Your child’s wounds will be managed by a team of specialists focusing on all parts of care. Wound care is unique for each patient. Your expert care team will determine the best treatment for your child.
Pain management is a key part of your child’s care. The nurse will give pain medication and/or anxiety medication as needed before burn wound care.
Generally, your child will have a bath or shower daily depending on your child’s skin care needs. Every morning, the team will bring your child to the whirlpool room for their bath. The wound dressings will be removed, and the wounds will be cleaned with soap and water. When finished bathing, your child will be brought to the treatment room to place new dressings.
During wound care, several members of the burn team check to see how the burn is healing.
Burns cause pain as part of the injury and healing process. Pain is normal at the time of the burn, during treatment, and during rehabilitation. This pain can cause anxiety and interfere with your child’s mood, sleep, and participation in daily activities and therapy.
We do all we can to minimize your child’s pain. Effective pain management leads a better outcome through treatment and rehabilitation. The goal of pain management is to reduce the intensity of the pain so your child can more easily participate in their daily care and therapy. Managing pain also can reduce your child’s anxiety and distress.
At Ranken Jordan, we typically control pain using oral medications. In addition, a child life specialist will be present during the entire process to help your child cope by using distraction and relaxation techniques.
What to expect from pain management:
- Anxiety and pain medicine in pill form will be given an hour before wound care, bathing and/or exercising/range of motion.
- Pictures of progress will be taken to share with caregivers.
- When narcotic drugs are used for your child’s pain during dressing changes, stretching and exercises, caregivers will not be present.
- Caregivers can join the sessions when narcotics are not used. This is the time when you will be taught how to care for your child’s skin and learn the exercise program.
- Our psychologists and child life specialists can provide caregivers with additional strategies to help your child cope with pain and discomfort.
Scars are part of the healing process after burns. A scar is damaged tissue that will always be a scar. Scars continue to grow and change over time. Soon after the burn heals, the scars may be raised or puffy. At first, they can be pink, red, or purple. Later, the scars may soften, flatten, and turn lighter in color. This may take several months to years.
A raised scar may keep the joints from moving well. Scar management helps scars heal correctly so they stay soft and flat enough to let the body move more freely. Splints and stretches are part of scar management, along with pressure garments.
Scars that become too thick and hard can limit movement of joints or become painful. A joint contracture, or stiffness, may develop if scars become so thick and hard that they limit motion at a joint. This could interfere with your child’s function and may require surgery to correct.
Our goal is to manage scarring to prevent these limiting contractures. During your child’s stay at Ranken Jordan, our therapists will provide scar massage to help flatten and soften scars. Scar management also can decrease itching.
A stretching and strengthening exercise program is vital for your child while new skin is forming and wounds are healing. Your child’s physical or occupational therapist will create a customized program for your child that includes stretching and strengthening two to four times a day once your child can tolerate it.
A strengthening program for your child is also important for overall strength and endurance after hospitalization.
Without daily exercise after burns, joints can become contracted, or stiff. A contracted joint is one that has limited or no movement due to tightening of the skin, muscles, or both. A joint contracture may require surgery to restore movement to a joint.
Movement allows the new healing skin to stretch and lengthen, which leads to greater range of motion at the joints. Good joint motion is necessary for activities like walking, dressing, eating and bathing.
Stretching and strengthening often follows scar massage. Your physical or occupational therapist will provide you with your child’s recommended stretches and how to continue them at home to improve function and quality of life.
In addition to stretching and scar massage, we often use splinting to help stretch the skin and muscles of joints affected by burns. Your physical or occupational therapist will determine your child’s need for splints and provide a customized wearing schedule. Not all patients require splinting. It is most useful when burns occur over a joint.
Regular use of splints can help maintain or improve joint range of motion and prevent stiffness. Sometimes more than one splint may be needed. Often splints are used at night to give your child a prolonged stretch to prevent skin tightening and muscle shortening. Typically, your child may wear a splint for six to eight hours a day. At times, your child may wear a splint for 24 hours a day.
Splints can be uncomfortable for your child but they are an important part of rehabilitation. Distraction techniques, along with stretching and scar massage can make applying the splint more comfortable. The consistent use of splints can dramatically improve your child’s long-term results.
The good news is wearing splints gets easier over time. With regular use, skin becomes more flexible and adjusts to the splints.
Good nutrition is critical in burn treatment. Wound healing requires extra protein and energy from calories. Wound healing also benefits from vitamins such as vitamin C, vitamin A and zinc.
A dietitian will work with you and your child to establish a healthy, nutritious diet while at Ranken Jordan and once you are home. Ask your doctor or dietitian if your child should take a multi-vitamin or nutritional supplement.
Your child should eat a variety of fruits and vegetables to provide the essential vitamins needed for healing. In addition, include high-protein foods such as meat, milk, cheese, yogurt, eggs, and beans. Limit juices to 4 ounces a day and avoid soda, excess desserts or sweetened drinks.
Often, children aren’t able to eat enough to meet nutritional needs during healing so a feeding tube may be temporarily placed to ensure adequate nutrition.
Sleep is one of the most important factors in wound healing. Poor sleep affects your child’s mood, stress, and behavior during the day.
Children often have sleep problems after a burn injury. They may have difficulty falling asleep, wake up several times throughout the night, wake too early, or even have nightmares. Sleep problems may be related to itching or pain, being in a new environment, or anxiety.
To help your child get the best sleep possible (in the hospital and at home):
- Avoid caffeine all together or at least after 2 p.m.
- Increase activity during the day as advised by your rehabilitation team.
- Try to get your child out and about to get natural light during the day.
- Limit naps during the day. Talk with your doctor about appropriate nap frequency and length.
- Follow a calm, soothing bedtime routine. This may include scar massage with lotion, putting on PJs, brushing teeth, reading a book, and singing a good night song.
- Turn off electronics at least one hour before bed. This includes phones, tablets, TV, and
- Try not to develop the habit of falling asleep to TV or a movie.
- Make the room as quiet and dark as possible, although you can use a dim night light.
- Consider using a white noise machine or download a white noise app on your phone to help block out sounds outside your child’s room.