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- Anatomy of the skin
- First-Degree Burn: Superficial Burn
- Second-Degree Burn: Superficial Partial-Thickness Burn
- Second-degree burn: Deep partial-thickness burn
- Third-Degree Burn: Full-Thickness Burn
- Your Child's Wound Debridement: Before Surgery
- Your Child's Wound Debridement: Returning Home
- Your Child's Skin Graft: Before Surgery
- Your Child's Skin Graft: Returning Home
Burns and Electric Shock
Most burns are minor injuries that occur at home or work. It is common to get a minor burn from hot water, a curling iron, or touching a hot stove. Home treatment is usually all that is needed for healing and to prevent other problems, such as infection.
There are many types of burns.
- Heat burns (thermal burns) are caused by fire, steam, hot objects, or hot liquids. Scald burns from hot liquids are the most common burns to children and older adults.
- Cold temperature burns are caused by skin exposure to wet, windy, or cold conditions.
- Electrical burns are caused by contact with electrical sources or by lightning.
- Chemical burns are caused by contact with household or industrial chemicals in a liquid, solid, or gas form, such as acids. Natural foods such as chili peppers, which contain a substance irritating to the skin, can cause a burning sensation.
- Radiation burns are caused by the sun, tanning booths, sunlamps, X-rays, or radiation therapy for cancer treatment.
- Friction burns are caused by contact with any hard surface such as roads ("road rash"), carpets, or gym floor surfaces. They are usually both a scrape (abrasion) and a heat burn. Athletes who fall on floors, courts, or tracks may get friction burns to the skin. Motorcycle or bicycle riders who have road accidents while not wearing protective clothing also may get friction burns. For information on treatment for friction burns, see the topic Scrapes.
Burns injure the skin layers and can also injure other parts of the body, such as muscles, blood vessels, nerves, lungs, and eyes. Burns are defined as first-, second-, third-, or fourth-degree, depending on how many layers of skin and tissue are burned. The deeper the burn and the larger the burned area, the more serious the burn is.
- First-degree burns are burns of the first layer of skin.
- There are two types of second-degree burns:
- Third-degree burns (full-thickness burns) injure all the skin layers and tissue under the skin. These burns always require medical treatment.
- Fourth-degree burns extend through the skin to injure muscle, ligaments, tendons, nerves, blood vessels, and bones. These burns always require medical treatment.
The seriousness of a burn is determined by several things, including:
- The depth, size, cause, affected body area, age, and health of the burn victim.
- Any other injuries that occurred, and the need for follow-up care.
Burns affect people of all ages, though some are at higher risk than others.
- Most burns that occur in children younger than age 5 are scald burns from hot liquids.
- Over half of all burns occur in the 18- to 64-year-old age group.
- Older adults are at a higher risk for burns, mostly scald burns from hot liquids.
- Men are twice as likely to have burn injuries as women.
Burns in children
Babies and young children may have a more severe reaction from a burn than an adult. A burn in an adult may cause a minor loss of fluids from the body, but in a baby or young child, the same size and depth of a burn may cause a severe fluid loss.
A child's age determines how safe his or her environment needs to be, as well as how much the child needs to be supervised. At each stage of a child's life, look for burn hazards and use appropriate safety measures. Since most burns happen in the home, simple safety measures decrease the chance of anyone getting burned. See the Prevention section of this topic.
When a child or vulnerable adult is burned, it is important to find out how the burn happened. If the reported cause of the burn does not match how the burn looks, abuse must be considered and resources for help, such as social services, offered. Self-inflicted burns will require treatment as well as an evaluation of the person's emotional health.
Infection is a concern with all burns. Watch for signs of infection during the healing process. Home treatment for a minor burn will reduce the risk of infection. Deep burns with open blisters are more likely to become infected and need medical treatment.
Check your symptoms to decide if and when you should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
It can be hard to tell how deep a burn is.
- A fourth-degree burn goes through the skin and fatty tissue to injure muscle, nerves, blood vessels, and bones.
- A third-degree burn goes through all the skin layers to the fatty tissue beneath. The skin is dry and swollen and may be pale white or charred black. This kind of burn destroys the nerves, so it may not hurt except on the edges.
- A second-degree burn involves several layers of skin. The skin may be swollen, puffy, moist, or blistered.
- A first-degree burn affects only the outer layer of skin. The skin is dry and hurts when you touch it. A mild sunburn is a first-degree burn.
Some common burn patterns and common areas for burns that result from abuse include:
- Circular burns that are the size and shape of the end of a cigarette or cigar.
- Burns on the bottom of the feet.
- Burns that look like gloves (on the hands), socks (on the feet), or a large circle on the buttocks. These come from putting someone's hands, feet, or buttocks in a sink or tub of scalding-hot water.
With burns caused by abuse, the explanation for the burn may not match the size, shape, or location of the burn. But it still can be hard to tell whether a burn was caused on purpose. A burn caused by throwing hot liquid on someone may look just like a burn caused by an accidental spill.
Symptoms of difficulty breathing can range from mild to severe. For example:
- You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
- It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).
Severe trouble breathing means:
- The child cannot eat or talk because he or she is breathing so hard.
- The child's nostrils are flaring and the belly is moving in and out with every breath.
- The child seems to be tiring out.
- The child seems very sleepy or confused.
Moderate trouble breathing means:
- The child is breathing a lot faster than usual.
- The child has to take breaks from eating or talking to breathe.
- The nostrils flare or the belly moves in and out at times when the child breathes.
Mild trouble breathing means:
- The child is breathing a little faster than usual.
- The child seems a little out of breath but can still eat or talk.
Severe trouble breathing means:
- You cannot talk at all.
- You have to work very hard to breathe.
- You feel like you can't get enough air.
- You do not feel alert or cannot think clearly.
Moderate trouble breathing means:
- It's hard to talk in full sentences.
- It's hard to breathe with activity.
Mild trouble breathing means:
- You feel a little out of breath but can still talk.
- It's becoming hard to breathe with activity.
Heartbeat changes can include:
- A faster or slower heartbeat than is normal for you. This would include a pulse rate of more than 120 beats per minute (when you are not exercising) or less than 50 beats per minute (unless that is normal for you).
- A heart rate that does not have a steady pattern.
- Skipped beats.
- Extra beats.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Pain in children under 3 years
It can be hard to tell how much pain a baby or toddler is in.
- Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
- Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
- Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.
Here are some ways to estimate how much of the body is burned in an adult or older child.
- The palm of the person's hand equals 1% of the body's surface area. Using the person's palm is a good way to estimate the size of a small burn.
- The total surface of the head plus the neck is 9% of the body's surface area.
- The total surface of one arm and hand is 9%.
- The chest is 9%.
- The belly is 9%.
- The upper back is 9%.
- The lower back is 9%.
- The total surface of one leg and foot is 18%.
- The groin area is 1%.
Here are some ways to estimate how much of the body is burned in a baby or young child.
- The palm of the child's hand equals 1% of the body's surface area. Using the child's palm is a good way to estimate the size of a small burn.
- The total surface of the head plus the neck is 21% of the body's surface area.
- The total surface of one arm and hand is 10%.
- The total surface of the chest plus the belly is 13%.
- The back is 13%.
- The buttocks are 5%.
- The total surface of one leg and foot is 13.5%.
- The groin area is 1%.
Symptoms of infection may include:
- Increased pain, swelling, warmth, or redness in or around the area.
- Red streaks leading from the area.
- Pus draining from the area.
- A fever.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:
- Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
- Long-term alcohol and drug problems.
- Steroid medicines, which may be used to treat a variety of conditions.
- Chemotherapy and radiation therapy for cancer.
- Other medicines used to treat autoimmune disease.
- Medicines taken after organ transplant.
- Not having a spleen.
Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.
Adults and older children often have several symptoms of shock. These include:
- Passing out (losing consciousness).
- Feeling very dizzy or lightheaded, like you may pass out.
- Feeling very weak or having trouble standing.
- Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.
Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.
Babies and young children often have several symptoms of shock. These include:
- Passing out (losing consciousness).
- Being very sleepy or hard to wake up.
- Not responding when being touched or talked to.
- Breathing much faster than usual.
- Acting confused. The child may not know where he or she is.
To clean a wound well:
- Wash your hands first.
- Remove large pieces of dirt or debris from the wound with cleaned tweezers. Do not push the tweezers deeply into the wound.
- Hold the wound under cool running water. If you have a sprayer in your sink, you can use it to help remove dirt and other debris from the wound.
- Scrub gently with water, a mild soap, and a washcloth.
- If some dirt or other debris is still in the wound, clean it again.
- If the wound starts to bleed, put direct, steady pressure on it.
If a chemical has caused a wound or burn, follow the instructions on the chemical's container or call Poison Control (1-800-222-1222) to find out what to do. Most chemicals should be rinsed off with lots of water, but with some chemicals, water may make the burn worse.
You may need a tetanus shot depending on how dirty the wound is and how long it has been since your last shot.
- For a dirty wound that has things like dirt, saliva, or feces in it, you may need a shot if:
- You haven't had a tetanus shot in the past 5 years.
- You don't know when your last shot was.
- For a clean wound, you may need a shot if:
- You have not had a tetanus shot in the past 10 years.
- You don't know when your last shot was.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Most minor burns will heal on their own, and home treatment is usually all that is needed to relieve your symptoms and promote healing. But if you suspect you may have a more severe injury, use first-aid measures while you arrange for an evaluation by your doctor.
Immediate first aid for burns
- First, stop the burning to prevent a more severe burn.
- Heat burns (thermal burns): Smother any flames by covering them with a blanket or water. If your clothing catches fire, do not run: stop, drop, and roll on the ground to smother the flames.
- Cold temperature burns: Try first aid measures to warm the areas. Small areas of your body (ears, face, nose, fingers, toes) that are really cold or frozen can be warmed by blowing warm air on them, tucking them inside your clothing or putting them in warm water.
- Liquid scald burns (thermal burns): Run cool tap water over the burn for 10 to 20 minutes. Do not use ice.
- Electrical burns: After the person has been separated from the electrical source, check for breathing and a heartbeat. If the person is not breathing or does not have a heartbeat, call 911.
- Chemical burns: Natural foods such as chili peppers, which contain a substance irritating to the skin, can cause a burning sensation. When a chemical burn occurs, find out what chemical caused the burn. Call your local Poison Control Center or the National Poison Control Hotline (1-800-222-1222) for more information about how to treat the burn.
- Tar or hot plastic burns: Immediately run cold water over the hot tar or hot plastic to cool the tar or plastic.
- Next, look for other injuries. The burn may not be the only injury.
- Remove any jewelry or clothing at the site of the burn. If clothing is stuck to the burn, do not remove it. Carefully cut around the stuck fabric to remove loose fabric. Remove all jewelry, because it may be hard to remove it later if swelling occurs.
Prepare for an evaluation by a doctor
If you are going to see your doctor soon:
- Cover the burn with a clean, dry cloth to reduce the risk of infection.
- Do not put any salve or medicine on the burned area, so your doctor can properly assess your burn.
- Do not put ice or butter on the burned area, because these measures do not help and can damage the skin tissue.
Home treatment for minor burns
- For home treatment of first-degree burns and sunburns:
- Use cool cloths on burned areas.
- Take frequent cool showers or baths.
- Apply soothing lotions that contain aloe vera to burned areas to relieve pain and swelling. These skin lotions can be used to relieve itching but should not be used if the burns have fluid weeping from them or have fresh scabs. Applying 0.5% hydrocortisone cream to the burned area also may help. Note: Do not use the cream on children younger than age 2 unless your doctor tells you to. Do not use in the rectal or vaginal area of children younger than age 12 unless your doctor tells you to.
- An antihistamine, such as a nondrowsy one like loratadine (Claritin) or one that might make you sleepy like diphenhydramine (Benadryl), can also help stop the itching. Read and follow all instructions on the label.
- There isn't much you can do to stop skin from peeling after a sunburn—it is part of the healing process. Lotion may help relieve the itching.
- Other home treatment measures, such as chamomile, may help relieve your sunburn symptoms.
It is important to protect a burn while it is healing. Newly healed burns can be sensitive to temperature. Healing burns need to be protected from the cold because the burned area is more likely to develop frostbite. And a newly burned area can sunburn easily. Sunscreen with a sun protection factor (SPF) of 30 or higher should be used to protect the new skin for the first year after a burn.
You may be able to treat second-degree burns at home.
Do not smoke. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Smoking.
First-degree burns and minor second-degree burns can be painful. Try the following to help relieve your pain:
Try a nonprescription medicine to help treat your fever or pain:
Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.
Be sure to follow these safety tips when you use a nonprescription medicine:
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
- Pain increases.
- Difficulty breathing develops.
- Signs of infection develop.
- Symptoms become more severe or frequent.
Most burns happen in the home. Simple safety measures decrease the chances of anyone getting burned.
Home safety measures
- Do not smoke in bed.
- Place smoke alarms and other fire safety devices in strategic locations in your home, such as in the kitchen and bedrooms and near fireplaces or stoves. Smoke detectors need to be checked and to have the batteries replaced regularly. A good way to remember to do this is to check smoke detectors twice a year when daylight savings and standard time change.
- Make a fire escape plan, and make sure the family knows it (babysitters, too).
- Keep a fire extinguisher near the kitchen and have it checked yearly. Learn how to use it. Put out food or grease fires in a pan with a lid or another pot.
- Set your water heater at 120°F (49°C) or lower. Always test the temperature of bathwater.
- Store cleaning solutions and paints in containers in well-ventilated areas.
- Use proper fuses in electrical boxes, do not overload outlets, and use insulated and grounded electrical cords.
- Keep trash cleaned up in attics, basements, and garages.
- Be careful with gas equipment such as lawn mowers, snowblowers, and chain saws.
- Be careful with any flammable substances used to start fires, such as lighter fluid.
- Avoid fireworks. Think of safety first when dealing with fireworks.
Your local fire department is a good resource for more information on how to prevent fires, make a fire escape plan, use fire safety devices, and provide first-aid treatment for burns.
Teach children safety rules for matches, fires, electrical outlets, electrical cords, stoves, and chemicals. Keep in mind child safety considerations. Prevention tips for children include the following:
- Keep matches and flames, such as candles or lanterns, out of the reach of children. Keep small children away from stoves and ovens when you are cooking, and do not place pot handles where a child can reach them. Do not let children play with any small appliances such as curling irons, hair dryers, toasters, or heating pads.
- Never hold a child while smoking or drinking a hot liquid, because any sudden movement by the child could cause a burn.
- Never leave hot foods or liquids within reach of children, such as on the edges of tables or counters. Also, be cautious about leaving hot liquids on a table with a tablecloth that young children can reach and pull down.
- Prevent electrical, chemical, friction, and heat burns in young children:
- Keep electrical cords away from a child's reach. A child chewing on a cord could cause an electrical burn of the mouth. Cover electrical outlets so children will not stick items in the outlet.
- Do not allow children to remove hot items from the oven or microwave. Use caution whenever heating baby bottles in the microwave so that the liquid does not get too hot. A liner may burst or a lid may not be secure, and when the bottle is tipped for feeding, the hot contents may burn the baby. For this reason, most doctors recommend that bottles not be heated in the microwave.
- Store cleaning solutions and chemicals out of the reach of children.
- Friction burns can cause small cuts and scrapes. Don't pull or drag your child across carpet while playing.
- Teach children who are old enough to understand to stop, drop, and roll if their clothing catches on fire so they can help put out the flame and prevent getting burned more.
- Buy children's sleepwear made of flame-retardant fabric. Dress children in flame- and fire-retardant clothing. Older adults need to be careful about wearing clothing with loose material that could catch on fire.
- Keep woodstoves and fireplaces in good working condition, and use screens to keep children a safe distance away. Keep portable heaters, furnaces, water heaters, and small appliances in good working condition.
Reduce the risk of a lightning strike
In general, avoid placing camping tents under tall trees, near bodies of water, or on the highest hill in an area. Seek shelter in a covered area, such as a car, if you get caught outdoors in bad weather. If no shelter is available, lie on the ground in a ditch or take cover in a thick grove of trees, where lightning striking a single tree is unlikely.
- Avoid handling metal or electrical objects.
- Avoid or stop using any machines outdoors.
- Get out of water and off of boats.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- What caused the burn?
- What kind of material was burning (such as wood, plastic, chemical, or asbestos)?
- When did the burn occur?
- What is the size and location of the burn? Can you estimate the depth as a first-, second-, or third-degree burn?
- Was there a possibility of smoke inhalation? Was the fire in an enclosed place?
- How was the fire put out?
- Were there other injuries?
- What home treatment has been used?
- Do you have any health risks?
Current as of: June 26, 2019
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
H. Michael O'Connor MD - Emergency Medicine
Martin J. Gabica MD - Family Medicine
Current as of: June 26, 2019
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