Third-Degree Burn in Children

What is a third-degree burn in children?

A burn is damage to tissues of the body caused by contact with things such as heat, radiation, electricity, or chemicals. A third-degree burn damages the entire thickness of both the outer layer of skin (epidermis) and the inner layer of skin (dermis). A child with a third-degree burn needs immediate medical care.

What causes a third-degree burn in a child?

In most cases, third-degree burns are caused by:

• Very hot liquids

• Contact with a hot object

• Fire

• Electricity

• Chemicals

What are the symptoms of a third-degree burn in a child?

Symptoms can occur a bit differently in each child. Symptoms can include skin that is:

• Dry and leathery

• Changes color to black, white, brown, or yellow

• Swollen

• May not be painful, because of damage to nerve endings

The symptoms of a third-degree burn can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is a third-degree burn diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health history. The provider will give your child a physical exam. The diagnosis of a third-degree burn is based on the signs and symptoms and recent exposure to something that can cause a burn. This may be the sun, something hot, electricity, or a chemical.

How is a third-degree burn treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. A child will usually be treated in a hospital unit that specializes in burns. 

Treatment for a third-degree burn will depend on how bad the burn is. Burn severity is determined by:

• The amount of body surface that is affected

• The part of the body where the burn is located

• The depth of the burn

Treatment for a third-degree burn may include:

• Immediate care in an emergency department, possibly in a hospital burn unit

• Breathing and blood circulation support

• IV (intravenous/given into a vein) fluids containing electrolytes

• IV or oral antibiotics for infections

• Cleaning and removal of dead tissue (debridement) from the burn area

• Antibacterial cream and other creams

• Special bandages or dressings

• Nutritional supplements and a high-protein diet

• Pain medicines

• Anti-itch medicines

• Tetanus vaccine

A large third-degree burn heals slowly. After the burn heals, surgery may be needed. This is done to improve the ability to move, and to remove and repair scarred skin.

In some cases, skin grafting may be needed to close or cover the burn. A skin graft is a piece of healthy skin from another part of the body that is removed and put on an area that needs skin. The burn area that’s covered is called the graft site. The area where a piece of skin is taken is called the donor site. After a skin graft, the donor site looks like a scrape. After a skin graft:

• A dressing is left on the graft site for a few days before it's changed. The site needs to be still and protected to start to heal.

• The donor site usually heals in about 2 weeks.

What are possible complications of a third-degree burn in a child?

Possible complications can include:

• Infections that may affect any part of the body, such as the lungs

• Scarring

• Inability to move a joint due to scarred tissue (joint contracture)

• Emotional problems, such as depression

• Organ failure and death

• Pain

What can I do to prevent a third-degree burn in my child?

The following are some ways to prevent burns in children:

• Make sure your hot water heater is set below 120°F (48.8°C).

• Be careful with hot drinks.

• Make sure pot and pan handles are turned toward the back of the stove.

• Be careful using car seats, strollers, and seatbelts that are left in hot cars. Their material and metal may get very hot.

• Keep your children away from fireplaces, stoves, and grills, and supervise your children if they are near these items.

• Keep your child out of the sun. Use sunscreen when your child is old enough, usually at 6 months.

• Keep cleaning products and other chemicals in a safe place. If they are under a sink, use a lock on the cabinet door.

• Use outlet covers.

• Keep hot appliances in safe places and away from the edge of a counter where a child could pull on top of them. This includes toasters, irons, and hair-styling tools.

• Teach your children to never play with matches or lighters and keep these items out of reach of young children. 

• Never hold a baby while drinking a hot liquid.

• Test bath water with your wrist before placing or letting your child get in the tub. The water should feel warm not hot.

• When bathing your children, put them in the bath facing away from the faucets so they don't accidentally turn on the hot water.

• Stay away from fireworks or only allow with close adult supervision.

How can I help my child live with a third-degree burn?

Your child will get treatment for a long period of time after a third-degree burn. Preventing and treating complications, such as scars and contractures, are part of ongoing care. Care may include:

• Physical and occupational therapy

• Rehabilitation

• Cosmetic or plastic surgery

• Orthopedic surgery

• Counseling for both your child and for family members

When should I call my child's healthcare provider?

Call your child's healthcare provider if your child has:

• Signs of infection, such as increasing redness, warmth, swelling, pain, or odor

• A fever above 100.4°F (38°C) rectally or by mouth, or as directed by your child's healthcare provider

• Pain that gets worse

• Uncontrollable itching

• A contracture

• Wound is not healing

Key points about a third-degree burn in children

• A third-degree burn damages all skin layers.

• Immediate medical care is needed for a child with a third-degree burn.

• Treatment is complicated and may involve supporting breathing and circulation.

• Serious complications and death may occur.

• Recovery can be long. It may require ongoing physical care and emotional support for the child. Other family members may need emotional and social or economic support.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s healthcare provider after office hours, and on weekends and holidays. This is important if your child becomes ill and you have questions or need advice.