Initial Pediatric Burn Management: A Practical Guide

Abstract

Children have an imperative to explore their environment to grow and develop, which puts them at risk for sustaining burn injury. Burn injury remains the third leading cause of injury-related death worldwide. Plastic surgeons, as experts in the evaluation and management of cutaneous injuries, are frequently called upon to evaluate and treat children with burn injuries. This article focuses on the unique physiologic aspects of children and how they impact initial evaluation and management of burn injury. Children are not “little adults,” and they have different airway, circulatory, and cutaneous systems. Understanding the signs of potential child abuse is important to avoid further child harm. Finally, recognition of the criteria for referral to a pediatric burn center is important to optimize both short- and long-term outcomes for patients and families.

Keywords

pediatrics - burn injury - initial management

Publication History

Article published online:
04 April 2024

• References

• 1 Libber SM, Stayton DJ. Childhood burns reconsidered: the child, the family, and the burn injury. J Trauma 1984; 24 (03) 245-252
• 2 Centers for Disease Control and Prevention, National Center for Health Statistics. 2020. Multiple Cause of Death 2017–2019 on CDC WONDER Online Database. Accessed January 2024 at: https://wonder.cdc.gov/mcd.html
• 3 Agency for Healthcare Research and Quality. 2021. National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), 2016–2018
• 4 Agency for Healthcare Research and Quality. 2021. Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project (HCUP), 2016–2018
• 5 Toon MH, Maybauer DM, Arceneaux LL. et al. Children with burn injuries–assessment of trauma, neglect, violence and abuse. J Inj Violence Res 2011; 3 (02) 98-110
• 6 Hsu G, von Ungern-Sternberg BS, Engelhardt T. Pediatric airway management. Curr Opin Anaesthesiol 2021; 34 (03) 276-283
• 7 Mack MC, Chu MR, Tierney NK. et al. Water-holding and transport properties of skin stratum corneum of infants and toddlers are different from those of adults: studies in three geographical regions and four ethnic groups. Pediatr Dermatol 2016; 33 (03) 275-282
• 8 Nikolovski J, Stamatas GN, Kollias N, Wiegand BC. Barrier function and water-holding and transport properties of infant stratum corneum are different from adult and continue to develop through the first year of life. J Invest Dermatol 2008; 128 (07) 1728-1736
• 9 Piérard GE, Piérard-Franchimont C, Lê T, Lapière C. Patterns of follicular sebum excretion rate during lifetime. Arch Dermatol Res 1987; 279 (Suppl): S104-S107
• 10 Walters RM, Khanna P, Chu M, Mack MC. Developmental changes in skin barrier and structure during the first 5 years of life. Skin Pharmacol Physiol 2016; 29 (03) 111-118
• 11 Griffin B, Cabilan CJ, Ayoub B. et al. The effect of 20 minutes of cool running water first aid within three hours of thermal burn injury on patient outcomes: a systematic review and meta-analysis. Australas Emerg Care 2022; 25 (04) 367-376
• 12 Dépret F, Hoffmann C, Daoud L. et al. Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study. Crit Care 2019; 23 (01) 421
• 13 Wolf SE, Rose JK, Desai MH, Mileski JP, Barrow RE, Herndon DN. Mortality determinants in massive pediatric burns. An analysis of 103 children with > or = 80% TBSA burns (> or = 70% full-thickness). Ann Surg 1997; 225 (05) 554-565 , discussion 565–569
• 14 ABLS 2023 Manual: Advanced Burn Life Support Course Manual, 2023 Update. Chicago: American Burn Association; 2023
• 15 Lund CC, Browder NC. The estimation of areas of burns. Surg Gynecol Obstet 1944; 79: 352-358
• 16 Deitch EA, Wheelahan TM, Rose MP, Clothier J, Cotter J. Hypertrophic burn scars: analysis of variables. J Trauma 1983; 23 (10) 895-898
• 17 Cubison TC, Pape SA, Parkhouse N. Evidence for the link between healing time and the development of hypertrophic scars (HTS) in paediatric burns due to scald injury. Burns 2006; 32 (08) 992-999
• 18 Accessed December 2023 at; https://www.nationalchildrensalliance.org/media-room/national-statistics-on-child-abuse
• 19 Peck MD, Priolo-Kapel D. Child abuse by burning: a review of the literature and an algorithm for medical investigations. J Trauma 2002; 53 (05) 1013-1022
• 20 Maguire S, Moynihan S, Mann M, Potokar T, Kemp AM. A systematic review of the features that indicate intentional scalds in children. Burns 2008; 34 (08) 1072-1081
• 21 Accessed January 2024 at: https://www.acf.hhs.gov/cb/data-research/child-maltreatment
• 22 Purdue GF, Hunt JL, Prescott PR. Child abuse by burning–an index of suspicion. J Trauma 1988; 28 (02) 221-224
• 23 Robert R, Blakeney P, Herndon DN. Maltreatment by burning. In: Herndon DN. ed. Total Burn Care. Edinburgh: Elsevier Saunders; 2007: 771-780
• 24 Edelman LS. Social and economic factors associated with the risk of burn injury. Burns 2007; 33 (08) 958-965
• 25 Ferguson DM, Parker TD, Marino VE. et al. Risk factors for nonaccidental burns in children. Surg Open Sci 2020; 2 (03) 117-121
• 26 Quiroz HJ, Parreco JP, Khosravani N. et al. Identifying abuse and neglect in hospitalized children with burn injuries. J Surg Res 2021; 257: 232-238
• 27 Accessed January 2024 at: https://ameriburn.org/resources/burnreferral/
• 28 Moritz AR, Henriques FC. Jr. Studies of thermal injury II: the relative importance of time and surface temperature in the causation of cutaneous burns. Am J Pathol 1947; 23: 915-941