Children with burn injuries require complex care, involving medical, surgical, critical care, and rehabilitation services. Assessment always initially involves evaluation of the ABCs. Most severely burned patients are intubated for airway protection and respiratory support. There may be presence of direct injury due to inhalation injury or secondary injury due to activation of systemic inflammatory response. Proper fluid management, prevention of infection, and adequate pain control are important factors for the continued care of burn patients.

Burn trauma leads to hypovolemic and distributive shock, due to generalized microvascular injury and interstitial third spacing. There are ongoing fluid shifts throughout resuscitation and recovery. Fluid resuscitation formulas have been developed based on the percentage of body surface area (BSA) burned and weight of the patient. The Parkland formula is the most widely used formula. The formula provides resuscitation with isotonic crystalloid solution at 4 mL/kg per percentage of BSA burned plus the maintenance intravenous fluid (IVF) rate; the first half of fluid resuscitation is provided over the first 8 hours and the second half over the next 16 hours. This formula provides an estimate of fluid requirements and continual clinical parameters must be assessed to adjustment the fluid resuscitation to meet the patient’s physiologic demands. The most common parameter to monitor is urine output. If the urine output is 1 to 2 mL/kg/hr, then fluid management is appropriate. If the output is <1 mL/kg/hr, an increase in fluid resuscitation, such as a fluid bolus may be necessary. When the output is >3 mL/kg/hr, the fluid rate should be decreased to two-thirds the calculated Parkland formula recommendation. Judicious use of fluid may avert such complications as pulmonary edema, cerebral edema, or acute electrolyte fluctuations.