PEDIATRIC BURNS

A pediatric burn is an injury to the skin or underlying tissue imposed

in under the age of eighteen. And is globally the most common type
of pediatric injury. Burns can be caused by heat, cold, chemical or
radiation.
Causes of Burns in Children-
Scalds from hot liquids:
- Accidental spills
- Contact with hot liquids such as boiling water, hot beverages,
soups or cooking oil
- Contact with hot objects:
- Children can sustain burns when they touch or come into contact
with hot objects such as hot pan, heaters, stove tops
- Flames and fire-related incidents:
- Exposure to flames or involvement in fire-related accidents
- Incidents may occur from house fires, open flames, fireworks,
matches or playing with lighters
- Electrical burns:
- Accidental contact with electrical outlets
- Faulty wiring or playing with electrical cords or appliances
- Chemical burns:
- Exposure to strong acids, alkalis or kerosene substances
- Sunburns:
 - Prolonged exposure to sun's radiation without proper protection
- Inhalation burns:
- Inhalation of hot gases, smoke or toxic fumes during fire or
chemical incidents

Classification of Burns
First Degree Burns- Superficial burns affecting only the outer layer
of the skin (epidermis)
- Symptoms include redness, pain, and minor swelling
- Usually heal within a week without scarring
- Examples include mild sunburns and brief contact with hot objects
Second Degree Burns- Partial thickness burns affecting both
epidermis and dermis
- Symptoms include redness, blistering, severe pain, and swelling
- Takes several weeks to heal and can leave scars
Third Degree Burns- Extend through all layers of the skin and may
affect underlying tissue
- Symptoms include white appearance, waxy or leathery texture, and
little to no pain
- Require immediate medical attention and skin grafting or
reconstructive surgery may be necessary for healing.
Clinical Manifestations of Burns
1. Skin Damage: Visible damage to the skin, including burns, blisters,
and lesions.
2. Pain and Discomfort: Patients may experience significant pain and
discomfort due to nerve damage or irritation.
3. Swelling and Edema: Fluid accumulation in the affected area can
lead to swelling and edema.
4. Blisters: Fluid-filled blisters may form, especially in second-degree
burns.
5. Skin Color Changes: The affected area may exhibit changes in skin
color, such as redness, blanching, or charring.
6. Impaired Mobility: Burns can limit mobility due to pain, swelling,
or contracture formation.
7. Respiratory Distress: Inhalation of smoke or toxic fumes can cause
respiratory symptoms, such as coughing, wheezing, or shortness of
breath.
8. Systemic Symptoms: Severe burns can lead to systemic symptoms,
including fever, infection, or organ dysfunction.
Effects of Burns on the Skin- Skin damage: The skin affected by
burns may appear red, blistered, or charred, depending on the severity
of the burn.
- Pain and discomfort: Burn injuries can cause significant pain and
discomfort in children.
- Symptoms:
- Pain, tenderness, and sensitivity at the burn site
- Swelling and edema: Burned areas may show swelling due to
inflammation and fluid accumulation in the surrounding tissues.
- Blisters: Blisters may form on the skin as a response to the burn
injury.
 - Skin color changes: Depending on the severity and depth of the
burn, the affected skin may appear red, white, pale, charred, or have a
mottled appearance.
- Impaired mobility: Burn injuries, especially those involving joints
or large areas of the body, can limit a child's mobility.
- Respiratory distress: If a burn affects the face or airway, there is a
risk of respiratory distress due to swelling and airway obstruction.
- Systemic symptoms: Severe burns can lead to systemic symptoms
such as fever, dehydration, electrolyte imbalance, and metabolic
disturbances.
Diagnosis Initial Assessment- Physical examination
- Classification and documentation: The burn will be classified
according to the depth and percentage of total body surface area
(TBSA) involved.
- Methods to estimate TBSA:
- Rule of nines
- Lund-Browder chart
Additional Investigations- Complete blood count
- Blood chemistry panel
- Blood gas analysis
- Imaging studies:
- X-rays
- Ultrasound
- Ordered to evaluate for associated injuries and complications.
Treatment of Burns
Medical Management- Pain Management: Pain relief is crucial and
can be achieved through various methods, including:
- Non-opioid analgesics
- Opioids if necessary
- Local anesthetics
- Non-pharmacological techniques such as distraction and
relaxation techniques
- Wound Care: The burn wounds need to be kept clean and protected
to prevent infection, involving:
- Gentle cleansing
- Application of topical antimicrobial agents
- Appropriate dressing selection based on the depth and location of
burns
- Fluid Resuscitation: In case of moderate to severe burns, especially
with larger total body surface area involvement, fluid resuscitation
may be necessary to maintain hydration and prevent hypovolemia.
- Fluids are administered intravenously and adjusted based on the
child's weight, burn severity, and ongoing fluid losses.
- Tetanus Prophylaxis: If the child's tetanus vaccination status is not
up to date or if the burn is contaminated, TT should be given.
- Nutritional Support: Burn injuries can increase the child's
metabolic needs; adequate nutrition, including protein
supplementation, is essential.
Surgical Management- Debridement: Surgical debridement may be
required to remove devitalized tissue, promote wound healing, and
reduce the risk of infection.
- Techniques include sharp debridement, enzymatic debridement,
or surgical excision.
- Skin Grafting: For deep burns that are unlikely to heal
spontaneously, skin grafting may be necessary.
- Involves transferring healthy skin from one area of the body
(donor site) to the burned area (recipient site) to promote healing.
- Scar Management: Burn scars can be managed through techniques
such as:
- Pressure garments
- Silicone gel sheeting
- Massage therapy
- Physical therapy
Pharmacological Management- Antibiotics: Can be given according
to the needs of the patient.
- Other Medications: May be prescribed to manage specific symptoms
or complications, such as:
- Anti-inflammatory drugs
- Anti-pruritic medication
- Prophylactic anticoagulants
Fluids and Calculation- Types of Fluids: Commonly used fluid
formulas include Parkland and modified Brooke formulas.
- Crystalloid Fluids: Most fluid regimens use crystalloids, which are
aqueous solutions of mineral salts and other small water-soluble
molecules.
- Colloid Fluids: Some studies suggest that colloids are useful in
decreasing total fluid administration, thereby reducing the risk of fluid
overload and edema formation.
- Colloid Options: Include albumin, dextran, and hydroxyethyl starch.

Parkland formula, which is used to calculate the total amount of

fluid required for burn resuscitation. The formula is:
Total fluid (in mL) = 4 mL × %TBSA (Total Body Surface Area
burned) × weight (in kg)
Given values:
- 4 mL
- 15% TBSA (Total Body Surface Area burned)
- 6 kg (weight)
Total fluid (in mL) = 4 mL × 15 × 6 kg
Total fluid (in mL) = 4 × 15 × 6
Total fluid (in mL) = 360 mL
So, the total fluid required for the first 24 hours would be 360 mL.
According to the Parkland formula, half of this volume is given in the
first 8 hours, and the remaining half is given over the next 16 hours.

Fluid for the first 8 hours = 360 mL / 2 = 180 mL

Fluid for the next 16 hours = 180 mL

Modified Brooke FormulaThe Modified Brooke Formula is used to

calculate fluid resuscitation needs for burn patients.
Initial 24 hours:- 3 mL × %TBSA (Total Body Surface Area burned)
× weight (in kg)
- Fluids used: Lactated Ringer's solution (no colloids)
Next 24 hours:- Colloids: 0.3-0.5 mL/kg/% burn
- No crystalloids are given
- Glucose in water is added to maintain good urine output
This formula helps guide fluid resuscitation in burn patients, but it's
essential to adjust according to individual patient needs and response.
Modified Brooke Formula:
3 mL × 20 (%TBSA burned) × 8 kg
Total fluid = 3 × 20 × 8
Total fluid = 480 mL
This is the total fluid required for the initial 24 hours. According to
the formula, this volume would be administered as lactated Ringer's
solution.