A serious burn injury to an adult can result in pain, scarring and psychological trauma.
For a child, the problems are amplified and joined by the risk of deformities as he or she grows. That makes the importance of prompt and strategic burn treatment and recovery all the more important.
Dr. Philip Chang of Shriners Hospital for Children – Cincinnati, a renowned expert in acute burn injury and reconstruction, answers some of our questions about the ways in which doctors are helping to reduce the risk of burn injuries causing lasting harm.
HealthScene Ohio: What advancements have you seen of late in the treatment of acute burn injuries?
Dr. Philip Chang: Without a doubt, looking back over the past 10 years, three advancements have really changed the practice. No. 1 is the emergence of longer-acting dressings that decrease the frequency of dressing changes. This has allowed patients to be discharged earlier from the hospital and decreased pain and suffering so that patients don’t require the same dosages of medication anymore. No. 2 is the emergence of Laser Doppler Imaging for burn depth diagnosis. This development has allowed for the early, more accurate diagnosis of burn depth assessment and also, in turn, allowed for a more predictable healing course for patients. No. 3 is better coordination within hospitals, with more participating team members, especially for those critically injured patients.
HSO: What sorts of advancements have been made recently in terms of acute burn reconstruction?
PC: The single biggest advancement has been the use of laser energy to help modulate scars. Laser treatments can help treat scar thickness as well as the itching and redness associated with scars in a way that does not involve prolonged hospitalization or more invasive surgeries.
HSO: What are some of the unique health issues caused by acute burn injury?
PC: One is the prolonged need for healing, even after the initial hospitalization. Burn patients often require several weeks, even after the skin-grafting operation, of healing and therapy before they can return to work. This is especially true when there are burns to more than 33 percent of their body. Patients in rural areas also present challenges due to the distance to medical care. In addition, the pain that burn patients feel is still very much a problem, and the opioid epidemic has caused an additional challenge because, often, patients will have chronic pain for months to years after the initial injury, and we have to be careful managing it with medication.
HSO: What extra considerations have to be made when treating child burn victims?
PC: Children especially face challenges with burn injury because, with young children, their skin tends to be thinner and they are more prone to deeper burns. Because children are still growing, they face challenges with burn scars because, often, the burn scars do not grow with the child, and the child may have to undergo multiple surgeries. When the children who are burned come from socioeconomically distressed families, an injured child can greatly magnify the stressors on the family. We’re fortunate that the Shriner system can at least help cover the cost of the medical care, but there are still issues that go beyond the economic aspects. Especially if the burn was caused by abuse, the children often need to be assigned to foster families, and even for those families that stay intact, that’s time off of work that the parents have to take.
HSO: What factors need to be considered when doctors are treating a burn victim who is still growing?
PC: Scars that are over joints and overhands can be range-limiting scars that prevent the child from being able to fully utilize his or her arms and legs. That can obviously have effects on development, especially with younger children. Fortunately, reconstructive procedures, as well as laser procedures and corrective physical therapy, can help correct these deformities if identified early enough in the patient’s course.
HSO: What are some of the points you emphasize in educational efforts for burn prevention?
PC: The kitchen can be a dangerous place for children because they’re often playing around adults who are cooking. It’s important to have a cooking lid or cooking sheet available to extinguish a cooking fire that goes out of control. Just having pot handles turned toward the wall, away from children, can make a significant difference. Keeping extension cords out of the reach of a child is important, too. We’ve had a number of injuries lately where children have pulled down a crock pot on top of themselves.
HSO: What are some burn risks the average person might not be aware of?
PC: In the winter, the dangers can range from hot fireplace glass doors to treadmill injuries, for families that are exercising indoors. Kids will see Mom or Dad running on the treadmill, and they’ll run and touch the belt, and get a friction burn on their hands. That friction burn is often deep enough that the child may require skin grafting. After the weather gets warmer, campfires and bonfires become risks. Around the Fourth of July, fireworks become a risk. And any time of year, house fires present a risk to children and family members. Scaldings are by far the most common injuries in children – coffee, tea, ramen noodles – and those are injuries we see year-round.
HSO: What have you learned from your research on burn victims’ issues with social interaction?
PC: It’s impressive, the potential that crowdfunding mechanisms such as GoFundMe can provide for burn patients, but like any other means of fundraising, it does require quite a bit of social effort. The most successful fundraisers distribute the message to all their social media outlets; the more social media networks associated with GoFundMe profiles, the more money people would raise. One of the other things that we offer is a school re-entry program for children, especially if they’ve had a severe burn injury. We will send a team out to the child’s school to help answer those questions from teachers and students before the child returns to school. We find it lessens social stress and helps the child integrate back into school more quickly.
HSO: What efforts are being made to reduce the pain of burn treatment?
PC: At our hospital, we carefully assess the patient and listen to the parents to get a sense of the child’s pain tolerance, and we have a range of sedation and pain medications available to make the wound care treatments tolerable. We can’t prevent all of the pain, but we can make the pain manageable for the patient so they can sleep and eat relatively well. Limiting the number of dressing changes can decrease the amount of pain experienced by the burn treatments. Usually, the most pain is experienced when the burns are exposed to air.
HSO: What are some of the psychological ramifications of severe childhood burns?
PC: A lot of it depends on the extent of the burn injury and where the burn injury is. Burn injuries in visible spots, such as the face and hands, will often have the most significant effect, because that’s what people in the public are more able to see, whether it be scars or bandages. The pain and itching associated with the burn injury can be quite difficult for patients to deal with because it can interfere with sleep, it can interfere with the patient’s ability to play and enjoy life, and that can be a significant stressor, not just on the child, but on the parent as well. Often, burn victims will have to wear pressure garments for about a year after treatment, and the pressure garments can be difficult for the child to wear year-round.
HSO: What are some of the cutting-edge treatments you’re working on?
PC: There’s amazing research going on here at the Shriners Hospital for Children and at the University of Cincinnati addressing wound healing issues and working on finding improved skin substitutes to treat burn victims. The holy grail for burn care is to come up with a skin covering that would not involve having to take skin grafts from the patient’s own body and would match the patient’s original skin color and have all the functions of the skin. Our team here at Shriners Hospital is working toward a skin substitute that has some of those properties and then, hopefully, down the road, would have all of those properties.
Garth Bishop is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
More Info
- Shriners Hospital for Children’s Be Burn Aware campaign launched in November. More information is available at www.shrinershospitalsforchildren.org/shc/bawtips.
- Shriners Hospital for Children – Cincinnati has a special summer camp for children who have sustained burn injuries. Camp Ytiliba features fishing, horseback riding, rafting, swimming, crafts and nature programs. It’s an opportunity for child burn victims to make new friends and build confidence and self-esteem. Shriners Hospital staffers serve as counselors.
Facts
- Among children ages 4 and under, scald burns account for 65 percent of burn-related hospitalization, and contact burns account for 20 percent.
- Scald burns among children ages 6 months to 2 years are most commonly caused by hot foods and liquids spilled in the kitchen.
- Hot tap water is the No. 1 cause of deaths and hospitalizations from scalding.
- The most likely in-home culprits for childhood burns include hair curlers, curling irons, room heaters, ovens, ranges, irons, fireworks and gasoline.
--Information courtesy Stanford Children’s Health
About the Expert
Philip H. Chang, M.D., is an attending burn surgeon at Shriners Hospitals for Children – Cincinnati. He is board certified by the American Board of Surgery and received his medical degree from the University of Alabama School of Medicine. He completed his residency at the University of Illinois at Chicago Medical Center and a fellowship at University of California Davis Medical Center. His previous position was as attending burn surgeon at Shriners Hospitals for Children – Boston and Massachusetts General Hospital. While in Boston, he was on the faculty of Harvard Medical School.
Dr. Chang cares for burn patients in the acute injury phase and then in the reconstructive phase. He enjoys participating in the education of medical professionals of varying disciplines, including medical students, physician assistant students, and pre-medical students. He has a particular interest in improving burn care in developing countries and has traveled to a number of countries in both Latin America and Africa.
