Ep 156: Understanding Pediatric Burns: Prevention and treatment with Matt Young, MD

In this conversation, pediatrician and burn expert, Dr. Matt Young  reviews the common causes of burns in children, reviews practical tips for parents to keep their children safe from burns.  He also discusses the most up to date treatment for 1st, 2nd, and 3rd degree burns.  Dr Matt Young is the medical director of pediatric outpatient service at the UCLA West Valley Medical Center, burn center.   Dr Young has been working at the burn center since 1978 and we thank him for sharing his expertise on this podcast!

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

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Transcript

Unknown: 0:00

Hi everybody. I'm Dr Jessica Hochman, pediatrician and mom of three. On this podcast, I like to talk about various pediatric health topics, sharing my knowledge, not only as a doctor, but also as a parent. Ultimately, my hope is that when it comes to your children's health, you feel more confident, worry less, and enjoy your parenting experience as much as possible. Welcome to today's episode of Ask. Dr Jessica, I'm thrilled to introduce today's guest, Dr Matt young. He's a pediatrician with an impressive background in burn care and prevention. Dr Young is the director of Pediatrics and the medical director of outpatient burn services at UCLA West Valley Medical Center. He began working in the burn center nearly half a century ago, since 1978 and he has dedicated his entire career to treating pediatric burn patients and child abuse prevention. I actually spent two weeks as a pediatric resident working with Dr Young, and I learned so much from him. I believe every parent will benefit from hearing this conversation as we talk about how to prevent childhood burns and best practices on how to treat burns, and as always, I am so thankful to my listeners. If you know anybody who would benefit from hearing this important information, please share it along. And also, if you can take a moment and leave a five star review, wherever it is you listen to podcasts, I mean it when I say this, but you will make my day. Now, let's get started. So Dr, Matt Young, thank you so much for being here on the podcast. You have no idea how excited I am to talk to you. It's been a long time, and I'm happy to see you. Good to see you too, Jessica. I remember when you came to the burn center, I had a lot of fun, and I have to tell you, I've taken a lot of learning points from my time spent there. There's a lot of things that I am scared to do with my kids ever since spending time in the burn unit. So, so yeah, thank you. A lot of those stories definitely stayed with me. So tell everybody about yourself. Tell us who you are and what you do for work, I'm trained as a pediatrician. I went to medical school in Texas, in Houston, University of Texas, did our internship in North Carolina, and I did a residency at Children's Hospital Los Angeles. And then I was at Cedars Sinai with your dad, and was chief resident there. And while I was there, I was hired by a pediatrician in Encino, Neil Minkoff to go to cover the burn center. The Burn Center started in as the Sherman Oaks Burn Center in 1969 so he had been, he was the same age as the founder of the burn center, Minkoff was, and they had, he had covered pediatrics at the burn center, and wanted somebody to help, share the time doing it. And so when I was still a resident in 1978 I started working at the burn center, and then I started with his pediatric practice in Encino, and was a regular pediatrician, just general pediatrician, for 13 years, but also did the burn center. And then he died in 1985 he was only 52 he had stomach cancer and just died within within a month of the diagnosis. And so I took over the doing the burn center all the time. Then it got so busy, and I was assisting in surgery and doing all we had a lot more burn kids actually then than we do today. And we would admit like, 100 kids a year to the hospital. So I left my pediatric practice after 13 years and did full time Birth Center, which I've done ever since. That's amazing, and it's such an interesting niche. Yeah, it's unusual. It's just, it's just one of those things that was very fortunate for me to fall into it was my fate. It was your fate. And I love what you said about how there's been fewer pediatric admissions since you started working. I'm so curious. Why do you think that is? I think parents are probably more conscientious. You know, we see a lot of birds of children who are in poverty. You know, where they cook on the stove, and they have to take the pot off and put it on the floor to let it cool off while they cook something else on their little stove, things like that. Somehow we don't see as many I think people are more conscientious. Probably there's the change of the of the temperature the hot water heaters probably makes a big difference. We used to see, you know, kids bite into electrical cords and see a lot of mouth burns. We don't see that as much anymore. There are a lot of kinds of burns that we don't see as much of or seldom, but the common ones are basically the in the young children around the age of one, is the hot liquid burn for either coffee or tea, probably the most common is like cup of noodle soup out of the microwave and they set it on the counter and the kid grabs it and pulls it off onto himself. That's probably the most common burn we see. So can I tell you that exact story about the cup of noodle soup when I mentioned that the cases that I saw with you how I still think about them today? That. That's the number one thing that I think about is we had seen about three top ramen or cup of noodle burns in a span of a couple weeks. Because I think a couple of the kids took soup out of the microwave, put it in between their legs, and the flimsiness of the styrofoam, you know, was so easy for the liquid to spill over into their thighs, and they caused quite a bad burn. Yeah, so after that, I don't think I've ever bought my kids a cup of noodle soup because of my time in the burn units. That's true. So I find that very interesting and refreshing, that while there still are burns that exist, it's nice to know that some public health measures and interventions have made a difference. I think so we don't. Also, I would say the thing we don't see as much as child abuse, which we used to see more, and I don't. I think that kind of ebbs and flows, but it's not as common right now as as it was in the past. I think that is amazing news to hear, but those are horrible cases where child abuse by burning. I mean, I'm sure there's a lot of child abuse, but not as common to see it by burning anymore. I think that's good. Yes, I can definitely agree with that. That is very good. So I'd love to ask you more about prevention of burns, because, of course, there are treatments we can do for burns that we'll talk about in a bit, but I'd love to spread more awareness about typical burns and how they may arise so that parents can know how to prevent them from happening in the first place. So what are some common household hazards that you see that may cause burns in children? I know that you had mentioned pots and pans. Is there anything that you wish parents knew to help make their home safer? I think the probably the most important one, is to keep your child, child as much as possible out of the kitchen when you're cooking. I mean, the kitchen's really the most dangerous room, and we not only see hot liquid burns from from water or soup, but also from oil, which is much hotter than water, and so it causes a much deeper burn, you know, just oil splashing out of a pot. Or the other thing that I think is I've seen more often is contact burns from children touching an oven door pretty bad. They can get bad burns to the hands from the oven. They also get bad burns from the hand from these fireplace doors, the glass fireplace door, where the child pulls his hand against the door and get they can get bad burns from that. I had a patient once get a burn from touching a fireplace door at a restaurant, actually, that got pretty severe. Yeah, yeah. It could be, it can be bad. Hand burns in a child are tricky, because they can end up being permanently dysfunction of the hand, where it just scars down and not functional. It's terrible, tragedy, terrible. I've heard tips that if you are to cook with your kids in the kitchen, to make sure you use the back burner of the stove and to turn the handle of the stove away from the child so that they can't reach up and as easily pull it down. Definitely, that's a good idea, yeah, to diffuse the back burners. Yes, and you're right about oil. That's something also that I learned more from spending time with you, is that oil can penetrate the skin more and cause a deeper burn. So for sure, keep your kids away when you're using oil that may potentially splatter right. And the other thing that happens with oil is sometimes it catches fire, and people try to carry the pan on fire outside or somewhere. And the thing that you know, when you have a pan that's on fire, you cover it up, put the top on it, or you put a blanket over something, just to cut the oxygen off. You don't try to take it anywhere. That's where you get bad burns is where you're trying to carry this flaming pan out the door and your child gets it falls on to your child. Do you recommend keeping a blanket by the kitchen something too? Probably a good idea. I think I saw an ad for something like that on Instagram, and I brushed it off. But maybe I should pay attention the next time. I don't know. I don't know. Maybe any blanket would work or a towel, I'm not sure. I think putting the top on is probably the best if you've got a top. Yes, and I like, and I like the reminder about coffee causing potential burns, because it's true. I picture parents that are tired with newborns, and they're holding their baby in one arm and their cup of coffee in the other hand, and they're just so tired, and the baby may move their arms and knock the coffee cup so easy to get a skull burn with coffee and a young child, yeah. And people don't realize how hot that coffee can be, especially if it's, you know, if it's just recently heated, or it's come out of the microwave, it's, it can be 180 degrees, which can cause a third degree burn, wow. And will you briefly explain the difference between a first second and third degree burn? Yes, so you basically have two layers of skin. You have the epidermis, which is the top layer, and then underneath that is the dermis. So a first degree burn is just redness, like a sunburn, where the epidermis gets red, but the skin doesn't blister. It's basically just treated with moisturizer, and it'll get well, you know, within a few days, second degree burn is a blister. So you that blister is your epidermis. So you basically lose the epidermis, or it's either a bliss forms a blister, or it just comes off. And so you're left with exposed dermis. Exposed dermis, if it's healthy, can make new epidermis, but if it's burned all the way through the dermis, then the only way that can heal is by scarring in from the edges. So a second degree burn is a blister with healthy dermis. Third degree burn is a is the epidermis is gone and the dermis is dead, so that that's what usually needs a skin graft. It's so interesting to think of burns in that capacity. Yeah, they, they can, you know, they that's the other problem with children. Of course, they have much thinner skin than adults do, so the same temperature of contact with hot water or coffee or whatever will cause a deeper burn in a child than a dozen and adult. Now that's an interesting point. Do you see as many electrical burns? I know you had mentioned that kids aren't chewing on wires as much, but I feel like the outlets now are much more updated in many of the homes where it's not as easy to put your finger in a socket and get a burn. Do you feel like you've seen fewer electrical burns? Yeah, definitely. The cords are thicker and the outlets are more protected, so it's harder. I mean, you don't see children who stick something in an electrical outlet very often, and usually even then, it's a minor kind of burn. It causes a flash, and the outlet goes, shorts out. So I think that's helped. What would you say are the most common electrical burns that you still see today? Well, in children, don't see it that often. I would say it's usually just trying to think if it would be a spark in the old days, it wasn't that they bit through the cord so much as they would take the end of an extension cord and put it in their mouth the terminal and that would cause really disfiguring burns around the mouth, and there wasn't good treatment for it. Surgery didn't still left a scar. You'll still see people who've had an electrical burn as a child with scars on their around their lips, but it's pretty rare. You may not know about this, but I have I use a hair dryer, and there's always this warning on the label of the hair dryer that Be careful if it falls into water it may cause electrical burns. Is this something that you see often? Because it makes me nervous when I see that sign of my kids around me. I, you know, I don't see that. I don't know if that causes a specific burn. I think it can cause some type of electrocution if it's in water, but I don't think they get I don't think it's a real specific burn what we see with hair dryers or and what is it? Curling irons are where the child grabs the curl, the hot end of the curling iron. And that's really bad. I've seen a child actually, where the pediatrician told the child had colic, and they the pediatrician told them to put a hair dryer in the in the crib with them to kind of, you know, calm them down. And they got a bad burn to their hand from that. Wow, you're right, because that is advice that I've heard pediatricians give the sound of the hairdryer provides that white noise machine sound, and that's a good thing to keep in mind. Thank you. Yeah, I really feel like talking about this is helpful, because just knowing what our potential causes of burns, I think, will hopefully help somebody out there avoid a burn in the future. So these are great tips. Yeah. Another question I want to ask you about, something that I remember from working with you is we saw quite a number of Treadmill burns, and that's something that we now have a treadmill in our garage, and I'm so careful with my kids around the treadmill, because I'm afraid that they may get a burn. Can you explain to people about that, like, how explain how a treadmill could cause a burn in the child? Okay, this is be a friction burn. So the child, it's just like a sander. Basically put their they put their hand or their fingers in a in a sander, and it just sands off the skin from the treadmill. Usually, they stick it underneath the treadmill, and they'll get a they can get a third degree burn, usually to the hands. Seen some kids who fell down on a treadmill and got friction burns on their face. But it's it can be again, catastrophic, because it's the hand is so critical as far as function goes, that often those kids need to have surgery and get skin grass. I believe the child that I saw with you did need surgery and skin grass. Yeah, probably, so, yeah, we see, still see that quite a bit. I think in this case, it was a baby that was crawling. The parents didn't see the baby, and they came right behind the treadmill, got their hand in the treadmill while it was moving, and they got a really bad burn. So I think that's a really I think that's something that people don't think that much about. So thanks for talking that through with us. Yeah, and especially if, like, mom's on the treadmill, the child wants to come do the treadmill too. Either the parent or the child don't realize how dangerous it can be. Honestly, after my time spent with you, the two things that I got the most nervous about that I wasn't nervous about before were kids in treadmills and kids and top ramen soup. Well, those are probably good things to be nervous Absolutely, absolutely. Now, what about being outside? Is there anything that you think parents should be aware of or any safety precautions? Maybe with things like barbecues or fire pits, any common burdens that you think parents should be aware of? That's that's quite common, and that is usually it's when they go to the beach or they go camping and there's a fire pit that was had a fire in it the night before, and people don't realize there's still hot coals in there. And we've seen children walk barefoot in the fire pit and receive terrible burns so their feet or they fall into the fire pit. And usually it's not a fire pit that's actively burning. It's a fire pit that's been that's hot from the night before with colds. So I think that's a something that's avoidable, but you have to really be aware of it to to be sure the fire pit you camp at is watered down or cooled off, or your child doesn't get near it. That's a great point, because you're right. We might not think about that if you don't see an act of fire in a fire pit. I feel like it could be easy to forget that it's potentially still hot. Yeah, I think the other thing that's outdoors that we see a lot is especially around Fourth of July, is fireworks, or firecrackers, especially sparklers that you know you're a sparkler gets to be, can become as as hot as a blowtorch. And people give sparklers to kids. I mean, people give sparklers as people at weddings and things and and you see a lot of kids where they either light their dress on fire or clothes on fire or a sparkler gets stuck in their eye, and just terrible stories related to sparklers and fireworks that are again preventable. And people, people think of sparklers as being kind of innocuous. It's true that that's that is one area too, that maybe there's been fewer burns with children, because I know there are a lot more rules around fireworks. Yes, that's true. Yeah, there are. I mean, they're illegal in Los Angeles, but you still, they still have them everywhere. But I think sparklers are different because we'll go to, I went to a an Ventura, some a wedding photographer who brought, who supplied sparklers for pictures at a wedding, and people weren't even aware of how dangerous they could be. What about chemical burns? Are there any chemicals that you've seen kids get into that parents should be aware of to avoid burns? Good question. I don't see many chemical burns in children. The you know you think of acids and alkali one thing do see quite a bit of which is generally undiagnosed, and which is a type of chemical burn, is what's called a photo phytodermatitis, where they're around citrus fruits, or usually it's lemons, and then they get out in the sun, and the combination of the lime juice on your skin and the sun creates, like a second degree burn. You get these big blisters, and then nobody knows what happened. You know what caused it, because it may not show up till the next day. And so you have to really, kind of delve into the history to find out and figure out it resolves, you know, within a week, and it's like a second degree burn. But it can be very disconcerting, considering you get this, these giant blisters all over you, and it looks like a burn. That's so true. I've seen it quite a few times, where the story is a patient shows up with a burn around their hands, and then you ask them questions about what they were doing in the last few days. And it turns out they're on a spring break trip in Cabo making margaritas, limes on the hands. And sure enough, they get that classic phytophthodermatitis. Yeah. That's right, that's a good diagnosis. Yeah, it's a fun one, because you you figure out the mystery. Yeah, exactly. Now, what about basic treatment? Let's say, let's say a child comes in and have a typical first degree burn. What would you recommend parents do in terms of treating that burn? Yeah, I think first degree is important to distinguish between seconds. So if you have, if you don't have blisters, you just have redness, and that's first degree. And probably can just, you know, generally treat it with, like, moisturizer, you know, something like Aqua for you generally don't need topical antibiotics for a first degree burn. Or because it's not going to get infected. What about things like cortisone, aloe vera? Do you think it's fine to use, but probably doesn't make a difference. I probably doesn't make a difference. I would stay away. In general, stay away from cortisone just because it theoretically, it slows down healing, but probably for first degree burn. It doesn't matter, aloe vera is fine. The only problem with aloe vera is it tends to if you choose just the pure like the aloe vera plant, it dries out, so you end up with these. It's not a moisturizer. So you can use moisturizer. You can use aloe vera if you use it with a moisturizer, but aloe vera itself is very drying. That's that's a good tip. My grandma kept aloe vera plants all over her house, and she put it on every cut we had, every cut and scrape that we had in our skin. She would put it on. So I think it's good. It's supposed to relieve the pain. Yes, yes, okay, but that's that's helpful. So for first degree burns, we'll stick with moisturizers, something like Aquaphor. That's perfect. Now, what about if it does form a blister? Is that a time when they should see a doctor? Or can they handle that and manage that on their own at home? I think it depends on how extensive it is and where the location of it, in general, with a the first thing you want to do when your child is burned, which is probably the most common mistake, is people will do all kinds of crazy things. Let's say they get a, you know, burn on their hand, and they get a blister. Somebody will put toothpaste on it, or mustard on it, or eggs on it, or butter on it, all those things you don't need. You just need to run cool water on it. The other thing people use, which is that's con that's terrible, is put to put ice on it, thinking they're cool it. And that's the wrong thing to do, because that, I mean, you can get burns from an eye from ice, because it basically decreases the circulation there, and it freezes the skin, so it's killing the skin in another way. That's a great point, because you're right. People often will jump to at the first sign of a wound in a child, they'll jump to getting ice. So that's a great point. So you just want cool water for like, three, five minutes to cool the burn, and then, depending on, you know, if it's just little, if the blisters not broken, it's probably best to leave the blister alone, let it stay intact, because there will be some healing under the blister. And also the blister protects it from infection. If it's open, if the blister is gone, and you've got an open wound there, then probably antibiotic ointment on it is fine, and then a dressing, I would keep it it's good to keep it covered. People think they want to let it dry out. That's not a good thing. It will heal better in a moist environment than it will if you let it dry out, same for all wounds, and so you want to keep it moist and generally just use antibiotic oima, because it's moisturizing and kills bacteria. So something like basic Neosporin, Neosporin is fine, Polysporin, Bacitracin, any of those. I'm so glad you mentioned to parents that it's important to keep the blister intact, because I think so often when kids get blisters, we want to pop them. But skin really does serve as a protective barrier. It'll keep kids from getting infected. Yeah, I will, and you'll get some. You know, sometimes they'll heal underneath, and then when the blister comes off, they're healed. So is there any situation in which you would puncture and drain a blister? Yeah, if it's depending on the amount of pain, if it's been very painful and and, of course, you can get infection under the blister. So in general, if it's more than three or four days, I'd probably take the blister off. But that's just, you know, my own opinion. I like it. You're the experienced guy. You've seen it all. And what about silvading self? A silvadine, I know that's a common ointment to use for burns, when and in what situations do you recommend using that cream? Interesting, I think silver Dean's Okay, although it's really out of favor right now, we don't, basically don't use silvidean on outpatients. At this point, we'll be and the reason is, there's some studies that show that Sylvain slows down healing, but I don't think that's the big reason. The big reason is the biggest advance in the treatment of outpatient Burns is the multi day dressing. It used to be you would put silvidean on. You would have to change it every day. The parent would have to wash it and change it, which is really difficult for him, because the child's in pain and screaming. And so now we there are new dressings, which I brought one here to show you. This is, this is methylex. It's mepilex, AG, so it's a foam dressing that that looks like this, and on the inside is it's medicated with silver, so it has the antibiotic effects of silver. And it's a dressing that's like a sponge so it can stay on. They're up to a week, so you can dress it, and then the parents don't have to change it every day, and you can just see them back. Usually you see them back in four or five days, or even a week, and and it heals under there. It's like magic. It's great. It's amazing. And do you notice better results than the self esteem? Yeah, I think so. And I think it's more also convenient. The convenience it's probably the biggest factor, is not having to change addressing because, first of all, everybody has a hard time putting a dressing on a child, and it's painful, and then maybe don't, usually don't do a good job of it. And so this is, this just sticks on there and stays on there. It's great. Can't get wet. That's the only disadvantage to it. So it doesn't get looked at. You leave it on the burn for a week, yeah, or change the dressing, and parents don't have to look at the burn in the meantime, right? That's right, of course, that's after you've seen it. And you know, it's not third degree, it's not infected and so forth. I mean, I wouldn't leave it on a week if I hadn't seen the burn. Interesting. This is great to know. I love to know that there's advancement in the treatment of burns happening. Yeah, that's for outpatient burns. That's the biggest advancements. And there are other brands that are copying this too. There's a lot of because we use it also. We use it in in the wound clinic, you do lots of wounds, and we do a lot of epilepsy where we can just leave it on there a week, and then they come back, and can parents buy that over the counter? Is that always through a doctor? You know, you can buy these foam dressings. I think the silver needs a prescription, but you can get the foam dressing by itself, and then you could put your own Polysporin on underneath, and then put the foam. This comes in all different sizes and stuff. Or you could even cut a piece of this and put it on. Or you can buy a different, you know, smaller size, and it comes with where it'll has stick them around it, so it'll stick on the burn. And you put the Polysporin on, then you put that on. You can leave that on, and you just wrap it in, like an ace bandage, for example, yeah, a curlex or an ace bandage. And I'm just curious. You may not know, you may not know the answer to this. Do we know why silver helps improve burns? Well, it kills bacteria, uh, aside from that, I don't know. I mean, I have patient, you know, patients that take Colloidal Silver orally and stuff. And I, you know, I don't know if it helps or not, but I don't think it's harmful and and so I think, you know, Silver's traditionally been used mainly because it kills bacteria. I mean, when, when I was probably, when your dad too, when we were pediatricians at the beginning, after a baby was born, they put silver nitrate in their eyes. So, okay, this is really helpful to know. So mepolex is. Meplex is going to help a patient in the case not of a minor burn, but if they have blistering or signs of a second degree burn, right? And you can buy the foam dressings, like they have them at CVS, not the may not be meplex brand, although you can look it up on Amazon or whatever, and they have meplex. It's kind of a brand that's probably made by meplex, that they sell at CVS or whatever, but it's a good dressing that you can leave on for a few days. And then in terms of third degree burns, obviously, that would be necessary to see somebody in the burn unit, but just so people are aware what kind of treatment is offered and how are the outcomes at the end, do you feel like there's been a lot of advancement in the way that third degree burns are treated? Yeah, I think the best value is still You can't beat human skin if you need a skin graft. You know, there are lots of skin substitutes, and we use those, but basically a third degree burn is all the way through the layers of the skin, through the dermis, and so it's not going to heal from the bottom up, and has to come in from the edges to heal. So instead of having to come in through the edges, you take a skin graft, which is basically a very thin tissue paper sized piece of skin, usually from the thigh or from the scalp. And you, you first, you have to do that. Usually do this in surgery, or almost always. And you first, you debride the wound, which is taking away the dead skin, and you get down to a healthy layer of skin. Basically, you try to get to a level of kind of pinpoint bleeding. We usually in the first stage, we'll use human skin that's frozen. Sometimes we'll use other skin substitutes. We use porcine, which is pig that's all fancy. In other words, it's been through the laboratory and everything. There's artificial skin substitutes made out of foreskin. There's skin substitutes made out of everything, but like placenta. So placenta, yeah, really, yeah, there's and is amnion layers that they. Sell later. I don't know, frozen or something that you can buy and put on a on a wound or a burn. You know why I'm chuckling a little bit is because people have this debate about whether or not to save a placenta delivery. And whenever you look at a placenta, it seems like not a great idea fresh placenta. So it is really interesting to know that there's a use for for placentas, okay, yeah, we don't really use it at very often, but it is around, especially for they sell it for wounds. Interesting, interesting. So anyway, you debride it, you take off the dead skin, then we put a temporary dressing on there a second substitute, just for three or four days. And what that does is it covers the nerve so it doesn't hurt anymore. The body thinks there's new skin there, so it builds up new blood vessels to this graft. And then we go back three days later, take that graft off, and at that time, it's healthy tissue, healthy base of bleeding tissue that you can take a skin graft from the using from a thigh or the scalp, and put it on there, and leave it on there for three days, and take it off, and you've got new skin. Amazing. That's basically skin grafting amazing. I remember watching you in the operating room take care of a third degree burn. It was really, really interesting to watch. Yeah, it's, it's the these really the standard of care. You know, a lot of things have changed, but the standard of care is really putting your own skin on. Parents often ask, well, can't they use my skin? But you'll reject somebody else's skin eventually you have to have your own skin put on now. What about other treatments, like other other useful therapeutic modalities to help with burn healing, like I remember seeing a hyperbaric oxygen chamber that was in the burn unit. Is that still in favor? Yeah, we have two oxygen chambers that most of our patients go into twice a day. Even little kids, I mean, two months old, will run in the oxygen chamber, and they do real well. It's basically a cylinder that has 100% oxygen at two atmospheres of pressure, and it basically saturates your plasma with oxygen. You can live in a hyperbaric chamber with a hemoglobin of zero. You don't even need hemoglobin to carry oxygen, because your plasma has so much oxygen in it, wow. So basically, we put patients in from the beginning, into the hyperbaric chamber twice a day, and it does several things. One is it every burn after you get it causes edema, swelling, even swelling in parts of your body that aren't burned. So it will decrease. The pressure will decrease the swelling, the oxygen will increase your circulation and helps make new blood vessels. And it can, it can take a second degree burn that might change into a third degree burn and keep it a second degree burn. I think it really it, because the burn is basically tissue ischemia. It's lack of blood, lack of oxygen to the tissue. So the oxygen chamber helps increase the oxygen to the tissue, to help a tissue that might not survive, let it be able to survive. Wow. Well, thank you so much for all this great information. It's amazing. I mean, I love hearing what we can do to prevent burns in the first place, but it's so nice to know that there are advancements in treatments and good things that we can do to help recover from a burn. I agree, it's a great field. And is there anything else that you wish parents knew? Any tidbits of knowledge that we haven't covered that you think may be beneficial to learn about. I think the most important thing is the cool water after a child gets a burn. The other thing is to wash it with soap and water. People, even doctors do this, they say, Oh, don't get it wet. You know? They'll say that for burns or wounds. I saw a guy this week who has had a burn on his on his feet for 14 months, and I turned into this horrible wound, but he the doctors were telling him to wear this, like, big sleeve on his leg so that it didn't get wet. So he's gone for like a year without washing his feet, you can imagine, not a good idea. So anyway, as soon as we told him to wash it with soap and water, that makes a difference. So these, these kind of things, you want to clean them, and that's true for any wounds too. You want to keep them clean with soap and water, and then after the burn heals, it'll tend to be drier than the rest of your skin, so you want to use moisturizer on it, like Aquaphor, Eucerin, coconut oil, whatever, and any pain reliever that you recommend, I think Tylenol or Advil is probably usually all you need. It's great. Well, this has been so helpful. Thank you. For your expertise. I've been so excited to talk to you. Dr Matt young, not only are you a wonderful doctor, but I also know you are a wonderful human being. So thank you so much. Thanks a lot, Jessica. Appreciate it. Thank you for listening, and I hope you enjoyed this week's episode of Ask. Dr Jessica also, if you could take a moment and leave a five star review, wherever it is you listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr Jessica, see you next Monday. You.