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Children, Third Degree Burns and How to Recognize 6 Degrees of Burns

Updated on June 7, 2017
Patty Inglish, MS profile image

Patty uses her MS in Preventive Medicine/Health Psych. and TKM as a contractor in research/treatment for public & private health agencies.


Screams in the Flames

An extensive burn injury is one of the most painful pieces of damage that the human body can suffer and in children, it is heartbreaking. In a house fire, the screams of a burning child that cannot be found are haunting.

The screams of agony from a child in a hospital burn unit undergoing the scrubbing away of dead and burned skin with metal brushes is nerve shattering.

The skin grafting surgeries are lengthy and entail months or years. Not all grafts are successful.

Not all plastic surgery can save a 2-year-old's twisted, scarred face that may no longer have a nose or ears. Fingers heal together or are burned off. Feet sometimes become charred stumps. Limb amputation sometimes becomes necessary, even in the truth of all this, the public hopes for the newest technologies to come to the rescue in these cases.

Fire prevention in the 2010s is still many times more effective than treatment of third degree burns.

Playing with matches and candles changed a 3-year-old's life. At age 10 in 2017, she was still undergoing plastic surgery treatments.
Playing with matches and candles changed a 3-year-old's life. At age 10 in 2017, she was still undergoing plastic surgery treatments. | Source

The little girl was just three years old.

On the Friday before Palm Sunday, her teen brother was watching her, her four-year-old sister, and the dogs. Mom, Dad, and a middle-school sister were away. Suddenly, fire broke out upstairs in the two-story home. Brother saved the 4-year-old and dogs, but was cut off from the youngest child by the fire.

He stood on the sidewalk screaming for help. A passerby jumped from his car and entered the house, heard screams, but could not navigate through the flames.

The fire department arrived; one of the men was burned himself as he extracted the youngest victim from the second floor inferno.

She was rushed to the children's hospital 100 miles away, where she was diagnosed with 3rd Degree burns over 60% of her body. Her mom, dad, and sisters moved into Ronald McDonald House next door, but sat by her bedside most of the time. Brother went to another city to stay with a friend.

What caused the fire on the second floor? It could be an electrical wiring problem in rental property that also had an unfinished basement with only a dirt floor - building codes may not have been met in other ways. The struggling family in Michigan had to find a new residence, victims of low income caused by a long spate of illnesses and deaths.

Shriner's Hospitals are famous for their pediatric burn units.
Shriner's Hospitals are famous for their pediatric burn units. | Source

Landlord Responsibilities

Landlords that own rental properties such as houses, apartments, redecorated converted garages, and other residences have the responsibility to provide fire-safe living arrangements according to the law.

Smoke detectors must be installed in these residences, checked at least yearly, and maintained in workable condition at all times. Electrical wiring throughout the building in these residences must be up to code according to legal standards.


Burn Damage

Sixty percent body coverage by 3rd Degree burns in a three-year-old is serious. All layers of skin are burned across more than half of the body, leaving her open to infection and dehydration, shock, possible loss of limbs or face, and the need for a tetanus shot. Fat, muscle, and under elements beneath the skin may be involved (Source: Mayo Clinic burn information).

A 4th Degree burn includes fire damage below all layers of skin into the muscle, tendons, and ligaments. This damage creates a rather carbonized appearance, like charcoal.

Persons struck by trains have been carbonized throughout their bodies with these burns and have been subject of an old traffic safety film, Signal 30. Some students in most classes that viewed the old movie suddenly left the room in horror and nausea when a folded-up charred body was shown.

Burn percentage chart for adults and children.
Burn percentage chart for adults and children. | Source

A common misconception is that there are only three degrees of burns. The reality is there are six; however most people will not survive burns past the fourth degree.

— DOCCS/Diagnostic and Clinical Care Services of Brevaerd County FL
Click thumbnail to view full-size
First Degree burn after one day.Second Degree burn.A small Third Degree burn.Fourth and Fifth Degree burnsThis wooden log is charred through and through. A body with 6th Degree burns looks much the same.
First Degree burn after one day.
First Degree burn after one day. | Source
Second Degree burn.
Second Degree burn. | Source
A small Third Degree burn.
A small Third Degree burn. | Source
Fourth and Fifth Degree burns
Fourth and Fifth Degree burns | Source
This wooden log is charred through and through. A body with 6th Degree burns looks much the same.
This wooden log is charred through and through. A body with 6th Degree burns looks much the same. | Source

The Worst Burns Do Exist

The highest two degrees of burns are not mentioned widely among the general public.

They have been used as specific medical pathology terms in autopsies of burned bodies, the highest level being similar to cremation. Attorneys speak Degrees 5 and 6 as usually found in autopsy reports used for legal actions. Anecdotal denials of the existence of the final two degrees may stem from a lack of such pathology knowledge.

Actual Use of Levels 5 and 6

Degrees 5 and 6 previously may have been limited to radiation victims of the Hiroshima and Nagasaki historic nuclear attacks, the radiation events of Soviet submarines like K-19 in the 1960s, and in the Chernobyl disaster.

In the near future advances in 21st century weapons of war and aerospace technologies may require these final two burn degrees to be more more widely used.

The fact that the terms for the worst levels of burns were first used in a science fiction TV series does not mean that they do not exist. After all, we do now have the artificial skin that was first given to us by Star Trek® episodes.

Diagram cross section of human skin. The 5th and 6th Degree burns burn all of these tissues and keep burning.
Diagram cross section of human skin. The 5th and 6th Degree burns burn all of these tissues and keep burning. | Source

Six Degrees of Burns

6th Degree burns

Generally, by the time a body part continues to burn to the 6th Degree, all tissue from the outer skin layer (epidermis) and completely down through all tissues to the bone is irrevocably damaged and the bone itself is charred black. No treatment exists for this level of damage.

5th Degree burns

The only difference between the two worst burn categories is that the 5th Degree burn does not include charred bone.

3rd and 4th Degree burns

In the 3rd and 4th Degrees, bones may be damaged without charring. However, these burns may damage bones enough to disable a patient and may lead to death. Professional treatment is necessary. More extensive tissue damage exists in the 4th Degree burn than in the 3rd Degree level.

These two levels of injury usually result from prolonged exposure to fires, chemicals, or very hot liquids. Children and adults can be badly scalded and further burned by hot bath water or hot soup on a stove.

2nd Degree burns

These burns include reddened skin and raised blisters that should not be popped open, because of infection risks. See a doctor.

1st Degree burns

These first-level burns include reddened skin and burning through the top layer or few layers of skin, with some swelling, but without blistering. They can be painful. If they cover a large area, then see your doctor for help.

Necessary Burn Treatment

First Degree burns: According to the American Red Cross small burns of this level can be treated with cool water or a cool compress. Electrical burns need a doctor's attention. If any burn becomes infected, see a physician.

You may possibly use a lidocaine spray to relieve pain, or apply aloe vera, honey, lotion, or antibiotic ointments. Never use any kitchen oil or butter on a burn, because they prevent healing.

Second Degree burns can be examined by a physician and the blisters handled according to his or her best practices. You may receive a prescription for antibiotic ointment and gauze wrapping.

Third Degree burns are professionally cleaned and dressed when the patient reaches a hospital. Since burns cause fluid loss, especially with 60% of the body burned as mentioned above, IV solutions are required to replace lost fluids and reduce the possibilities of complications.

In these burns, some tissue under the skin is also lost. Children's hospitals often maintain dedicated Burn Units in which burn victims can receive the needed round-the-clock care by specialists.

Debridement after the initial treatment is the scrubbing away of dead skin, usually causing severe pain and much screaming. New methodologies are on the market that can reduce this level of pain, but they are not yet mainstream.

One method uses super-oxidized water and hydrotherapy to remove dead tissue and was developed in a clinic in Mexico. Other countries use fish skin to cover healing burns. Other specialists recommend hyperbaric oxygen treatment as an adjunct to speed healing with additional oxygen. Research is underway to develop more effective and less painful burn treatments.

Some 3rd and 4th Degree cases require surgical removal of dead skin and tissues, followed by skin grafting, another surgical procedure in which skin is transferred from thigh or buttock and sewn over a cleaned burn. Some of the worst cases require amputation of body parts. Fifth Degree damage rarely responds to debridement and grafting, and no treatment is successful for the 6th Degree burn.

Newer Treatments

The Pig Matrix of New Skin

Interestingly, Star Trek® fictitious medical procedures resulted in stimulating research that produced an artificial skin. Today that artifice can be laid over well-cleaned burn areas instead of using bandages; and the body heals around it, after which it dissolves.

Another technique involves the use of powdered pig-tissue matrix. It can be laid beside human tissues with the result that new human tissues grow at the site. This includes muscle, bone, an esophagus, skin, and many other types of tissue. In still other methods, a patient's own stem cells have been used to grow new skin.

Wound Dressings

Dressings and bandages are used to cover burns in order to help the body maintain its normal heat and to resist infection. In the 1980s, a child in our Cincinnati children's hospital Burn Unit was hypnotized to raise his 2nd Degree-burned arms shoulder high in front of him and maintain them there without tiring. This technique worked for him for two important weeks, with the result that he needed fewer bandages, his arms did not rub against his body to do more damage, and he felt less pain. Overall healing was also quicker.

Extreme Care Needed

With 3rd Degree burns, skin grafting and more extensive plastic surgery are often needed. These surgeries may take up to several years to complete.

Infections can be a long-standing problem. Amputations are still sometimes necessary and the fitting of prostheses can take prolonged periods of time and require help with funding.

Severely burned children are often supported in their home communities with fund raising events sponsored to provide money in the absence of adequate insurance coverage.


Call your local Red Cross for additional information and First Aid Training. Call or visit your healthcare professional or hospital in case of burns above 1st Degree and for even 1st Degree damage covering a large area of the body.


  • American Red Cross First Aid Training.
  • “Burns.” MedLine Plus at the US National Library of Medicine, 31 Oct 2013. http://www.nlm.nih.gov/medlineplus/ency/article/000030.htm Retrieved June 5, 2017.
  • Memory Alpha, Star Trek® Fandom. memory-alpha.wikia.com/ Retrieved June 6, 2017.
  • Morgan, Walker. Fourth, Fifth & Sixth Degree Burns. walkermorgan.com/fourth-fifth-sixth-degrees Retrieved May 10, 2016.
  • Ohio State Highway Patrol and the Highway Safety Foundation. Movie: Signal Thirty. 1959; out of print.

© 2011 Patty Inglish


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    • profile image

      solex 5 years ago

      please can any one give me advice on how to help a young lady treat a childhood burn that has partially disfigured her left hand. It appears toe to be a third degree burn caused by her dipping her hand into hot oil on a frying bowl when she was rather too young. To fully describe the appearance her hand the skin on the left hand is slightly dis-colored and there is a partial web between four fingers. Thanks anybody

    • LailaK profile image

      LailaK 6 years ago from Atlanta, Georgia

      Your hub is very informative and practical! Thanks for sharing!

    • dusy7969 profile image

      dusy7969 6 years ago from San Diego, California

      I get the lot of information about the treatment of burn.Thanks for this hub.I agree with Cobranurse you say right.We should not leave the children alone in the house.Thanks for this informative and useful sharing.

    • Support Med. profile image

      Support Med. 6 years ago from Michigan

      Glad she's alive - so sad - I have a family member who's retired from the Fire Department - stories can be heartbreaking-and it seems city officials do not give them the support and credit they deserve. v/r

    • Hello, hello, profile image

      Hello, hello, 6 years ago from London, UK

      Thank you, Patty, for such a really interesting and onfirmative hub. Also useful because you never know when it is needed and can save lives or more damage.

    • Patty Inglish, MS profile image

      Patty Inglish 6 years ago from North America

      Thanks for your comment, Cobranurse. It stunningly dangerous to leave very young ones unattended and asking teens to watch more than one is hard. A third young child is now said to have been in the house as well - 3 is too many for a teen to watch along with dogs and cats on two different floors.

    • profile image

      Cobranurse 6 years ago

      Good day to you Patty!...I'm amazed on your topic and now i'm aware that you cannot leaved the children alone in the house.

    • L.L. Woodard profile image

      L.L. Woodard 6 years ago from Oklahoma City

      The Shriner's Hospitals do wonderful work with young burn victims. It would be great if those services were no longer needed, but good to know they are there when needed.

    • Patty Inglish, MS profile image

      Patty Inglish 6 years ago from North America

      Thanks for taking the time to read and comment, KKG!

      I had only one burn, associated with restaurant work - a small steam plate boiler exploded on my leg (only 1st degree because I jumped back). Ice helped a lot, but I had an odd discoloration for months until I heard to put witch hazel on it - that worked. What they will have to do with Ally, I am not yet sure. She's in critical condition, but alive.

    • KoffeeKlatch Gals profile image

      Susan Haze 6 years ago from Sunny Florida

      Patty, I can only imagine the agony that accompanies a 3rd degree burn. For a child to have to endure this is unthinkable. I had hear a little about 4th degree burns, not much. But I never knew about 5th and 6th degree burns. As always, well-written and incredibly informative. Rated up and awesome.

    • Patty Inglish, MS profile image

      Patty Inglish 6 years ago from North America

      Thanks for taking the time to read this one, kashmir56. I appreciate your concern!

    • kashmir56 profile image

      Thomas Silvia 6 years ago from Massachusetts

      Hi Patty thanks for all this great and valuable information,doing the right treatment for any burns is very important !

      Awesome and vote up !!!