Objective To analyze the effect of CO2 fractional laser combined with medical silicone gel dressing on scar improvement in children with hypertrophic scar. Methods A total of 100 children with hypertrophic scar treated in the Central Hospital of Yongzhou from March 2022 to August 2024 were selected as the research subjects. According to the random number table method, they were divided into group A (n =35), group B (n =33) and group C (n =32). Group A was treated with medical silicone gel dressing, group B was treated with CO2 fractional laser, and group C was treated with CO2 fractional laser combined with medical silicone gel dressing. The clinical efficacy, scar improvement, scar pruritus degree, satisfaction and adverse reactions were compared among the three groups. Results The total effective rate of treatment in group C (96.88%) was higher than that in group A (71.43%) and group B (75.76%) (P <0.05). The VSS score of group C at 3 months after treatment was lower than that of group A and group B (P <0.05). The VAS score of group C at 3 months after treatment was lower than that of group A and group B (P <0.05). The satisfaction rate of group C (96.88%) was higher than that of group A (80.00%) and group B (81.82%) (P <0.05). There were no obvious adverse reactions in the three groups. Conclusion CO2 fractional laser combined with medical silicone gel dressing in the treatment of children with hypertrophic scar can improve the total effective rate of treatment, effectively ameliorate scar degree and pruritus, enhance patient satisfaction, and has good safety, which is worthy of clinical application.