Created by : Hebatullah ElAjou

Burns in
Pediatric
The main outlines
At the end of this seminar , you
would be able to:
Define the burns and define differentiate between its various
types
Knowing the structures of the skin
Counting the total body surface area that is affected from the
burn
Managing the injury
Counting the amount of fluid that you should give to the
patient
Understand the complications of burns , especially in
paediatrics
Some steps to prevent burns
 Definition of burns

Burns is : tissue injury result from thermal

effect to skin layers which may include the
underlying tissue of the skin ( muscles , bones)
burns can lead to serious complications or
maybe death
The depth of the burn depends on two
main things:
The intensity of heat
The duration of exposure
The
anatomy
of skin
 Types of burns
Burns are classified based on
their cause into several types:

1. Thermal Burns: Caused by heat from fire,

hot liquids, or objects.
2. Chemical Burns: Resulting from contact
with corrosive substances like acids or
6. Cold Burns (Frostbite): Occur
bases.
from prolonged exposure to
3. Electrical Burns: Caused by electric
extreme cold.
shock, often affecting internal tissues.
7. Scald Burns: Caused by hot
4. Radiation Burns: Due to exposure to
liquids or steam, common in
radiation, such as from the sun or medical
children.
treatments.
5. Friction Burns: Caused by rubbing
Each burn type requires
against a surface, generating heat and skin
different treatment based on its
damage
damage.. specific cause and severity.
degrees of the burns
Degree of burns
 The most dangerous
type of burns according
What is the most
to degree: common type of
In pediatrics, third-degree burns burns according to
(full-thickness burns) are
considered the most dangerous.
the cause…?
These burns destroy both the
outer layer (epidermis) and the
entire underlying layer (dermis), The most common type of burns in
and can even extend into deeper
pediatrics, based on the cause, are
tissues such as muscle, fat, or
bone. Third-degree burns are scald burns. These burns result
particularly dangerous in from exposure to hot liquids or
children
steam
 The rule of Pediatric Rule of Nines (for
Infants and Young Children):

nines • Head and Neck: 18% (larger

than adults due to the
proportionally bigger head).
is a method used to estimate the • Each Arm: 9% (same as in
percentage of the total body adults).
surface area (TBSA) affected by • Each Leg: 14% (smaller than in
burns. It differs from the adult adults, where each leg is 18%).
version due to the different body • Anterior Trunk (Front of the
proportions in children, Body): 18% (same as in adults).
particularly the larger head and • Posterior Trunk (Back of the
smaller limbs in younger patients. Body): 18% (same as in adults).
Here’s how it works for children • Perineum/Genital Area: 1%
(same as in adults).
The difference between adults and pediatrics in
the rule of nines
 How to manage burns in
Pediatric patients
The management of burns in pediatric patients involves a systematic approach that includes
initial assessment, treatment of the burn, pain management, and ongoing care. Here’s a
comprehensive overview:

1. Initial Assessment

• Evaluate the Burn: Determine the type (thermal, chemical, electrical, etc.), depth
(first, second, third), and extent (using the Rule of Nines) of the burn.
• Assess the condition: Check for airway patency, breathing, circulation, and signs of
shock
 How to manage burns in
Pediatric patients
2. First Aid and Immediate Management

• Stop the Burning Process:

• For thermal burns: Remove the child from the source of heat and cool the burn with cool (not
cold) running water for 10-20 minutes to reduce the temperature and pain.
• For chemical burns: Flush the affected area with large amounts of water to remove the chemical.
• Cover the Burn: Use a clean, non-stick dressing or a sterile gauze to cover the burn to protect it
from infection.
• Prevent Shock: If the burn is extensive, position the child flat and elevate the legs. Monitor vital
signs closely.
 3. Pain Management

• Medications: Administer appropriate analgesics

based on the child’s age and weight.
• Comfort Measures: Use distraction techniques, such
as toys or music, to help ease anxiety and discomfort.

4. Wound Care 5. Infection Prevention

• Cleansing: After initial cooling and dressing, gently • Maintain strict hygiene during wound
clean the burn area with mild soap and water. care.
• Topical Treatments: Apply appropriate topical • Administer tetanus prophylaxis if
antibiotics as recommended by a healthcare indicated (typically if the child’s
professional. vaccinations are not up to date).
• Dressing Changes: Change dressings as needed,
typically every 1-3 days, and watch for signs of 6. Psychosocial Support
infection (increased redness, swelling, pus).
• Provide emotional support and
reassurance to the child and family.
• Involve child life specialists if available
to help manage anxiety and fear.
 Medications for pediatric
burns
Pain management Topical antibiotics

• Acetaminophen: 10-15 mg/kg every 4-6 hours for mild to

moderate pain.
• Silver Sulfadiazine: For second- and third-
• Ibuprofen: 5-10 mg/kg every 6-8 hours for mild to moderate
degree burns; applied once or twice daily.
pain and inflammation.
• Bacitracin: For minor burns; apply a thin
• Opioids (e.g., Morphine, Fentanyl): Used for moderate to
severe pain, with doses based on the child’s weight and
layer as needed.
condition. • Mupirocin: For infected or colonized areas;
• Topical Lidocaine: For local pain relief in minor burns. applied as prescribed.

Hydration

The Parkland formula is used to calculate the fluid

resuscitation needs for burn patients, including pediatric
patients
 Parkland formula in Pediatric

3 ml of crystalloid fluid * % TBSA * weight (kg)

in burns, the most common fluid is used is
ringer’s lactate
Some physical findings you may notice when you’re assessing
the patient:

• Temperature (may be elevated if wounds are infected)

• Heart rate (may be elevated because of pain)
• Blood pressure (may be low if child is in shock)

The type of shock that a pediatric patient may experience following a burn is hypovolemic shock. This
occurs due to significant fluid loss from the burn injury, which damages the skin and underlying tissues.
The skin normally acts as a barrier to fluid loss, but burns cause the loss of plasma and other fluids
through the damaged surface, leading to dehydration, decreased blood volume, and subsequent
hypovolemic shock.
 Complications of burns

Common Complications of Pediatric Burns

1. Infection: Burns can get infected because they break the skin barrier.
2. Fluid Loss and Shock: Severe burns can cause a lot of fluid loss, which can lead to shock and might
need emergency treatment.
3. Scarring: Deeper burns can leave scars and make movement difficult.
4. Pain and Emotional Issues: Burns are painful, and children may feel anxious or scared. Some may
develop stress-related problems.
5. Growth Problems: Burns on arms or legs can affect how children grow and move.
6. Breathing Problems: Burns on the face or chest can cause breathing difficulties.
7. Nutrition Issues: Kids with burns might not eat well, leading to nutritional problems.
8. Social Issues: Children may feel teased or bullied because of their scars, which can hurt their self-
esteem.
And finally, here are some simple things will help you to avoid burns injury in Pediatrics
The first article

“Epidemiology and Severity of Burns in Children: A Study in Ilam „

• Aims: The study aimed to investigate the epidemiology and severity of burns in children
under 12 years of age admitted to Imam Khomeini Hospital in Ilam from 2015 to 2019.
• Location: Imam Khomeini Hospital, Ilam, Iran.
• Design: A retrospective descriptive study that examined medical records of children
admitted with burn injuries between 2015 and 2019.
• Sample Size and Characteristics: The study included 150 children under 12 years old with
burn injuries. The majority of cases were in children under 3 years (61.3%, 92 individuals), with
more than half being boys (55.3%, 83 individuals).
• Main Results:
• Second-degree burns accounted for 87.3% of cases (131 individuals).
• Approximately 80% of cases (120 individuals) involved burns covering 1-20% of the body surface area.
• Hot liquids were the leading cause of burns (79.9%, 119 individuals).
• 84% (126 individuals) of burns occurred in enclosed spaces.
• 18.7% of cases (122 individuals) required hospitalization, with no fatalities reported.
• Recommendations: Preventive measures should target young children, particularly those under three
years of age and boys, to reduce burn incidents. Addressing factors like the availability of combustible
materials, especially hot liquids, through educational programs is recommended to contribute to burn
prevention efforts.
• Conclusion:
Preventive measures, particularly targeting young children and boys, are crucial in reducing burn incidents.
Educational programs and reducing exposure to combustible materials like hot liquids are essential
strategies for burn prevention.
The second article:

• Title: The Early Childhood Development of Pediatric Burn

Published: 14 May 2024
• Aims: The study focuses on understanding the developmental outcomes of pediatric burn patients,
specifically looking at cognitive, motor, and social development.
• Location: This study is international in scope, but the journal is affiliated with the European Burns
Association.
• Design: It appears to be a review or observational study analyzing the impacts of burns on early childhood
development, referencing existing literature and data.
• Sample size and characteristics: The specific sample size isn’t detailed, but it is implied to focus on early
childhood (likely ages 0-5) and pediatric burn patients.
• Main results: The study likely outlines developmental delays or challenges faced by young children following
burn injuries, particularly in motor and cognitive development, as well as social integration issues.
• Recommendations: There may be suggestions for early interventions, rehabilitation, and holistic care
approaches tailored to enhance recovery and development in burn patients.
• Conclusion: The overall emphasis would likely be on the need for targeted developmental support for pediatric
burn patients to ensure better long-term outcomes.
Thank you for
your attention