Consult the medical resource doctors trust

UpToDate is one of the most respected evidence-based medical information resources in the world, used by over 400,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Emergency care of moderate and severe thermal burns in children

INTRODUCTION

Burns are the third leading cause of accidental death (following motor vehicle/pedestrian and drowning injuries) among children in the United States (US) [1]. Although mortality from serious burn injuries has declined as the result of advances in burn care and the implementation of prevention strategies, children with moderate and severe burn injuries require intensive treatment and often experience scarring and long term disability.

Early identification and treatment of associated injuries, fluid resuscitation, and prompt referral of children with major burns to burn centers improve outcomes.

This topic will review the emergency care of moderate and severe thermal burns in children. The care of adult burn patients, minor thermal burns, smoke inhalation, and electrical injuries are discussed separately. (See "Emergency care of moderate and severe thermal burns in adults" and "Treatment of minor thermal burns" and "Smoke inhalation" and "Environmental electrical injuries".)

EPIDEMIOLOGY

Over 120,000 children (20 years of age or younger) receive care in emergency departments (EDs) for fire or burn related injuries annually [1,2]. Many burn injuries are minor and do not require hospital admission [3,4]. The mortality rate for children admitted to burn centers is less than 3 percent [5,6].

Worldwide, scalds account for 60 to 80 percent of burn injuries for young children [3,4,7-11]. Among children in the United States less than 5 years of age with burn injuries reported to the National Burn Repository, 65 percent sustained scalds [8]. In comparison, 27 percent of patients 5 to 20 years of age had scald injuries.

» To continue reading this article you need to login or subscribe.

Ready to join over 400,000 satisfied users? Subscribe to read this article and others like it.
Last literature review version 18.2: May 2010
This topic last updated: May 11, 2010
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2010 UpToDate, Inc.
References
Top
  1. National Center for Injury Preventions and Control www.cdc.gov/ncipc/wisqars/ (Accessed April 12, 2007).
  2. D'Souza, AL, Nelson, NG, McKenzie, LB. Pediatric burn injuries treated in us emergency departments between 1990 and 2006. Pediatrics 2009; 124:1424.
  3. Carlsson, A, Uden, G, Hakansson, A, Karlsson, ED. Burn injuries in small children, a population-based study in Sweden. J Clin Nurs 2006; 15:129.
  4. Drago, DA. Kitchen scalds and thermal burns in children five years and younger. Pediatrics 2005; 115:10.
  5. Barrow, RE, Spies, M, Barrow, LN, Herndon, DN. Influence of demographics and inhalation injury on burn mortality in children. Burns 2004; 30:72.
  6. Sheridan, RL, Remensnyder, JP, Schnitzer, JJ, et al. Current expectations for survival in pediatric burns. Arch Pediatr Adolesc Med 2000; 154:245.
  7. Tse, T, Poon, CH, Tse, KH, et al. Paediatric burn prevention: an epidemiological approach. Burns 2006; 32:229.
  8. Miller, SF, Bessey, PQ, Schurr, MJ, et al. National Burn Repository 2005: a ten-year review. J Burn Care Res 2006; 27:411.
  9. Liu, EH, Khatri, B, Shakya, YM, Richard, BM. A 3 year prospective audit of burns patients treated at the Western Regional Hospital of Nepal. Burns 1998; 24:129.
  10. Al-Shehri, M. The pattern of paediatric burn injuries in Southwestern, Saudi Arabia. West Afr J Med 2004; 23:294.
  11. Lowell, G, Quinlan, K, Gottlief, LJ. Preventing unintentional scald burns: moving beyond tap water. Pediatrics 2008; 122:799.
  12. Ryan, CM, Schoenfeld, DA, Thorpe, WP, et al. Objective estimates of the probability of death from burn injuries. N Engl J Med 1998; 338:362.
  13. Istre, GR, McCoy, M, Carlin, DK, McClain, J. Residential fire related deaths and injuries among children: fireplay, smoke alarms, and prevention. Inj Prev 2002; 8:128.
  14. Smith, GA, Knapp, JF, Barnett, TM, Shields, BJ. The rockets' red glare, the bombs bursting in air: fireworks-related injuries to children. Pediatrics 1996; 98:1.
  15. Jones, D, Lee, W, Rea, S, et al. Firework injuries presenting to a national burn's unit. Ir Med J 2004; 97:244.
  16. Sheridan, RL, Ryan, CM, Petras, LM, et al. Burns in children younger than two years of age: An experience with 200 consecutive admissions. Pediatrics 1997; 100:721.
  17. Hight, DW, Bakalar, HR, Lloyed, JR. Inflicted burns in children recognition and treatment. JAMA 1979; 242:517.
  18. Kumar, P. Child abuse by thermal injury--a retrospective survey. Burns Incl Therm Inj 1984; 10:344.
  19. Weimer, CL, Goldfarb, IW, Slater, H. Multidisciplinary approach to working with burn victims of child abuse. J Burn Care Rehabil 1988; 9:79.
  20. Daria, S, Sugar, NF, Feldman, KW, et al. Into hot water head first: distribution of intentional and unintentional immersion burns. Pediatr Emerg Care 2004; 20:302.
  21. Titus, MO, Baxter, AL, Starling, SP. Accidental scald burns in sinks. Pediatrics 2003; 111:E191.
  22. Sheridan, RL, Weber, JM, Schnitzer, JJ, et al. Young age is not a predictor of mortality in burns. Pediatr Crit Care Med 2001; 2:223.
  23. Ali, SN, O'Toole, G, Tyler, M. Milk bottle burns. J Burn Care Rehabil 2004; 25:461.
  24. Chuang, SS, Yang, JY, Tsai, FC. Electric water heaters: a new hazard for pediatric burns. Burns 2003; 29:589.
  25. Sheridan, RL. Burns. Crit Care Med 2002; 30:S500.
  26. Klein, GL, Herndon, DN. Burns. Pediatr Rev 2004; 25:411.
  27. Reynolds, EM, Ryan, DP, Sheridan, RL, Doody, DP. Left ventricular failure complicating severe pediatric burn injuries. J Pediatr Surg 1995; 30:264.
  28. Press, B. In: Grabb and Smith's Plastic Surgery, Fifth Edition, Aston, SJ, Beasley, RW, Thorne, CHM (Eds), Lippincott-Raven Publishers, Philadelphia 1997.
  29. Bessey, PQ, Watters, JM, Aoki, TT, Wilmore, DW. Combined hormonal infusion simulates the metabolic response to injury. Ann Surg 1984; 200:264.
  30. Hill, GL. Jonathan E. Rhoads Lecture. Body composition research: implications for the practice of clinical nutrition. JPEN J Parenter Enteral Nutr 1992; 16:197.
  31. Aarsland, A, Chinkes, D, Wolfe, RR, et al. Beta-blockade lowers peripheral lipolysis in burn patients receiving growth hormone. Rate of hepatic very low density lipoprotein triglyceride secretion remains unchanged. Ann Surg 1996; 223:777.
  32. Baron, PW, Barrow, RE, Pierre, EJ, Herndon, DN. Prolonged use of propranolol safely decreases cardiac work in burned children. J Burn Care Rehabil 1997; 18:223.
  33. Herndon, DN, Pierre, EJ. In: Pediatric Surgery, Ashcraft (Ed), WB Saunders, Philadelphia 2000.
  34. Gilpin, DA, Barrow, RE, Rutan, RL, et al. Recombinant human growth hormone accelerates wound healing in children with large cutaneous burns. Ann Surg 1994; 220:19.
  35. Allison, K, Porter, K. Consensus on the prehospital approach to burns patient management. Emerg Med J 2004; 21:112.
  36. Nguyen, NL, Gun, RT, Sparnon, AL, Ryan, P. The importance of immediate cooling--a case series of childhood burns in Vietnam. Burns 2002; 28:173.
  37. Jandera, V, Hudson, DA, de Wet, PM, et al. Cooling the burn wound: evaluation of different modalites. Burns 2000; 26:265.
  38. Madnani, DD, Steele, NP, de Vries, E. Factors that predict the need for intubation in patients with smoke inhalation injury. Ear Nose Throat J 2006; 85:278.
  39. Watts, AM, McCallum, MI. Acute airway obstruction following facial scalding: differential diagnosis between a thermal and infective cause. Burns 1996; 22:570.
  40. Goldstein, AM, Weber, JM, Sheridan, RL. Femoral venous access is safe in burned children: An analysis of 224 catheters. J Pediatr 1997; 130:442.
  41. Sheridan, RL, Weber, JM. Mechanical and infectious complications of central venous cannulation in children: lessons learned from a 10-year experience placing more than 1000 catheters. J Burn Care Res 2006; 27:713.
  42. Barrow, RE, Jeschke, MG, Herndon, DN. Early fluid resuscitation improves outcomes in severely burned children. Resuscitation 2000; 45:91.
  43. Nguyen, NL, Gun, RT, Sparnon, AL, Ryan, P. The importance of initial management: a case series of childhood burns in Vietnam. Burns 2002; 28:167.
  44. Graves, TA, Cioffi, WG, McManus, WF, et al. Fluid resuscitation of infants and children with massive thermal injury. J Trauma 1988; 28:1656.
  45. Cartotto, RC, Innes, M, Musgrave, MA, et al. How well does the Parkland formula estimate actual fluid resuscitation volumes?. J Burn Care Rehabil 2002; 23:258.
  46. Mitra, B, Fitzgerald, M, Cameron, P, Cleland, H. Fluid resuscitation in major burns. ANZ J Surg 2006; 76:35.
  47. Carvajal, HF, Griffith, JA. Burn and inhalation injuries. In: Pediatric critical care, 3rd ed, Furhman, BP, Zimmerman, J (Eds), Mosby Elsevier, Philadelphia 2006. p.1565.
  48. Fodor, L, Fodor, A, Ramon, Y, et al. Controversies in fluid resuscitation for burn management: literature review and our experience. Injury 2006; 37:374.
  49. Roberts, I, Alderson, P, Bunn, F, et al. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2004; :CD000567.
  50. Alderson, P, Bunn, F, Lefebvre, C, et al. Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database Syst Rev 2004; :CD001208.
  51. Bunn, F, Roberts, I, Tasker, R, Akpa, E. Hypertonic versus near isotonic crystalloid for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2004; :CD002045.
  52. Huang, PP, Stucky, FS, Dimick, AR, et al. Hypertonic sodium resuscitation is associated with renal failure and death. Ann Surg 1995; 221:543.
  53. Singer, AJ, Thode, HC Jr. National analgesia prescribing patterns in emergency department patients with burns. J Burn Care Rehabil 2002; 23:361.
  54. Martin-Herz, SP, Patterson, DR, Honari, S, et al. Pediatric pain control practices of North American Burn Centers. J Burn Care Rehabil 2003; 24:26.
  55. Sargent, RL. Management of blisters in the partial-thickness burn: an integrative research review. J Burn Care Res 2006; 27:66.
  56. Alsbjorn, B, Gilbert, P, Hartmann, B, et al. Guidelines for the management of partial-thickness burns in a general hospital or community setting--recommendations of a European working party. Burns 2007; 33:155.
  57. Bryan, J. Moist wound healing: a concept that changed our practice. J Wound Care 2004; 13:227.
  58. Hussain, S, Ferguson, C. Best evidence topic report. Silver sulphadiazine cream in burns. Emerg Med J 2006; 23:929.
  59. Caruso, DM, Foster, KN, Blome-Eberwein, SA, et al. Randomized clinical study of Hydrofiber dressing with silver or silver sulfadiazine in the management of partial-thickness burns. J Burn Care Res 2006; 27:298.
  60. Muangman, P, Chuntrasakul, C, Silthram, S, et al. Comparison of efficacy of 1% silver sulfadiazine and Acticoat for treatment of partial-thickness burn wounds. J Med Assoc Thai 2006; 89:953.
  61. Paddock, HN, Fabia, R, Giles, S, et al. A silver-impregnated antimicrobial dressing reduces hospital costs for pediatric burn patients. J Pediatr Surg 2007; 42:211.
  62. Pham, TN, Warren, AJ, Phan, HH, et al. Impact of tight glycemic control in severely burned children. J Trauma 2005; 59:1148.
  63. Thomas, SJ, Morimoto, K, Herndon, DN, et al. The effect of prolonged euglycemic hyperinsulinemia on lean body mass after severe burn. Surgery 2002; 132:341.
  64. Gibran, NS, Klein, MB, Engrav, LH, Heimbach, DM. UW Burn Center. A model for regional delivery of burn care. Burns 2005; 31 Suppl 1:S36.
  65. Klein, MB, Nathens, AB, Emerson, D, et al. An analysis of the long-distance transport of burn patients to a regional burn center. J Burn Care Res 2007; 28:49.
  66. Spies, M, Herndon, DN, Rosenblatt, JI, et al. Prediction of mortality from catastrophic burns in children. Lancet 2003; 361:989.
  67. Cancio, LC, Reifenberg, L, Barillo, DJ, et al. Standard variables fail to identify patients who will not respond to fluid resuscitation following thermal injury: brief report. Burns 2005; 31:358.
Emergency care of moderate and severe thermal burns in children Infant benefits of breastfeeding Patient information: Seborrheic dermatitis (including dandruff and cradle cap) Bronchioloalveolar carcinoma Chorionic villus sampling: Risks, complications, and techniques Patient information: Chorionic villus sampling Thin basement membrane nephropathy (benign familial hematuria) Chronic menorrhagia or anovulatory uterine bleeding Clinical manifestations and diagnosis of calcium pyrophosphate crystal deposition disease Patient information: Depression treatment options for adolescents