The single most important step: cool water

The first 20 minutes after a burn determine how badly the skin is damaged. Cool running water — not ice, not butter, not toothpaste — is the only first aid that has been shown to reduce burn depth.

  • Place the burned area under cool (not cold) running water for at least 20 minutes.
  • This works even up to 3 hours after the burn happened.
  • Remove any jewelry or tight clothing from the area before swelling sets in.
  • Do not apply ice — ice can deepen the injury by causing further tissue damage.
  • Do not apply butter, oil, toothpaste, or home remedies. They trap heat and increase infection risk.
For any significant burn, go to the emergency department after first aid. Even small-looking burns in children may be deeper than they appear, and burn assessment requires direct examination.

How burns are classified

Doctors describe burns by depth and by area:

Depth

  • Superficial (1st degree): Red, painful, no blisters. Like sunburn. Heals in days without scarring.
  • Superficial partial-thickness (shallow 2nd degree): Red, blistered, very painful. Heals in 1–2 weeks usually without scarring.
  • Deep partial-thickness (deep 2nd degree): Blistered or peeling, may be paler in spots, less painful than expected because nerves are damaged. Often needs specialist care; risk of scarring.
  • Full-thickness (3rd degree): White, leathery, or charred. Painless because all skin layers are destroyed. Always needs surgery.

Area (rule of palms)

The child's palm (including fingers) represents about 1% of their body surface. This is a quick way to estimate burn size.

When to go to the emergency department

Most burns in children should be evaluated by a clinician. Emergency assessment is needed if:

  • The burn covers more than the size of the child's palm (over 1% body surface)
  • The burn affects the face, hands, feet, genitals, or major joints
  • The skin is white, leathery, or painless
  • The burn is circumferential (goes all the way around a limb or finger)
  • The burn was caused by chemicals, electricity, or fire
  • The child has inhaled smoke or hot air
  • The child is younger than 1 year
  • You are unsure of the depth

Caring for a small burn at home

If the burn is small (less than the child's palm), superficial, on the trunk or limbs (not face/hands/joints/genitals), and a doctor has confirmed it can be cared for at home:

  • Keep it clean and covered with a non-stick dressing
  • Change the dressing daily, and any time it gets wet or dirty
  • Watch for signs of infection: increasing redness, swelling, pus, fever, increasing pain
  • Use paracetamol or ibuprofen for pain
  • Do not pop blisters. The blister roof is sterile cover that helps healing.

Pediatric surgical care of burns

Larger or deeper burns are often managed at specialist burn centers. Treatment can include:

  • Wound debridement: Removing dead tissue to allow healing
  • Specialized dressings: Silver-impregnated or hydrocolloid dressings to reduce infection and promote healing
  • Skin grafting: For deep or large burns where the body cannot heal the wound on its own
  • Pressure garments and physiotherapy: To reduce scarring and maintain joint mobility

Prevention

The most common burns in children are scalds from hot drinks, hot bathwater, and stovetop spills. Practical prevention:

  • Set hot water heater to maximum 50 °C (122 °F)
  • Always check bath water temperature with your wrist before placing a child in
  • Keep hot drinks out of reach — and remember that a hot tea cup can cause severe burns up to 30 minutes after pouring
  • Turn pot handles away from the edge of the stove
  • Test microwaved food and milk before giving it to a child