Burns

Children who suffer from burns are treated by a surgical team in the Pediatric Surgical Ward.

A burn is a type of damage sustained by the tissue, and caused by exposure to heat. A burn can occur after exposure to an open flame, or any other source of heat or cold. Burns are classified into three main groups, based on the following:

Burn Area: what percentage of the body was burned? What organs are affected?

Burn Degrees
burns are generally classified into three types of degrees, based on the severity of the burn:
First Degree Burns: Damage is sustained on the top layer of the skin (epidermis). The burn area appears red and changes to white when pressure is applied. The burn usually takes 3-6 days to heal and usually heals on its own (sunburns etc.).
Second Degree Burns: Both the epidermis and the layer underneath, the dermis are damaged. Second degree burns are classified into two types: superficial partial thickness or deep partial thickness burns. Superficial partial thickness burns are characterized by local redness, blisters. The burn takes around 3 weeks to heal. There is generally no scarring, but the pigmentation of the burned area may change. A deep partial thickness burn is characterized by pain and whiteness in the area of the burn. This type of burn leaves a scar.
Third Degree Burns: This type of burn damages all the layers of the skin. The affected area is white, dry and hard. The burn causes scarring and requires skin grafts and pressure bandages.

Sometimes, the affected area can have several burn degrees.

What damage does a burn cause to a person's body?
A burn can expose a child to a number of infections, nutritional imbalance and acute pain caused by the burn itself or treatment. Additionally, the affected skin is scarred and outward appearance can change. Both the hospitalization and recovery period tend to be long, which can affect the lives of the entire family. The injury can induce anxiety and panic for the child and his parents. All of these factors require a multidisciplinary, all-inclusive treatment plan. The staff includes plastic surgeons, nurses, a social worker, a dietician, an occupational therapist, a physical therapist, staff from the Pain Clinic and educational staff.

The doctors do rounds daily in the pediatric surgical ward. Nurses can be found in the department throughout the entire day. The head nurse is available every morning. The nurses are responsible for coordinating your child's treatment plan. They can also provide pain relievers. The social worker can be found in the department throughout the week. She can help you and your child handle the new challenges they now face as they heal. The social worker can help your child as he emotionally and processes the trauma. In addition the social worker can give you guidance in matters of social security, follow-up treatment in your local health clinic and continued support with a local social worker.

A number of other professionals are available to help your child's recovery, including dieticians, occupational therapists and physical therapists. The dietician will determine the child's nutritional status and based on that, recommend a diet plan for your child. The occupational therapist works to maintain and expand your child's mobility, mainly in the upper limbs. Based on your child's condition, the therapy sessions are conducted in the Occupational Therapy Center or the department. Physical therapists help your child maintain basic functionality such as getting out of bed, walking and standing still. Burns can limit mobility, due to the inability of tissues to stretch or grow afterwards. It is important for the parents to take an active role in the child's physical therapy treatment.

The educational staff consists of teachers, babysitters, music and art therapists. The staff organizes activities, private sessions, games and helps your child keep up with his school work.

Treatment of burns
Treatment includes special baths, bandages, pain relief, anxiety treatment, nutritional counseling, and assistance with other emotional and physical needs. Additionally, doctors monitor your child's general condition, behavior and responsiveness.

  • Pain Relievers: acamol, ibuprofen; methadone, oxycodone (stronger)
  • Baths: During these baths, the burn area is washed by a nurse. The nurse washes away any dead skin cells from the burn area. This will later be done by parents, after they've received instruction by the nurse. The bath does cause discomfort, and therefore the child will be given pain relievers prior to the bath. The baths allow the skin to heal. Afterwards the nurse will rub antibiotic ointment on the burn to prevent infection.
  • Hydrotherapy: hydrotherapy helps lower the trauma of water contact and allow the child to express himself non-verbally.
  • Nutrition: the body requires protein in order to rebuild tissue.
  • Skin Grafts: the decision to perform a skin graft depends on the doctor. Skin grafts are vital if the burn is too deep for traditional treatment. Skin grafts are performed under general anesthesia.
  • Pressure Bandages: they are used to soften the scarring from deep second or third degree burns.



How can parents help?
Parents play a vital role in their child’s recovery process. Our department’s policy is to include the parents as much as possible. We understand that you know your child best, and are with him every day. We recommend that you be present during bathing, so you can help the nurse. Your child needs your support and patience. Your presence will likely lessen their fear and anxiety.

Recovery Challenges
Your child may experience post-traumatic stress disorder, which may include behavior regression, anxiety, bed-wetting, nightmares, aggressiveness, and lower self-esteem. This behavior is normal and can last for a few weeks after the incident. If they last longer than a month, you should take your child to counseling. Your encouragement and acceptance is extremely important to your child’s recovery. Our staff includes a social worker who is happy to help you through this experience. You can also make an appointment with the Pediatric Center for Trauma Treatment in Hadassah Mt. Scopus (02-5844341).

Discharge and Home Treatment
Your child will be discharged when his condition is stable and the burns begin to heal. You will be discharged after coordinating with a nurse from your healthcare provider for further treatment and physical therapy sessions (if needed). Please make an appointment with the plastic surgery clinic as well. Once you’re home, it is important to wash and dress the burns once or twice a day (based on the doctor’s recommendation). Sun exposure should be limited during the first six months of recovery.

In which cases do I need to take my child to the ER?
You child should be taken to the ER anytime-

  • You notice a change in their behavior: diarrhea, apathy, loss of appetite
  • Your child has a fever of over 100.4 F (38 C)
  • The burn area looks infected, has pus or is more painful than normal



Recovery from burns
As a result of the burn, your child’s physical appearance of physical capabilities may be affected. These changes are generally caused by the scarring process. Physical therapy can help your child regain mobility in the affected limbs. In some cases, your doctor will recommend corrective surgery.

Scarring
Conventional treatment methods for scarring include dressing, pressure bandages and occupational therapy.

Prevention of burns
There are a number of precautions you can take to lower the risk of your child getting burned:

  • Keep children away from heat sources (pots, kettles etc)
  • Keep pots, tea kettles, etc. and any wiring out of their reach. Remember! Your child can climb chairs and drawers, so make sure it is out of reach.
  • Check the water temperature in the bath or shower before your child gets in.
  • Do not use fire, boiling water or oil when your child is around.



Important numbers
Pediatric Surgery: 02-6777599; 02-6776477
Plastic Surgery: 02-6776616/5
Plastic Surgery Clinic: 02-6777614