Best treatment for a burn is 20 minutes of cooling with running water

Author: Ingrid Torjesen

Cooling with running water is the best initial treatment for a child's burn, a study* published in Annals of Emergency Medicine has confirmed.

The researchers emphasise that first aid using cool running water on the burn should continue for at least 20 minutes as their study showed that this length of time reduced the odds of needing a skin graft, expediated healing and lessened the chance that a young burn victim required admission to the hospital or a skin graft procedure.

The Australian study involved 2,495 children with a burn injury, of which 2,259 (90.6%) received first aid involving running water and 1,780 (71.3%) for at least 20 minutes.  A total of 236 children (9.5%) required grafting.

Analysis of the data showed that children who received adequate first aid involving 20 minutes or more of cooling with running water had the odds of skin grafting reduced by more than 40%. Providing any amount of cool running water was associated with reduced odds of hospital admission by 35.8% and reduced the odds of requiring treatment in an operating room by 42.4%.

"If a child is burned, the first course of treatment should be 20 minutes of cool running water," said Bronwyn R. Griffin, honorary senior fellow at the University of Queensland Child Health Research Centre (Australia) and study co-author. "Cool running water is most effective immediately after a burn occurs, but evidence suggests it remains beneficial for up to three hours following an injury."

The study’s findings confirmed that children with burns cooled with running water fared better than those that received no first aid or an alternative to cool running water, such as aloe, gels, compresses, toothpaste, butter or egg whites. And among patients who did not require grafting, the speed of healing was faster with the administration of any cool running water. This is important because faster healing reduces the risk of scarring, the authors noted.

Childen in the study cohort were treated most frequently for scalds, liquid or steam burns, on or near their arms or legs. These types of mild to moderate burns commonly occur at home.

The optimal duration of cool running water therapy remains under discussion. The Australian Burn Association, British Burn Association and European Burns Association all recommend 20 minutes of cool running water. The American Burn Association calls for five or more minutes and the British Red Cross and St. John Ambulance (UK) both prescribe 10 minutes or more. This study lends further support to the recommendation of a full 20 minutes, the authors concluded.

*Griffin BR, Frear CC, Oakley E, et al. Cool Running Water First Aid Decreases Skin Grafting Requirements in Pediatric Burns: A Cohort Study of Two Thousand Four Hundred Ninety-five Children. Annals of Emergency Medicine. January 2020, DOI:10.1016/j.annemergmed.2019.06.028