Learn how to classify first-degree, second-degree, and third-degree burns, and when to seek immediate medical attention.

November 18, 2014

Degrees of Burns

A child can receive a burn from hot liquids or objects, fire, electricity, or chemicals. Prolonged exposure to the sun can also cause sunburn. It is common to grade burn injuries according to how deep the burn goes in the skin.

First-degree burns: Only the top layer of the skin is damaged. The skin is red, warm, and tender. The surface of the skin is dry and without blisters. This type of burn injury will heal after a few days without leaving a permanent scar on the skin. Most sun burns are first-degree burns.

Second-degree burns: The skin has been damaged to a deeper level. The skin will be extremely painful, red or pale, and will have swollen and blistered areas. Healing will often take 14 days or more, and there is a small risk of scarring.

Third-degree burns: All layers of the skin have been destroyed. The skin may be white, brown, or blackened and charred. It feels dry, like parchment or leather. There usually is little or no pain at first because the nerves, which make it possible to sense pain, have also been damaged. With this type of burn injury, there will always be permanent scarring, and a skin graft will be needed.

All burn injuries, regardless of the degree, in which the damage corresponds to more than 10 percent of the child's body surface, must be regarded as potentially serious. Burn injuries to the face, genitals, hands, and feet are the most serious. When burn injuries occur in children, it is important to estimate the extent of the burn or the total amount of the skin area that has been damaged. The palm of a child's hand corresponds to approximately 1 percent of her entire body surface. Use the child's palm size to estimate the extent of the burn.

How to Prevent Burns

In General

  • Install electrical outlets with built-in child safety features. For other outlets, use plugs that the child cannot pull out.
  • Keep the child at a safe distance from any open flames such as fireplaces, candles, and torches. Never leave children alone in a room with such items. Matches, lighters, electric or kerosene heaters, and wood stoves with high surface temperatures must be kept out of reach of children.
  • Never leave the cord of a clothes iron or curling iron dangling where a child can get hold of it.
  • Never have young children on your lap when you are drinking hot liquids.

In the Kitchen

  • Never leave objects or food (serving spoons or ladles; cakes or candy) that will attract the child near the stove. Keep kettles, coffee makers, slow cookers, rice cookers, fondue pots, and other hot appliances out of reach of children.
  • Think about where you position saucepans and frying pans on the stove. Put them on the back burners and turn the handles so they point toward the middle or back of the stove. Never leave handles turned outward beyond the edge of the stove, where a child can easily reach them.
  • Always keep your child away from hot surfaces and never place hot food near the child. Install scald-proof faucets. This will help protect your child from serious burn injuries as a result of running the hot water. Keep your hot water heater set at 120°F or lower.
  • Protect warming cupboards, ovens, and electrical outlets with guards. Use safety covers for stove knobs or remove them when not in use.

In the Bathroom

  • Never leave young children alone in the bathroom, even for a few seconds.
  • Never use water hotter than 120°F in your child's bath. Add cold water first and then fill the tub with hot water. Always check the water temperature by putting your elbow or forearm in the water before you put the child in.
  • Have a rubber mat inside the bath tub to prevent the child from slipping.
  • Keep the child away from the faucets. Place him at the opposite end of the bath with his back towards the faucets.
  • Install scald-proof hot-water faucets.

In the Backyard

  • Position the barbecue far away from where the child plays. Ensure that the barbecue is stable.
  • Keep the child away when you light the barbecue. Lighter fluid and matches should be out of the reach of children.
  • Never leave the barbecue unattended when it is in use. Be especially careful with small, disposable barbecues; put them on a high surface, not on the ground.

Treatment for Burns

Cool the burned area immediately. This is even more important than getting to a doctor quickly. For first- and second-degree burns, use water at a temperature that is cool but not ice-cold. Use whatever is available: a bathtub, shower, hose, fountain, lake, or seawater. Do not put ice or snow directly on a burn, as this can cause frostbite; wrap the ice or snow in a towel and hold that on the burn. Do not rub the burn because this can cause blisters to form. Continue to cool the area for at least 10 minutes; this will relieve the child's pain and prevent the burn injury from penetrating deeper into the skin. Use special burn bandages if you have them. These bandages consist of a water-based gel that has a cooling effect, reducing the pain and keeping the wound clean and moist.

Call 911 or your doctor immediately if:

  • Your child receives first-degree burns located on the face, scalp, hands, feet, or genitals.
  • The first-degree burns exceed 5 percent of the child's body surface and do not improve within 24 hours.
  • Your child has second-degree or third-degree burns, or if the burn appears to cover more than 10 percent of the body.
  • You suspect that your child received burn injuries through inhalation of superheated air and toxic gases, or if the injuries involve electrical or chemical damage.
  • You suspect that a burn injury has gotten infected. Signs of infection may include increased pain, tenderness, redness, or the presence of pus in the wound.