1 How common are burns and fire-related deaths among children?

Injury-related deaths are the leading cause of death in children ages 1–14 years. Centers for Disease Control and Prevention statistics from 2002 rate fire- or burn-related injuries as the third leading cause of injury-related deaths in this age group, behind motor vehicle–related deaths and drowning. Burns and fire-related injuries were responsible for 480 childhood deaths in the United States in 2002 and more than 1600 hospitalizations.

National Center for Injury Prevention and Control: www.cdc.gov/ncipc

2 What functions of the skin do burns affect?

3 How are different depths of burns classified?

See Table 51-1.

Table 51-1 Classification of Burn Depth

4 What are the common sources of burns in children?

The cause of burns in children varies with the setting in which they are evaluated and the age of the child (Table 51-2). Common burns treated in an emergency department (ED) differ from those requiring hospitalization. Contact and scald burns make up a higher proportion of burns treated on an outpatient basis. The true pattern of burn injuries in children, including those not seeking medical care, may be substantially different. Scald burns predominate in the younger age group. Most of these occur when the child pulls over a hot liquid from the surface of a table or stove. Burns due to flames account for most hospital admissions in older children.

Table 51-2 Common Sources of Burns in Children

Banco L, Lapidus G, Zavoski, et al: Burn injuries among children in an urban emergency department. Pediatr Emerg Care 10:98–101, 1994.

Morrow SE, Smith DL, Cairns BA: Etiology and outcome of pediatric burns. J Pediatr Surg 31:329–333, 1996.

5 How long must the skin be in contact with hot water to cause a burn?

The actual duration of contact and water temperature required to cause a partial-thickness burn depend on the location and thickness of the skin. Partial-thickness burns on the soles of the feet require a longer period of contact with the water because of the thick layer of skin. Scald burns occur more rapidly in the skin of young children than in adults, and partial- or full-thickness burns can occur in less time than listed below:

Tepas JJ III, Fallat ME, Moriarty TM: Trauma. In Gausche-Hill M, Fuchs S, Yamamoto L (eds): The Pediatric Emergency Medicine Resource, 4th ed. Boston, Jones and Bartlett, 2004, pp 268–323.

6 Why is it important to interview the paramedics who arrive with fire victims?

Paramedics can provide the answers to questions that influence therapy as well as prognosis. Important questions include the following:

7 Name the methods commonly used to estimate the percentage of body surface area (BSA) damaged by burns in a child

The distribution of BSA is different in children and adults. The standard “rule of nines” used in adults is not as accurate in children. The young child has a greater proportion of the BSA in the head and less in the lower extremities. Nagel and Schunk demonstrated that the entire palmar surface of a child’s hand (including the fingers) is approximately 1% of BSA. The Lund and Browder chart (Fig. 51-1) provides useful estimates of larger contiguous burn areas in children younger than 10 years of age. First-degree burns are not generally included in the calculation of total BSA burned.

Figure 51-1 Lund and Bowder charts are somewhat more accurate to estimate the percentage of body surface burn than the rule of nines. Compared with adults, children have larger heads and smaller legs. Other areas are relatively stable through life.

From Roberts JR, Hedges JR: Clinical Procedures in Emergency Medicine, 2nd ed. Philadelphia, W.B. Saunders, 1991, pp 614–615.

Lund C, Browder N: The estimation of areas of burns. Surg Gynecol Obstet 79:352–358, 1944.

Nagel TR, Schunk JE: Using the hand to estimate the surface area of a burn in children. Pediatr Emerg Care 13:254–255, 1997.

8 What is the initial treatment of major burns in a child?

Tepas JJ III, Fallat ME, Moriarty TM: Trauma. In Gausche-Hill M, Fuchs S, Yamamoto L (eds): The Pediatric Emergency Medicine Resource, 4th ed. Boston, Jones and Bartlett Publishers, 2004, pp 268–323.

9 Name some recommended topical therapies for burns

Multiple creams and ointments are appropriate for the treatment of burns. They should perform several functions, including minimizing bacterial colonization, preventing desiccation, and reducing pain. Superficial burns require only a moisturizer. Commonly used topical therapies include:

Monafo WW: Current concepts: Initial management of burns. N Engl J Med 335:1581–1586, 1996.

10 How should blisters be treated?

Intact blisters maintain a sterile environment below the surface, while unroofing the blisters allows for easier cleaning. Nonviable skin from a ruptured blister that is allowed to remain in the burn provides a medium for bacterial growth. Blisters should never be aspirated as this predisposes to infection by disrupting the sterile environment and can introduce bacteria into the wound. The treatment is controversial, but in general, small blisters should be allowed to remain intact. Open blisters, large blisters likely to rupture, and those crossing joints should be unroofed and debrided. The burn is then cleaned with mild soap and water.

Reed JL, Pomerantz WJ: Emergency management of pediatric burns. Pediatr Emerg Care 21:118–129, 2005.