Define Burns in Children. Describe its management, pathophysiology and prevention.

Definition

Burns are tissue injury from heat, chemicals, electricity or radiation; scalds (hot liquids) are the commonest in children. Assessment of extent and depth guides management.

Assessment

• Extent — % total body surface area (TBSA) using a paediatric-modified rule of nines or the Lund-Browder chart (children have a relatively larger head).
• Depth — superficial, partial-thickness, full-thickness.
• Assess for inhalation/airway injury (facial burns, soot, stridor).

Management

• Stop the burning and cool with running water; secure the airway (early intubation if inhalation injury).
• Fluid resuscitation for significant burns using the Parkland formula, titrated to urine output.
• Analgesia, wound care, infection prevention, tetanus prophylaxis, and nutritional support.
• Refer major/complex burns to a burns unit.

Criteria for Referral / Admission

• Large %TBSA, full-thickness or circumferential burns, burns of face/hands/perineum, inhalation injury, electrical/chemical burns.
• Suspected non-accidental injury (pattern/immersion burns) — assess for abuse.

Pathophysiology of Burn Shock

Large burns cause massive fluid shifts and plasma loss into the burnt/injured tissues, producing hypovolaemia ('burn shock') — the reason for formula-guided fluid resuscitation titrated to urine output.

Prevention

Many paediatric emergencies are preventable — safe storage of poisons/medicines, supervision, protective measures and prompt first aid substantially reduce serious harm and mortality.