Sick Kids

The Hospital for Sick Kids Toronto

Like most of the wards at Toronto’s Hospital for Sick Children, known to many as Sick Kids, the burn unit is brightly painted with child-friendly murals and the staff is caring, friendly, and sensitive to the needs of its small patients from the moment they are admitted.

The health care team at the Sick Kids burn unit admit about 100 patients a year and perhaps surprisingly, 90% of the children are there because of scalding. “It’s usually coffee or tea. Often, the kids see their parents drinking tea or coffee and want to try it too and kaboom,” says Julie Zettel, outpatient coordinator and long-time nurse in the unit. “Parents say ‘I had no idea that hot water could do this’. Some of these cases require a skin graft. Parents should know that hot liquids can burn just like fire.” In most homes, hot water directly from the tap can scald a child in less than one second because the temperature on the hot water tank is set too high.

Parents should also know that most burn injuries are easily preventable. As caring and professional as the burn unit is, it is a place any parent would want their child to avoid. A typical scald can result in a one to three week stay in the hospital. Children with more serious burns, for example those resulting from a house fire, might require a stay of six months. Dressing changes and frequent baths to clean the wounds are often painful experiences despite pre-medicating the small patients. “It can be very scary: the average age of our patients is only one year old,” says Zettel, adding that “because we can’t explain what is going on to children so young, anxiety is a factor which will often increase the amount of discomfort a child feels."

In addition to the physical pain of the treatments that burn patients go through there can be psychological factors that are difficult for the family. On top of the worry about healing and the potential for permanent scarring, some parents feel very guilty about what has happened to their child. “For many, the guilt is overwhelming and can persist for a long time,” says Zettel. “Parents drive themselves into emotional distress wondering about the ‘what if’s’ and wishing they could turn back the clock.”

Worse, sometimes one parent blames the other because it happened on their watch. “This is not very helpful. It puts a big strain on the family right when they need to support each other more than ever,” says Zettel. “The size and depth of the burn often has nothing to do with how people cope emotionally. Over time and with the right psychological interventions though, the guilt generally dissipates.”

While some families cope well, the need for social support can be enormous. At times, the experience of being burned can lead to post-traumatic stress disorder which might require a substantial amount of continuing psychological support. Bad burns with permanent scarring may affect self-esteem and body image. While most people have heard of skin grafts and perhaps other therapies used to heal burns and minimize scarring, “many people don’t seem to understand that in these cases, the scarring never completely goes away,” Zettel says.

In cold weather, the number of scalds caused by hot drinks often increases. The best way for you and your child to avoid a visit is to prevent injuries in the first place.