Case 1: Hand burns in a 13-month-old

Abstract

A 13-month-old girl presents to the emergency department with burns involving the palmar surfaces of both hands and a superficial burn of her forehead. Her parents report that they were visiting a friend who lives in a new home with a gas fireplace in the living room. The fireplace was inset into the wall with a flat glass enclosure flush to the walls on either side. The child had been cruising for one month and started to take a few steps independently over the previous week. The child was playing near the fireplace with her parents close by. They were distracted and suddenly heard a scream. They turned to see her falling back from the glass fireplace. They immediately picked the child up and ran her hands under cold water. Skin sloughed from her palms immediately and redness on her forehead was noted. The parents reported no prior injuries and no previous hospital visits. Physical examination demonstrated partial thickness burns on the palm of each hand. The palmar surfaces of the distal fingers also demonstrated partial thickness burn injuries. A round area of erythema (superficial burn) of the central forehead was noted. The remainder of the skin examination was normal. The child was distressed and appeared to be in pain. The physical examination was otherwise normal. Plastic surgery was consulted and recommended admission to the burn unit for pain control and daily dressing changes. The burns healed gradually over two to three weeks. Occupational and physiotherapy were involved. Massage with moisturizing lotion and range-of-motion exercises were recommended to prevent contractures. Splints were used regularly on a tapering schedule for three months with good functional outcome.