This document discusses the management of burns in children. It notes that burns and scalds account for 6% of pediatric injuries, with the majority occurring between 1-2 years of age. House fires are a common cause. Scalds from hot drinks, water, or oil are also frequent. Burns affect different body surface areas in children compared to adults. Younger skin is more susceptible to deeper burns from lower temperatures or shorter exposures. The document provides guidelines for assessing burn severity, fluid resuscitation, monitoring, wound care, and rehabilitation considerations for pediatric burn patients.

1. MANAGEMENT
OF
BURNS IN CHILDREN
Prof. Dr. G. Maheswari., Ph.D. (N).,
Dept. Child Health Nursing,
Dhanvantri College of Nursing,
Namakkal District

2.  Burns and scalds account for 6% of
paediatric injuries
 The majority of burns occurs between 1 to 2
years
 House fires are the common cause of
paediatric burn with smoke inhalation being
the immediate cause of death in many cases
 Scalds are the most commonly associated
with hot drinks, over heated water and hot
cooking oil

3.  Body surface areas differ from adults, with the
head and neck accounting for 21% of total body
surface area (TBS A) (<24).
 The skin is much thinner so that lower temp, or
shorter exposures to heat or chemicals may
creates deeper burns: young child. Therefore,
many wounds that initially appear superficial may
require skin graft.

4.  Scald injury initially appears "cherry red"
Thus frequently is mistaken for superficial
injury when reality it is full-thickness.
 Dehydration is a frequent post burn
complication due to diarrhea, evaporative
water loss, and increase liquid
requirements.
 Burn greater than 10% TBSA requires
formal fluid resuscitation.

5.  Temperature control is more difficult, and
hypothermia is a common post burn
complication.
 Burn injury in young pediatric patients has
a higher mortality rate.
 Hypertrophic scarring is more severe and
scar maturation is prolonged.
 Rehabilitation is more difficult due to poor
cooperation among very young children.

6.  Rule of nine (Quick estimate of percentage
of burn)
 Lund and browder (More accurate
assessment tool)
 Rule of palm (Good for estimating small
patches of wound)

8. Age 0yr 1yr 5yr 10yr 15yr Adult
A 9.5 8.5 6.5 5.5 4.5 3.5
B 2.75 3.25 4 4.5 4.5 4.75
C 2.5 2.5 2.75 3 3.25 3.5

10.  ABG or VBG
 CBC
 C- profile
 Electrolytes, RFT, LFT
 Grouping and cross matching

11.  Primary survey (A,B,C,D,E,F)
 High flow O2 from face mask
 Cervical collar if suspected spine injury
 Cool the burn wound by cold running water
for 15 to 20 mts

12.  Prevent hypothermia
 Insert IV cannula in unburned skin if
possible
 Fluid resuscitation according to protocol
 Urinary catheterization in child with > 20%
of BSA

13.  Insert NG tube with > 20% of BSA, all
intubated patients with head and neck burns
 Adequate analgesia – IV narcotics
 Emergency wound management (Clean non
adhesive dressing)
 Escharotomy if indicated

14.  Evidence of possible airway
compromise
 Burn of head and neck with facial
swelling, hoarse voice, swelling lips,
carbonaceous sputum
 Unconscious patients
 Severe burns more than 20% in child

15. Parkland formula
 4ml Hartmann’s solution X % of Burn X Body
weight in kg
 50% of calculated fluid is administered in the
first 8 hours
 50% remaining fluid should be given in next 16
hours
 The resuscitation fluid requirement is
calculated from the time of the burn, not the
time of presentation.

16. The maintenance fluid is calculated based on the
hourly basis by4-2-1-Rule
 4ml/kg for first 10 kg of body wt
 2ml/kg or 2nd 10 kg of body wt
 1ml/kg for >20 kg of body wt

17.  Maintain urine output at 0.5 ml/kg/hour
 If evidence of extensive tissue damage, then
aim for higher urine output 1-2 ml/kg/hour
 If urine output is not achieved, increase the
fluid volume
 Monitor serum electrolytes specially suspect
for hyponatremia

18. Drops/mt
Total amount of fluid to be infused X Drop factor
------------------------------------------------------------------
Duration in minutes
Macro drops factor = 15
Micro drops factor = 60

19. Calculate fluid volume for resuscitation for 10
years old baby with 30% of full burn and with
23 kgs of body weight
 Hw much to be administered in the first 8
hours ? and hw many drops/mt?
 How much to be given in next 16 hours and hw
many drops/mt?

20. Total volume
2760
First 8 hours – 1380
110 drops/mt
Next 16 hours – 1380
86 drops/mt