Preventing Burn Scars and Contractures in Children

Scars are thickened marks left after a burn has healed. Most second- and third-degree burns cause some degree of scarring. Physical therapists will work with your child to prevent or reduce scarring.

Wearing pressure garments can minimize scarring and help reduce pain. Pressure garments are tight-fitting clothes that are worn over burned areas to reduce scarring. Children with deeper burns need pressure garments. These must be worn 23 hours per day (taken off only for bathing) for at least 1 year and up to 2 years after the burn.

Your child should have at least two sets of pressure garments. They can wear one set while the other set is being washed. Hand wash the pressure garment, rinse it, squeeze it gently on a towel, and hang it to dry. Don't use bleach on the garment or put it in the dryer. This will damage the garment. As your child grows, they many need to have new, larger garments.

Vitamin E ointments and honey may help decrease scarring from second-degree burns. But there hasn't been a lot of research on how well these work. Silicone-based scar gel and gel sheets can also help reduce scarring.

Contractures occur when the burn scar matures, thickens, and tightens. This can prevent movement. It usually happens when a burn occurs over a joint. A contracture is a serious complication of a burn. If your child gets a contracture, they will not be able to move the scarred area normally. For example, your child may have trouble doing things like dressing, walking, eating, or playing. It depends on where the scar contracture is located. It's important that you let your child do things for themselves regardless of how long it might take or how hard it might be. This will help prevent contractures and help your child become independent and confident.

Most second- and third-degree burns do cause some degree of scarring. But several things can be done to minimize scarring and reduce contractures. They include:

• Wearing a splint. Sometimes after a child has been burned, they will need to wear a splint on the joint to keep it in a stretched position and to help prevent a contracture. Splints should be worn on top of the pressure garment.
• Doing range of motion exercises. Range of motion (ROM) exercises help keep the muscles and joints of the burned limbs flexible. A physical therapist (PT) will teach you and your child how to do ROM exercises, so you can help in the healing process. The types of exercises and how often to do them will be determined by the PT. But they should generally be done several times a day.
• Exercising. Do the special exercises given by your child's PT with your child faithfully. Exercises are very important to keep the scar area stretched and prevent a thick, hard, and tight contracture. Exercises must be done even if your child doesn't like them. You may want to reward your child for doing a good job at the end of the exercises. If pain affects their ability to exercise, talk with their doctor about how to ease the pain.
• Promoting independence. Have your child do daily activities for themselves as much as possible. For example, let your child brush their teeth, brush their hair, eat, and dress on their own. Even if it is a little difficult for your child, try to resist the temptation to help. The movement that occurs during daily activities will help keep the scar area stretched. Your child should do daily ROM exercises as directed by the PT or your child's doctor. If appropriate, consider having your child attend a support group or a camp for burn survivors. Emotional support and encouragement from peers can make a positive difference in your child's recovery.