Burns in children: first aid step by step

Cool the burn straight away under cool running water for 15 to 20 minutes, not ice-cold, and remove clothing and jewellery that is not stuck to the skin. Then cover with cling film or a clean, dry dressing, do not burst any blisters, and do not put anything on it. Call 1177 (the national healthcare helpline) if the burn has blisters, is bigger than your child's palm or is on the face, hands, feet, joints or genitals. Call 112 if the burn is large or the child has inhaled smoke.

Tuesday, a quarter to six, a kitchen in Huddinge. The coffee cup is on the edge of the table, the one-year-old on your lap reaches for it, and in a second she has tea over her arm and chest. Scalds from hot drinks and water are the most common burn in children under three, and the vast majority happen in the kitchen, around dinner time, with an adult a metre away. It is not a question of blame. It is a question of what you do in the next twenty minutes.

First aid, step by step

1. Away from the heat. Put out flames with a blanket or by rolling the child on the floor. Switch off the power before you touch a child who has had an electric shock.
2. Cool running water for 15 to 20 minutes. Tap water, lukewarm to cool, not ice-cold and no ice. The shower for larger areas, the basin for a hand. It hurts for the first few minutes and then it soothes. Start even if a few minutes have passed.
3. Remove clothing and jewellery while cooling, with scissors if needed. If fabric is stuck to the skin: leave it.
4. Keep the rest of the child warm. Cool only the burn. A baby standing under the shower for twenty minutes quickly gets cold. A blanket round the rest of the body, and stop cooling if the child starts to shiver.
5. Cover the burn loosely with cling film from the roll, laid in layers, not wrapped tightly. If there is no cling film: a clean, dry, lint-free dressing or a clean towel. No cotton wool against the wound.
6. Pain relief dosed for age and weight, and something to drink if the child is awake.
7. Call 1177 or 112 according to the lists below. If in doubt: call.

What not to do

• No ice and no ice-cold water. It damages the skin further and chills the child.
• No butter, no toothpaste, no oil, no ointment in the first days. It traps the heat and makes the medical assessment harder.
• Do not burst blisters.
• Do not pull off fabric that has stuck.
• Do not wrap tightly, and put nothing fluffy against the wound.
• Do not put a plaster straight on a blister.

How deep is the burn?

	Superficial	Partial thickness	Full thickness
Appearance	Red, dry, like sunburn	Blisters, moist, pink to red	White, leathery or brown, dry
Pain	Tender, stinging	Very painful	Little or none, the nerves are damaged
Examples	Brief contact with a hot surface, sunburn	Scalding from tea, boiling water	Fire, electricity, prolonged contact
What you do	Cool, cover, stay home	Cool, cover, call 1177	Cool, cover, 112 or A&E

You measure the size with your child's own palm, fingers included, which corresponds to roughly one per cent of the body surface. Anything bigger than a palm with blisters should be assessed by a healthcare professional, and in children even smaller burns quickly become serious if they are in the wrong place.

Call 1177 or seek care if

• The burn has blisters and is bigger than your child's palm
• The burn is on the face, neck, hands, feet, over a joint or on the genitals
• The burn is white, brown or leathery, or the child says it does not hurt even though it looks deep
• The burn was caused by electricity or chemicals
• The child is under one
• The burn has not started to heal within two weeks, or becomes red, swollen or weeping, or the child gets a fever
• You are unsure of the depth. That is common; even healthcare staff find it hard to tell on the first day

Call 112 if

• The burn is large, more than a few palms, or covers a large part of a limb
• The child has inhaled smoke or hot steam, is coughing, is hoarse or has trouble breathing
• The burn is around the mouth or nose after a fire
• The child has had an electric shock from a socket or appliance, even if they look unharmed
• The child is drowsy, pale, clammy or hard to rouse
• The clothes have caught fire

Healing and the next few days

A superficial burn heals in a week without scarring. A partial-thickness burn takes two to three weeks, and that is the one healthcare wants to look at, because it may need special dressings and can sometimes heal with a scar. Change dressings as instructed, keep the burn clean, give pain relief before changing, and watch for signs of infection: spreading redness around the wound, swelling, pus, a bad smell, fever. Newly healed skin is sensitive to the sun for a year, so cover it or use sunscreen. How to look after wounds in general is in Wound care for children.

How to prevent burns, in the kitchen where the accidents happen

• No hot drinks with your child on your lap, and no cups on the edge of the table or on a tablecloth
• The kettle at the back of the worktop with the cord wound up
• Pan handles turned inwards, a hob guard, the back rings first
• Bath water 37 degrees, cold in first and hot last, test with your elbow
• The hot tap set so it cannot run scalding hot
• The oven door, the radiator and the sauna: teach your child they are hot, and block them off until they understand
• The full list room by room in Childproofing your home, and take a course in Paediatric CPR, which includes first aid for burns

How it works with our families

Our nannies do not drink tea with a child on their lap, and they do not boil anything while a child under three is in the kitchen unless the child is strapped into their chair. It is a rule Aleksandra goes through with everyone. This summer Esther had a two-year-old in Bromma who pulled a cup off the kitchen table while she was laying it: hot, not boiling. She had the girl under the shower within a minute, for fifteen minutes with a towel round the rest of her body, rang the mother from the bathroom and then 1177 together with her. It left a red patch on the forearm that was gone after four days. The note that evening had a time, what had happened and what 1177 had said.

This text is general information and does not replace advice from BVC (the child health clinic every family is enrolled in), your vårdcentral (local health centre) or 1177. If you are worried about your child, call 1177. In an emergency, call 112.

Read more: Childproofing your home · Wound care for children · Child swallowed something dangerous · Paediatric CPR

Frequently asked questions

How long should we cool a burn?

Fifteen to twenty minutes under cool running water, not ice-cold. It eases the pain and reduces the depth of the burn, and it helps even if you start a few minutes after the accident. Keep the rest of the child warm in the meantime; small children get cold quickly.

Should we pop the blister?

No. The blister is the body's own dressing and protects against infection. Cover it with a clean, dry dressing or cling film and leave it alone. If it bursts by itself: wash gently with lukewarm water, a dry dressing, and keep an eye out for redness and pus.

When does a burn need stitches or a doctor's assessment?

Burns are not stitched, but they need to be assessed by a healthcare professional when they are bigger than your child's palm, have blisters, are on the face, hands, feet, joints or genitals, or were caused by electricity or chemicals. Infants with a burn should always be assessed. Call 1177 if in doubt.

What do we do about sunburn?

Cool water or cool compresses, plenty to drink, indoors for the rest of the day and the next few days, moisturiser once the skin has cooled. Blisters, fever or a child who feels unwell are reasons to call 1177. Children under one should not get burnt at all; they should be in the shade.

Can we give painkillers?

Yes, dosed by age and weight, according to the packaging or advice from the pharmacy or 1177. The pain from a superficial burn is worst in the first hours and is eased most by the cooling. Do give painkillers before changing dressings in the first few days.