1. Burns In The Pediatric Population
Dr. E. M. Regis Jr. MD.
House Officer
Dept. of General Surgery

2. Overview
• Definition
• Incidence/ Etiology
• Risk/ Contributing Factors
• Child Abuse
• Pathophysiology
• Classification
• Criteria for admission
• Management
• Complications

3. Definition
• A burn is a type of injury to the flesh or skin
caused by heat, electricity, chemical, friction or
radiation

4. Incidence
• One of the leading causes of accidental injuries
at home.
• 5th most common cause of accidental death in
children
• Hot tap water burns cause more deaths and
hospitalizations than burns from any other hot
liquids.

5. Etiology
• Flame 57%
• Scalding 32%
• Chemical 7%
• Electricity & Radiation 4%

7. Contributing Factors
• Socio-economics
- children from low income homes have 8x a risk of
sustaining burns than those from higher income
homes
- severity of burns inversely proportional to
decreasing SES
- burn mortality is higher among children from
lower SES

8. • Living Conditions
- children are naturally curious, impulsive and
active,…increases risk of burns
- flammable and caustic substances stored in the
home
- heating with indoor fires
- cooking practices;
NB. 2 billion people worldwide cook with open flames or unsafe traditional
stoves

9. - lack of adult supervision
- overcrowding
•Medical conditions
-Epilepsy
* Increase risk of fall
* Traditional medicine practices; eg. The
deliberate burning of feet to “rouse the child
from convulsive state”.

10. Child Abuse
• Burns account for 10% of all cases of child
abuse
• Majority of victims are < 2 years of age
• Scalding is the most common cause

11. Suspicion of child abuse
Burns to:
– Perineum
– Ankles
– Wrists
– Palms
– Soles
•Burns with clean line of demarcation
•Presence of older injuries
•Contradictory accounts of “accident”
•Delays in seeking treatment

12. Pathophysiology
According to Jackson’s Thermal wound theory, there are
three zones associated with burn injuries:
Zone of Coagulation
- area closest to the wound
- ruptured cell membranes, clotted blood & thrombosed
vessels
Zone of Stasis
- area around zone of coagulation
- inflammation & decreased blood flow
Zone of Hyperemia
- peripheral area of the wound
- limited inflammation & increased blood flow

13. Classification

15. Criteria for admission
• Greater than 10% burns in a child
• Any burn in the very young or the infirm
• Any full thickness burn
• Burns of special regions: face, hands, feet, perineum
• Circumferential burns
• Inhalation injury
• Associated trauma or significant pre-burn illness: e.g. diabetes

16. TBSA

18. Management
• ABC
Intubate and mechanically ventilate if you suspect
inhalation injury
Quickly establish IV access (ideally 2 large bore IVs)
Evaluate for compartment syndrome, particularly with
circumferential burns

19. Assessing inhalation injury
• Look for:
– – Singed facial hairs
– – Edema of nose, mouth, pharynx and larynx
– – Carbonaceous sputum
– – Hoarseness
– – Stridor

20. Fluid Resuscitation
– – Restoring adequate intravascular volume to
prevent hypotension and shock
– – Correcting electrolyte abnormalities
– – Minimize renal insufficiency
• If burns >15%
– – Massive fluid shifts will likely occur due to
systemic inflammatory response syndrome (SIRS)
– – Fluid needs will be greater than anticipated
based on appearance of burn alone

21. • Parkland formula:
– 3-4 ml x kg x % total burn surface area (TBSA)
1⁄2 in first 8 hours
Remaining in next 16 hours
• Galveston Shriner’s formula
– 5000 mL/m2 TBSA burn + 2000 mL/m2 body
surface area (BSA)

22. • Fluid: Lactate Ringer
– plus 12.5 g 25% albumin per L
– plus D5W as needed for hypoglycemia
Remember to monitor glucose levels
• Glycogen stores of children <5 y/o run out
quickly
• Inhalation injury increases fluid requirements
by 1.1 ml/kg/% TBSA
• Goal of fluid resuscitation = Adequate urine
output (1-1.5ml/kg/hr)

23. Muir & Barclay Formula
• TBSA % x weight (kg) = volume (mls) fluid need
per period.
•The volume needs to be recalculated at each
change in time period:
• Every four hours for the first 12 hours;
• Every six hours between 12 and 24 hours;
• After 36 hours.

24. Dressings
Topical antibiotic:
– Silver nitrate
• Cheap
• Does not penetrate eschar
• Depletes electrolytes
– Silver sulfadiazine
• Some penetration of eschar
• Risk of neutropenia
– Mafenide acetate
• Penetrates eschar
• Risk of developing acidosis

25. Nutrition
• Burns lead to increased metabolic demands and
energy requirements
– For burns >40%, resting metabolic rate increases
up to 200%
– Primarily protein catabolism
* Protein requirement increased to 2.0 g/kg/day
• Without adequate nutrition wound healing will
not occur

26. • Goal: Loss of less than 10% of preinjury weight
– Patients should be weighed daily
• Enteral feeds are superior to parenteral
– Feed child orally if possible
– Otherwise place nasogastric feeding tube

27. Management cont’d.
• PPIs…. Prophylaxis against stress ulcers
• Adequate analgesics
• Prophylaxis antibiotics
• Physiotherapy/ pressure garments

28. Complications
• Disfigurement
• Contractures
– Lead to severe disability in many cases
• Emotional damage/sequelae
• Delay in reaching developmental milestones and
educational development
• Death

29. Summary
• Burns account for a significant proportion of pediatric
morbidity and mortality worldwide, particularly in LSES.
• Majority of burns are due to fire or scalding, often related
to cooking practices.
• Initial evaluation should always include an assessment for
child abuse.
• Ultimately, the key to decreasing morbidity and mortality
associated with burns is prevention via...
– Educational campaigns
– Legislative changes
– Hazard reduction and environmental modification

30. References
Stone, Keith and Humphries, Roger; Current Diagnosis
and Treatment: Emergency Medicine. McGraw- Hill
New York 2008
Stead, Latha G. etal ; First Aid for the Emergency
medicine Clerkship; McGraw Hill 2002
www.emedicine.com
www.google.com/images
Global Health Education Consortium