Burns and Scalds in Babies

When to get help

Cool the burn first — that comes before the phone. Then call emergency services or go to an emergency department — 999 in the UK, 112 or 999 in Ireland and across the EU, 911 in the US and Canada, 000 in Australia, 111 in New Zealand — for any of these:

• Any burn or scald on a baby that is bigger than the baby's own hand.
• Any burn on the face, hands, feet, genitals, or across a joint.
• A burn that goes all the way round an arm, leg, finger or the chest.
• Skin that looks white, waxy, leathery or charred, or a burn that does not seem to hurt, which can mean the nerves have been damaged.
• A chemical or electrical burn, or a burn from a hot iron, oven, hair straighteners or a firework.
• Any sign of smoke inhalation: coughing, a hoarse cry, soot around the nose or mouth, or difficulty breathing.

The NHS advises that all burns in babies and young children should be assessed by a health professional, even small ones, so if you are in any doubt after cooling, seek urgent same-day advice — NHS 111 in the UK, your GP or out-of-hours service in Ireland, your paediatrician in the US or Canada, healthdirect on 1800 022 222 in Australia, Healthline on 0800 611 116 in New Zealand.

The first aid, in order

Get the source of heat away from your baby, or your baby away from it. Remove any clothing or nappy over the burn unless it is stuck to the skin, and take off anything tight nearby before swelling starts. If fabric is stuck, leave it and cool over the top of it.

Cool the burn under cool or lukewarm running water for 20 minutes. Both the NHS and the HSE give twenty minutes as the target, and it is longer than almost everybody does it for. Cooling still helps if you start within the first three hours. Use a tap, a shower or a jug; if running water is not available, immerse the area or use a cool wet cloth changed frequently.

Do not use ice, iced water, or anything frozen. Cold that extreme damages the tissue further and drops a baby's body temperature fast.

Keep the rest of your baby warm while you cool the burn. A small baby loses heat quickly, so cool the burnt area only, keep the room warm, and wrap the rest of them in a blanket. Twenty minutes under water is a long time for a small body.

Then cover the burn loosely with cling film, laid on in a sheet rather than wrapped round a limb, or with a clean non-fluffy cloth or a plastic bag for a hand or foot. Cling film keeps air off, which reduces pain, and it lets staff see the burn without disturbing it.

What never to put on a burn

No butter, oil, toothpaste, egg white, flour, honey or any home remedy. No antiseptic cream, petroleum jelly or nappy cream. No adhesive dressings or cotton wool, which shed fibres into the wound. Do not burst blisters — they are a sterile cover, and breaking them opens a route for infection.

For pain, infant paracetamol or ibuprofen may be an option, but follow the instructions on the packaging or ask a pharmacist, and check the age the product is licensed from. Never give aspirin to a child under 16.

Why babies burn faster

A baby's skin is thinner than an adult's, so the same temperature for the same time causes a deeper burn. A drink that feels merely hot to you can scald a baby badly. Hot drinks stay hot enough to scald for far longer than most people assume, which is why a cup put down and forgotten is one of the commonest causes.

Surface area matters as well. A burn covering the same physical area is proportionally much larger on a baby, which is why the rule of thumb is the baby's own palm and fingers, not yours.

Where baby burns actually happen

Hot drinks account for a large share, usually a cup on a low table, a mug held while carrying a baby, or a drink placed near the edge of a worktop. Bath water is next: run cold first and add hot, mix it thoroughly, and test with your elbow or wrist rather than your hand. Then come hair straighteners and irons, which stay dangerously hot for many minutes after being switched off, oven doors and hobs, radiators and wood burners, and sunburn.

Simple changes remove most of the risk: no hot drinks while holding or feeding a baby, mugs at the back of surfaces, kettle cords short and out of reach, a heat-proof pouch for straighteners, a fireguard fixed to the wall, and a thermostatic valve on the bath if you can fit one.

Sunburn counts

Babies under six months should be kept out of direct sunlight altogether, and a sunburn in a baby is treated as a burn. Cool the skin, keep fluids up by offering more frequent milk feeds, and get advice if there is blistering, if your baby seems unwell, or if the burn is extensive.

Healing, scars and follow-up

Superficial burns usually heal within a couple of weeks and often without scarring. Deeper burns can take longer and may need dressings changed at a clinic or a referral to a specialist burns service. Go back if the area becomes more painful, more swollen, hot, smelly or oozing, if your baby develops a fever, or if the burn has not healed in about two weeks.

Once healed, new skin burns easily. Keep the area covered or out of the sun for the rest of the season. If you are asked, at any point, to explain how the burn happened, that is routine safeguarding practice in every burns unit and it is applied to everyone.