Management of the Pediatric Burn Patient
Stephanie Scurci
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For centuries, physicians have searched for treatments for burn victims; however, survival has improved dramatically in the last 50 years with advancements and better understand-ing of the pathophysiology.
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Ancient burn care consisted primarily of topical treatments including honey, rendered pig fat, wine, and myrrh.
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The discovery of penicillin by Sir Alexander Fleming in 1928 played a large part in burn treatments with systemic antibiotics.2
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In the 1940s, Underhill studied the importance of fluid resuscitation in burn patients. In 1952, body weight and body surface area burned were combined to create a formula for resuscitation, which underwent substitution of normal saline for lactated ringers and is now known as the Parkland formula.2
RELEVANT ANATOMY
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Children have thinner skin and less developed thermoreg-ulation systems compared with adults, so they tend to get deeper burns, lose heat more rapidly, and have greater insen-sible fluid loss.
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Pediatric patients also differ in the larger body surface area of their heads and smaller legs.
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The traditional classification for burns (first, second, third) has been adjusted to reflect the need for surgical therapy, which now includes superficial (first), superficial par-tial-thickness (second), deep partial-thickness (second), full-thickness (third), and fourth degree burns (Figure 11.1).
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Second degree burns are divided into superficial partial and deep partial because of the difference in treatment. Deep partial may require surgical excision, whereas superficial par-tial can often be treated topically.
Figure 11.1 Skin burns are classified as superficial, partial thickness, or full thickness. A, Superficial burns affect only the outer layer of epidermis. B, Partial-thickness burns affect the lower layers of epidermis. C, Full-thickness burns destroy the entire layer of epidermis. (Reprinted with permission from Shaw KN, Bachur RG, eds. Fleisher & Ludwig’s Textbook of Pediatric Emergency Medicine. 7th ed. Philadelphia, PA: Wolters Kluwer; 2016.) |
EPIDEMIOLOGY AND ETIOLOGY
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One-fourth of burn injuries occur in children under the age of 16 years.
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Burns are the third leading cause of accidental deaths after vehicle and drowning deaths.
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Overall mortality rates are <3%; however, rates are higher for children <4 years of age.
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These 2 defects vary in etiology, epidemiology, and genetic predisposition.
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History and physical examination findings concerning for child abuse include delayed presentation for care, conflict-ing histories, previous injuries, sharply demarcated margins, uniform depth, absence of splash marks, stocking or glove patterns, flexor sparing, dorsal location on hands, and very deep localized contract injury.
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Common accidental mechanisms for burn injuries in children include biting electrical cords, exposure to hot bathwater, and spilling of hot liquids (Figure 11.2).
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Risk factors for scalding include age, crowded homes, unsu-pervised play, low socioeconomic status, younger unmarried mothers, and lack of maternal education.
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