Introduction
Burn injuries in children are a significant concern due to their delicate skin and the potential for severe complications. Proper assessment and management are crucial to improve outcomes and prevent long-term consequences. This guide covers essential aspects of burn assessment in pediatric patients.- Scalds: Hot liquids or steam, often from kitchen accidents.
- Contact burns: Touching hot objects like irons or stoves.
- Flame burns: From fire, often due to playing with matches or lighters.
- Electrical burns: Contact with electrical outlets or cords.
- Chemical burns: Exposure to household chemicals.
- Superficial (First-degree) burns: Affect only the outer layer of skin (epidermis). They are red, painful, and dry without blisters.
- Partial-thickness (Second-degree) burns: Involve the epidermis and part of the dermis. These burns are red, blistered, and very painful.
- Full-thickness (Third-degree) burns: Extend through the dermis and affect deeper tissues. The burn site may appear white, charred, or leathery, and there is often no pain due to nerve damage.
How is the extent of a burn measured?
The extent of a burn is typically measured as a percentage of the total body surface area (TBSA) affected. In children, the
Lund and Browder chart is often used for a more accurate assessment, as it takes into account the different body proportions of children compared to adults.
- Airway: Ensure the airway is clear. Look for signs of inhalation injury.
- Breathing: Assess breathing and provide oxygen if necessary.
- Circulation: Check for signs of shock and assess circulation.
- Disability: Evaluate neurological status.
- Exposure: Remove clothing and assess the extent of the burn while keeping the patient warm.
- History: Gather information about the burn incident, including the time, mechanism, and any first aid provided.
- Examination: Thoroughly examine the burn wounds, noting the depth, TBSA, and any associated injuries.
- Pain management: Assess and manage pain using appropriate analgesics.
- Infection: Increased redness, swelling, pus, or fever.
- Dehydration: Dry mouth, sunken eyes, or decreased urine output.
- Respiratory distress: Difficulty breathing, hoarseness, or soot in the mouth or nose.
- Shock: Pale, cool skin, rapid heart rate, or low blood pressure.
- Fluid resuscitation: Use the Parkland formula for calculating fluid needs in the first 24 hours post-burn.
- Wound care: Clean the wound, apply appropriate dressings, and monitor for infection.
- Nutritional support: Ensure adequate caloric intake to support healing.
- Pain management: Provide appropriate analgesia to manage pain effectively.
- Rehabilitation: Early physical therapy and occupational therapy to prevent contractures and promote function.
- Burns greater than 10% TBSA.
- Full-thickness burns.
- Burns involving the face, hands, feet, genitalia, perineum, or major joints.
- Electrical or chemical burns.
- Inhalation injury.
- Burns in patients with pre-existing medical conditions that could complicate management.
Conclusion
Burn assessment in pediatric patients requires careful consideration of the burn depth, extent, and potential complications. Prompt and appropriate management is essential to improve outcomes and minimize long-term sequelae. Always consider referral to a specialized burn center for severe or complicated cases.
