anyone's child had deeper than superficial burns?

[vannah]

My 18 month old dd is on day 10 after a horrific accident involving a saucepan of boiling water. The burns are all mid-partial (not superficial partial) but a couple of patches a deeper where the skin looks white and is not 'healing'. been advised that this may need skin grafting and dreading that.
Bandages are off, the white areas are now covered with silicone plasters and a dab of flamazine (silver cream).

We go back to the burns unit every 3 days to change plasters but are wondering if there is anything we can do ourselves to encourage healing of the deep white areas? Ive read about flamazine, though preventing infection can actually hinder healing. And that some experiments have been carried out with honey instead, with more success. any experience of alternative care? We are too nervous to 'experiment' ourselves...

Diet wise giving her lots of protein, red meat, eggs cheese, and vit c rich fruit. Anything else crucial to speed healing?

also do you know how often the plasters should be changed? the nurses are very non-commital and say change them if you want to, else leave them soggy and smelly till the next visit. I have no idea what to do.

any advice really appreciated
thankyou

Sorry no useful burn advice - just wanted to say that I hope your DD is doing OK - it must have been terrifying for all of you.

Hopefully someone more knowledgeable will be along now!

How terrible! Poor DD (and you).

thankyou both...she is happy overall though clearly still traumatised. Im a wreck..

I had deep burns myself when I was a child. Can't help with what to put on them but just wanted to warn you about something.

Just when it seems it's all over the burns start to itch like crazy. No-one seems to understand why, when it should all be over, you suddenly start to go crazy. It's the itch. I still remember it vividly, and it's been over 30 years!

Doesn't mean anything bad is happening - it's just part of the scarring process. But do cut her some slack if she suddenly gets really squirly.

I think omega oils are good for healing too (not sure).

Hope it's all over soon. Really sorry you are going through this.

There is info here on nutrition for children's burns.

DD 11 burnt her hand when she was 2.4 with an iron. It was a huge blister, I ran her straight round to the doctors who bandaged it up with a melanin dressing, after a week she could not bend her hand so we were referred to the burns unit. She needed a skin graft on her hand which had to be done within a few days or in 2 years time. Chose to have it done straight away.
She was in for just a day. The graft was taken from the inside of her thigh.
She was in a cast for a week and her leg was heavily bandaged.

All I was told for healing was to make sure that the skin was kept moisturised and to make sure to massage the scar, also to get her to use her hand as much as possible with things like plastacine and actually swimming was very good because they reach their hands out. Obviously this was a bit further down the healing process than you are. Also to be careful about sunburn on the hand.
She healed very well. She has a scar on the back of her hand and fingers and a very feint scar on the inside of the thigh which is square with very straight lines.
He hand is not obvious but she says she does get asked about it.

really useful coco and thanks ib, know about itching - will get omega3 capsules...

thanks bruffin...

My DD had 33% of her body scalded when she was 22 months old. We adopted her when she was 3 nd a half, but I knew her as I was working on the Burns Unit to which she as admitted. So I know a fair bit about burns and skin healing from my (now old)professional experience. Also know intimately how it is to care for a child who has significant scarring. Not sure if there's anything I can offer, but feel free to ask specifics. Sorry you've all had this experience - very scary and distressing for all. Thinking about...and please do ask.

Where is the Burns Unit tht you are receiving care from...?

flamazine is really good. Continue using it. Years ago I had a terrible burn on my hand. Skin falling apart and I was sre I would have terrible scar, but you can't see anything now. Bandages are to keep skin isolated from any contact so clean or dirty (they get yellowish from the cream)doesn't matter. What is really important is to protect the skin, keep it moist, avoid sun rays, even through a window, so cover it if necessary. Continue using flamazine, keep the cream in the fridge, and apply often. put the greasy plaster over it

Since my accident, I keep a tube of flamazine in the fridge. For me it was a miracle cream.

How are things going, vannah? Have been thinking about you and dd. Hope all is well. MPD x

many thanks again
gordonpym, I read somewhere that flamazine shouldnt be used for more than a week and that it was not so good for little ones? Didnt know about sun rays through the window - thankyou for that! Will keep her more covered at home..

Misspolly, thankyou. Ive had a really deflating day yesterday so couldnt log on. Great to know you worked in a burns unit. Got lots of questions for you then if you dont mind!
We were at chelmsford broomfield burns unit but are now with chelsea in london, and the care is totally different so very confusing! eg, the plasters that were put on for a few days by broomfield have been removed and replaced with dressings and she is all bandaged up again by chelsea...even over the 'healed' skin because there are a few scabby crusts.. In your opinion, do you think the silicon plasters or the bandaging would work best to heal the stubborn deep areas? My own view is the less there is on there the better the skin heals but Im no expert.
tomorrow will be day 14, but the 2 'deep' patches looked a bit more pinkish to me,as opposed to white. like pink dots coming through - but the doctor still said there may be a need to operate and that it was reasonable progress.I found that upsetting. Any idea how long they would allow us to wait to see if it healed itself? and if in your experience skin hasnt healed by 14 days, does it do so within the third week? (we are losing hope that it will heal by itself despite the pink promising dots showing through..)

sorry this was long
many thanks

Hi vannah,

Sorry you are having a really stressful time of it. I am guessing that your DD has a mixed depth burn, since they are waiting to see how well things heal by theselves and this is a good sign as it suggests that as far as possible they want it to heal naturally. Take this as far as you can as a positive - it's just a tough waiting game for you not really knowing what's going on.

There is a likelihood that they will need to do a small skin graft(s) on the area(s) that may not have healed in the coming week or two - but by this point (and it would be worth asking the team you are now with how long they usually wait before making a decision, so that you are still 'in the loop' so to speak) the areas will probably be fairly small, which in the long run will be better for you all. They seem to be fairly hopeful that it will heal pretty well itself, so don't lose heart just yet and do trust the team - burns teams are always highly skilled but may need reminding to communicate more effectively with parents!

(Out of interest, where is your dd's burn? and what percentage is it?)

Without seeing it, it's hard to comment on healing but pink area would suggest some healing - will keep all fingers and toes crossed for you! Ultimately all areas would heal with or without grafting, but the longer an area take to heal, the more it is (literally) open to infection and also the more of a scar will be left afterwards. If they opt to graft any remaining areas it will be to minimise these two factors as far as possible. For now though just worry about getting her healed. Tackle any issues of scarring as and when you move into the area of burns aftercare - come back to me with more questions then if you want to.

As for the dressings - do you know which dressings they have been using? They may have opted for a more heavily bandaged approach because they have used a certain ointment or topical treatment that needs to be contained more adequately. Alternatively it may just be their own particular approach - and things do differ between burns units. Sometimes it's as simple as the lead burns surgeon has had better results with 'this' particular way of treating or dressing an injury so now it's the done thing across the board. Try to trust that what they are doing is for the best for your DD, but I know that's easier said than done.

Try to find a nice member of staff whom you feel you can trust and to whom you can pose all your questions. I was a Hospital Play Specialist on the burns unit and we are always an approachable, honest and surprisingly knowledgeable bunch of people. The play specialist at Chelsea is called Sarah Howarth - she might be worth talking to anyway, especially if you feel DD is struggling with all that's gone on.

Sorry - that was even longer! - and not sure if helpful but do post again as it would be good to keep in touch. Thinking about you! Try not to worry - all will be well.

thankyou so much again misspolly. Good to have the name of a person at chelsea, but please can i ask what's a play specialist?

her burns are about 10% they were on her face (cleared up now) all down her right arm, part of her left arm, right side of neck and down her chest.
One more question if you dont mind! We've been given a list of moisturisers for the areas that are not bandaged - including creams like cocoa butter, nivea, e45, vit e cream. Any idea if one is better than the other? She has very fair asian skin...

many thanks

First things first, play specialists work with children in hospitals, when they are both inpatients and outpatients. They provide and maintain the play facilities for children in their rooms, in ward playrooms and in waiting areas. But crucially they also use play to guide children through their experiences in hospital, giving them vital information about what will happen to them and then helping them to cope as well as possible, often by playing with them and distracting them while they have invasive procedures. They are highly skilled in comminicating and using play to assist children when they are unwell and receiving treatment, but also become very knowledgeable about the specialities in which the work. Try to find out who the play specialist that covers the children's clinics at the C&W and have a chat with her - hope she is helpful!

As for skin creams, you basically need this cream for two reasons - firstly to get vital moisture locked into newly healed skin but secondly the massage action of rubbing cream into the healed areas will help to keep scarring to a minimum - firm but gentle pressure on the areas that have just healed will continue to help those areas stay as flat and well-healed as possible. Bear in mind that scar tissue can be active (changing, growing and maturing) for a very long time after an injury has seemingly healed - up to two years - and regularly applying gentle pressure and massaging the area will aid this prolonged healing. For these reasons the cream needs to be fairly greasy.

I wouldn't go for anything like Nivea or similar creams that are highly perfumed. My DD was initially given aqueous cream, but this is not recommended as a moisturiser as it can be an irritant so do not use this. I would use something like Aveeno lotion which is really nice or Epaderm - either the ointment, which is very greasy, or you could ask your GP for Epaderm cream which is quite new but might be good for this purpose. (I've since worked for 5 years in a children's skin clinic, so have got to know quite a bit about skin treatments too!)

As areas heal and no longer need to be dressed, regularly (twice a day, morning and evening if you can) massage moituriser into the areas as firmly as your DD will let you.

Hope this helps! Keep in touch. MPD

thnkyou so much misspolly!! really will take up your advice on creams, i have aveeno but not ever bought epaderm.
Had no idea about the firm pressure, been lightly dabbing on the cream.
Thankyou, your advice has been so good, youve been so kind. x

forgot to comment on how admiring it is that you took care of a girl with 33 percent burns..how hard it must have been for your little girl. I hope she healed well?

She did heal eventually, although she did have MRSA during her initial spell in hospital. She is however left with extensive scarring, which most people would class as severe, I imagine. She has this scarring on her scalp, face, neck, chest, back and laft hand. We have so far had a number of operations on her scarring to enable her to grow normally and we certainly have more to come. The hardest bit for my DD (and us) is that people - especially other children stare and ask difficult questions, but I am always amazed and proud of her courage and bravery to face new situations and to make friends along the way.

I am certain your DD will heal very well - my DDs scalds were very deep - mostly full thickness and required a lot of skin grafting (not helped by the MRSA). Do keep me in touch with how things are going...I hope this week is going well so far. Any chance to look up the play specialist in the Chelsea and Westminster...?!

Best wishes...MPD

How's it going, vannah?

Oh no, so sad misspolly. Just tuned in again (spent the last several evenings just crying)
Your poor poor little girl. We had an mrsa scare too...how scary.

There is a special group organisation for burns survivors - mostly kids I think (got a leaflet from chelmsford) has your daughter joined? However do you teach her to be so brave?

My son has a little birth mark on his arm and refuses to wear tshirts, and try as i might i cannot make him keep his chin up about it. So Im truly amazed at your daughter, you are doing something great there!

forgot to check out the play specialist, going on friday will do. Get so distracted by dd's screams and terror at having dressings changed that I usually forget half tof the questions i mean to ask. The good news is that she might not need skin grafting but the 2 deep patches will leave thick scars. Ive taken your advice misspolly, am really massaging in that moisturiser well twice a day! she doesnt complain anymore...and can spend longer massaging it.

thankyou so much for keeping in touch with me about this x

Hi Vannah - no experience of this myself but I just wanted to say I'm sure I'm not the only one following this thread and wishing you and your DD well.

I don't know if you know the actress Amanda Redman but she went through a similar thing as a child when she received 3rd degree burns to 75% of her body after pulling a pan of soup onto herself at the age of 18 months. I'm not sure if you want to read her story (here) in case it's upsetting, but her story is nonetheless quite inspiring as the vast majority of the scarring healed completely despite (or because of, I suppose) extensive skin grafts. She's left with bad scarring on one arm, but she's never been self-conscious of it or tried to cover it up, and she feels that in fact the accident was much worse for her parents than for her. As a child she found drama classes a great confidence booster and as a result has founded a theatre school for children who have suffered trauma or bullying.

Anyway, I'm rambling on a bit, but just wanted to know I'm following your story and sending you all my best wishes. x

thanks for that very touching story cuppachar, very sad but hopeful..looking up her trust now x

Does anyone know the name of a charity for the paediatric burns foundataion and how i would go about raising money for them I to myself have just been discharged with my 14 month old son from The Royal manchester paediatric Burns HDU & Pinderfields Burns uint. Its been the most terriffying soul destroying experience i ever wish to go through, i feel blessed my little boy pulled through and is now back to his happy little self. Sorry to hear your story also vannah.

hi mrskjf, sorry for the delayed response.Life is chaotic as you can only imagine. WE still do trips to burns outpatients every couple of days, its a nightmare. Sorry to hear about your little boy, how bad are his burns?
I dont know the charity you mean, but if you ring chelsea and westminster hosptial burns unit, they should have it? I saw an occupational therapist today for scar management, she mentioned something about this charity but i didnt get the details - will enquire next time.
very sad that my litte girl will have to wear a compression vest 23 hours a day for the next 1.5 years...what about heatwaves?!!!