By Dr Khutso N. Sebetseba — Paediatrician | Pocket Paediatrics with Dr K
It happens in seconds.
A toddler pulls on a kettle cord. A cup of tea is placed just within reach. Bath water runs a little too hot. One moment is all it takes – and suddenly, a child presents with a burn.
Burn injuries remain one of the most common causes of paediatric emergency visits in South Africa, particularly in children under five. While many are preventable, outcomes are determined not only by the severity of the burn, but by the timeliness and appropriateness of initial management.
What is often under-appreciated is this:
the first 10 minutes following a burn injury can significantly influence tissue damage, need for intervention, and long-term outcomes.
Why burns are different in children
Children are not simply smaller adults. Their skin is thinner, allowing heat to penetrate more rapidly and deeply. As a result, burn depth may progress quickly, even with brief exposure. Injuries that initially appear superficial may evolve into deeper burns if not managed appropriately.
For clinicians, this highlights the importance of early intervention, accurate assessment, and reassessment, particularly in younger children where burn severity may be underestimated.
The first 10 minutes: Immediate management
Initial burn management should prioritise limiting tissue injury and preventing progression.
1. Active cooling
The affected area should be cooled under cool running tap water for at least 20 minutes. This is one of the most effective interventions to reduce burn depth and improve healing outcomes. Ice should be avoided, as it may worsen tissue injury.
2. Removal of constricting items
Clothing, nappies, and jewellery near the burn should be removed promptly, unless adherent to the wound. Oedema can develop rapidly, increasing the risk of further tissue compromise.
3. Avoidance of topical agents
Common home remedies such as butter, toothpaste, or ointments should be avoided. These can trap heat, increase infection risk, and complicate subsequent wound assessment.
4. Wound coverage
The burn should be loosely covered with a clean cloth, sterile dressing, or cling wrap. This protects the wound, reduces contamination, and may assist with pain control.
Assessing severity: When to escalate care
Burn severity is not always immediately apparent, and early clinical assessment is essential.
Referral or urgent evaluation is indicated when:
- Burns involve the face, hands, feet, genitals, or major joints
- There is blistering, suggesting partial-thickness injury
- The burn surface area exceeds the size of the child’s palm
- The child is very young, particularly under 1 year
- There are features suggestive of deeper injury or significant pain
In clinical practice, a low threshold for escalation is appropriate, particularly where burn depth or total body surface area (TBSA) is uncertain.
Common mechanisms in the South African setting
The majority of paediatric burns are scald injuries.
Typical mechanisms include:
- Kettle cords and hot beverages within reach
- Bath water that has not been tested
- Cooking pots pulled from stoves
Open flames or paraffin stoves in certain settings
Understanding these mechanisms allows clinicians to provide targeted, practical prevention advice during routine consultations.
Prevention: A clinical responsibility
Burn prevention should form part of anticipatory guidance in paediatric care.
Practical measures include:
- Keeping hot liquids and appliances out of reach
- Turning pot handles away from the edge of the stove
- Testing bath water before use
Avoiding carrying hot liquids while holding a child
These interventions are simple but clinically significant in reducing the burden of injury.
A moment that influences outcome
Burn injuries are often sudden and distressing. However, early intervention provides a critical opportunity to reduce harm.
Appropriate first aid, particularly effective cooling, avoidance of harmful topical agents, and timely clinical assessment, can:
- limit burn depth
- reduce complications
- improve healing outcomes
minimise long-term scarring
For clinicians, reinforcing these principles during both acute presentations and routine visits is essential.
Because in burn injuries, management does not begin in hospital.
It begins in those first few minutes; where early actions shape clinical outcomes.
🔲 (Sidebar )
Quick First Aid for Burns
Do:
- ✔ Cool under running water for 20 minutes
- ✔ Remove clothing and jewellery
- ✔ Cover with a clean cloth or cling wrap
- Don’t:
- ✘ Apply ice
- ✘ Use butter, toothpaste, or home remedies
- ✘ Delay clinical assessment if severity is uncertain