One third of all burn unit admissions and deaths involve children. Flame and scald burns are the major mechanisms of injury in the pediatric burn population. Children younger than 4 years of age are at greatest risk. Despite improvement in burn care, burn injury remains the fifth leading cause of unintentional child injury-related death. Approximately 10% to 20% of pediatric burns are a result of child abuse. The majority of all deaths related to burns are due to smoke inhalation rather than surface burns or their sequelae.

As with any patient, the priority during the assessment of a child with a burn is the adequacy of the airway, breathing, and circulation (ABCs). Early identification and treatment of life-threatening injuries are critical. It is crucial to evaluate for the possibility of inhalation injury early on. It is equally important to understand the mechanism of injury and the circumstances surrounding the burn so that other life-threatening injuries, such as a closed head injury, can be identified.

Smoke inhalation injury can cause respiratory decompensation by several mechanisms. Direct thermal injury to the airway can cause airway obstruction and require immediate intubation. Clinical markers to suspect upper airway compromise include respiratory distress, hypoxemia, hoarseness, stridor, deep burns to the face or neck, blistering on the oropharynx, tongue swelling, carbonaceous sputum, and singed eyebrows and nasal hairs.