Peds Skin Trauma
Burns
See also Burns (Adult)
For Burns by Age see Age-Related Tables
Initial Management
- ABCs
- Advanced PALS
- Airway
- Breathing
- Circulation
- O2, intubate PRN
- Thermal burns have increased risk of delayed airway closure
- Isotonic IVF (bolus)
- Consult
- Surgery & burn specialist
- Anesthesiology
- Use sterile sheets with aseptic technique
- Determine
- Cause of burn: thermal, electrical
- Duration of contact
- Monitor vitals
- Respiratory rate
- Mental status
- Calculate size of the burn
- Examine
- HEENT for signs of inhalation injury
- Lungs for stridor or other signs of compromise
- CXR
Thermal Burns
- Determine extent of burn
- Superficial (1st deg)
- Epidermal, erythema only, pain
- Partial thickness (2nd deg)
- Dermal, bulla formation (View image), pain
- Full thickness (3rd deg)
- Dermal destruction, NO pain
- Deep (4th deg)
- Bone/ muscle injury
- Partial thickness burns
- Increased fluid loss via increased capillary permeability
- Can cause shock
- Deep burns
- Can cause hemolysis/ rhabdomyolysis with resultant renal shut down
- Fluid resuscitation:
- Minor burns
oral hydration
- Burns >10% TBSA
IV fluids (initial 20 mL/kg crystalloids)
- Parkland Formula: % burn x weight (kg) x 4 cc LR over 24 h), PLUS
- Maintenance fluids (children < 5 yo)
- Intraosseous route if IV access difficult or not possible
- Evaluate for:
- Incidental CO exposure
- Toxic fume exposure (HCN)
- Ischemia
- Generalized: impaired gas exchange due to lung injury
- Localized: vascular compromise due to circumferential burns
- GI complications
- Decreased motility, ileus
- Ischemia
- Pneumatosis intestinalis
Electrical Burns
- Determine type of current (AC vs DC)
- Assess specific organ involvement (physical exam)
- Electricity follows path of least resistance:
- Nerve tissue
- Blood
- Muscle
- Skin
- Tendon
- Fat
- Bone
- Internal injuries may be more severe than external injury
- Monitor for:
- Rhythm disturbances from cardiac injury
- Hemolysis, rhabdomyolysis with renal failure
- Cataract formation
- Labs/Tests
- CBC +diff
- Electrolytes
- BUN/Cr
- CPK
- ABG, CO
- Urinalysis
- Type & cross (as indicated)
- Other Tests
Medical/Pharmaceutical
- Analgesia
- Tetanus prophylaxis
- Administer if not up to date
- Corticosteroids
- Controversial
- Increased risk of infection
- Prophylactic antibiotics
Disposition
- Admit to non-burn unit if:
- Partial thickness burns on <20% of TBSA and NOT on face, hands, feet or perineum
- Full thickness burn on <10% of TBSA
- Questionable social situations
- As needed for other trauma
- Admit to burn unit if:
- Partial thickness of >20% TBSA
- Full thickness of >10% TBSA or on face, hands, feet, or perineum
- Any burns involving face, hands, feet, joints, or perineum
- Significant respiratory injury
- Circumferential burns
- Electrical injury
- Chemical burns
- As needed for other major trauma
- Discharge with follow-up in 1 day if:
- Partial thickness <10% of TBSA
- Full thickness <2% of TBSA if follow-up assured
- Dress with Silvadene cream and bulky dressing
References
- Conti E. [Burns of the hand in children.]. Chir Main. 2013.
- Hardwicke J, Bechar J, Bella H, Moiemen N. Cutaneous chemical burns in children - A comparative study. Burns. 2013.
- Hyland EJ, D'Cruz RA, Harvey JG. Burns from motorcycle exhausts among children in New South Wales: a continuing problem. Med J Aust. 2013;198(10):530.
- Othman N, Kendrick D. Risk factors for burns at home in Kurdish preschool children: a case-control study. Inj Prev. 2013;19(3):184-190.
- Palmieri TL, Nelson-Mooney K, Kagan RJ, et al. Impact of hand burns on health-related quality of life in children younger than 5 years. J Trauma Acute Care Surg. 2012;73(3 Suppl 2):S197-204.
- Porro LJ, Al-Mousawi AM, Williams F, Herndon DN, Mlcak RP, Suman OE. Effects of propranolol and exercise training in children with severe burns. J Pediatr. 2013;162(4):799-803.e791.
- Porter C, Cotter M, Diaz EC, Jennings K, Herndon DN, Birsheim E. Amino acid infusion fails to stimulate skeletal muscle protein synthesis up to 1 year after injury in children with severe burns. J Trauma Acute Care Surg. 2013;74(6):1480-1485.
- Ravindran V, Rempel GR, Ogilvie L. Embracing survival: a grounded theory study of parenting children who have sustained burns. Burns. 2013;39(4):589-598.
- Rosenberg M, Celis MM, Meyer W, et al. Effects of a hospital based Wellness and Exercise program on quality of life of children with severe burns. Burns. 2013;39(4):599-609.
- Schricke DI, Jennings PA, Edgar DW, et al. Scald burns in children aged 14 and younger in Australia and New Zealand-An analysis based on the Bi-National Burns Registry (BiNBR). Burns. 2013.
- Sejpal K, Ali MH, Maddileti S, et al. Cultivated limbal epithelial transplantation in children with ocular surface burns. JAMA Ophthalmol. 2013;131(6):731-736.
- Selig HF, Nagele P, Lumenta DB, et al. [Thermal injuries in the OEAMTC air rescue service : Epidemiological characteristics of burns/scalds in children and adults.]. Unfallchirurg. 2013.
- Shi XQ, Luo Y. Is disability really a protective factor for burns in Kurdish preschool children? Inj Prev. 2013.
- Simons M, Ziviani J, Thorley M, McNee J, Tyack Z. Exploring reliability of scar rating scales using photographs of burns from children aged up to 15 years. J Burn Care Res. 2013;34(4):427-438.
- van Ewijk R, op de Coul ME, Teeuw AH, Wolf BH. [Burns in children: child abuse or another cause?]. Ned Tijdschr Geneeskd. 2012;156(47):A5026.
- Warner P, Stubbs TK, Kagan RJ, et al. The effects of facial burns on health outcomes in children aged 5 to 18 years. J Trauma Acute Care Surg. 2012;73(3 Suppl 2):S189-196.
- Suman A, Owen J. Update on the management of burns in paediatrics. BJA Educ. 2020 Mar;20(3):103-110.
Contributor(s)
- Ballarin, Daniel, MD
Updated/Reviewed: October 2022