttle et al., 2009, Burns; Bartlett et al., 2008 systematic review).
Twenty minutes is specific and must be continuous. Stopping and restarting does not achieve the same cooling effect.
Start cooling within 3 hours for benefit. After 3 hours, cooling is no longer effective.
While cooling: call 999 or take the child to A&E if the burn is serious; remove any clothing or jewellery from around the burn if it is not stuck to the skin (do not pull off stuck material); do not apply anything else – no butter, toothpaste, oil, aloe vera gel, or ice.
After cooling: cover the burn loosely with cling film or a clean non-fluffy material (cling film is ideal because it is transparent, non-adherent, and maintains moisture). Avoid fluffy materials like cotton wool that will stick to the wound.
For a chemical burn: remove contaminated clothing carefully, then flush with large amounts of cool running water for 20 minutes. Call 999 for significant chemical exposure.
When to Seek Emergency Care
All burns in children other than very minor superficial burns (small, red, unbroken skin, a tiny area) should be assessed by a healthcare professional on the same day.
Seek emergency care (999 or A&E) immediately for:
Burns covering more than 1% of the body surface area (roughly the size of the child's palm) in a child under 2, or more than 2% in older children. Burns affecting the hands, feet, face, genitals, perineum, or any major joint (elbows, knees) – these areas have high functional and cosmetic significance and require specialist care. Burns that appear white, brown, or black, or that are painless (suggesting full-thickness damage to nerve endings). Circumferential burns (going all the way around a limb or the trunk). Burns from chemicals, electricity, or flame. Burns in children under 5 months. Any burn where there is concern about the circumstances (possible non-accidental injury).
Burn Depth
Superficial (epidermal): red, painful, no blistering. Heals in 7-10 days without scarring. Like sunburn. Minor cool water and analgesia; no specialist referral needed.
Superficial partial thickness: blistering, very painful, moist appearance. Heals in 7-21 days usually without significant scarring. Needs medical assessment.
Deep partial thickness: can look dry, mottled, less painful (damaged nerve endings), takes more than 21 days to heal and usually results in scarring. Requires specialist care and possibly skin grafting.
Full thickness: white, brown or black; painless; dry; does not heal without surgical skin grafting.
Prevention
Turn down the household water heater to 49 degrees. Use a bath thermometer (target 37-38 degrees). Never leave hot drinks within reach of young children. Use back rings of the hob; turn handles away from the front. Keep children out of the kitchen while cooking. Install smoke alarms on every floor.
Key Takeaways
Scalds from hot liquids are the most common cause of serious burns in children under 5, with most occurring in the kitchen or bath. The correct first aid for a burn or scald is to cool the affected area with cool running water for a minimum of 20 minutes, starting within 3 hours of the injury. Do not use ice, butter, toothpaste, or other home remedies. Remove clothing and jewellery from the affected area but not if it is stuck to the skin. All burns in children other than very minor superficial burns should be assessed by a healthcare professional, and specific features – burns to hands, feet, face, genitals, or joints; large burns; circumferential burns; chemical burns; and burns in children under 5 months – require emergency assessment.
