Most burns are minor and involve burns to the hands, feet, head or trunk area. A common problem is todecide as whether the child needs to be admitted, whether fluids should be introduced, and whether grafting is needed. In general burns to the hands, feet, face and genital areas always require admission. Often a history ishelpful in that if the child had a simple splash injury and there is only erythema than the child can bemanaged as an outpatient. Alternatively a child who has grabbed a hot iron and burns to the flexor creasesof the hand should be admitted and early grafting considered.
A child under 1 year of age has a head and neck surface area equal to 18% of total body surface area witheach lower limb being 14%. Each year after this the head proportionally looses 1% and the lower limbsgain 0.5% each. Therefore adult proportions are reached at around 10 years of age. The estimation of thesurface area and depth of burn is always difficult and more important than precise calculations, is to startthe appropriate fluids, insert a urinary catheter and review the child regularly. The aim in children is toproduce 1mL per kilogram per hour of urine. A starting resuscitation infusion is 4ml of Ringer’s lactate per kilogram body weight, for each percent of burns over the first 24 hours. Once the 24 hours fluid is worked out one half of the fluid is administered inthe first 8 hours and the remaining half in the next 16 hours. It is important to remember that the abovefluid requirement is for resuscitation and maintenance fluids must be added. In young children glucoseneeds to be added to the solutions to maintain their blood sugar levels. It must be stressed that the early calculations are only an approximation and the most important feature inthe resuscitation of burns is frequent reassessment and adjustments of fluids depending on the urineoutput.
Estimation of body surface area in children may be difficult
It is important to start fluid resuscitation early.
The management of paediatric burns is a specialized area. As early as possible the child should betransferred to a burns unit for assessment by a Paediatric Burns Surgeons. The reason for this is not somuch the expertise in treating the burn per se, but rather the large team effort, which involves complexpain relief, specialist nurses, social workers, physiotherapists, nutritionists, and family therapists. Burnsoften occur in families where there has recently been some social disruption and this together with the guiltfelt by the parents greatly aggregates the difficulty in treating the burns. Contractures can occur quickly