Think about it…. Each year, more than a thousand children aged 1 to 14 years die of

burns, making this the second leading cause of injury-related death in this age group.

Burn injuries are the leading cause of death within the home. They are particularly common in children younger than 3 years.

Eighty percent of childhood burns result from preventable household injuries, while many of the rest are due to child abuse.

Children have thinner skin than adults, so they are more easily burned and more likely to die of a comparable burn injury. Seventy-five percent of all children younger than 3 years who have burns involving more than 40% of the body surface area will die. More than 85% of all children with burns covering more than half their body surface will die.

These figures are considerably higher than for adults. SOURCE: American Burn Association

What we will Cover

• Common causes and classification of pediatric burns

• Initial assessment and management of pediatric burns

• Assessing the depth and extent of a pediatric burn

There are 7 key differences between adult and pediatric burn patients:

(1) children have thinner skin that is more easily damaged, so that a similar mechanism results in a deeper burn;

(2) very young children are more likely to die from their burns; (3) infants, toddlers, and preschoolers are more likely to be

burned as a deliberate act of abuse; (4) children’s body proportions necessitate separate burn

assessment charts for infants, young children, and adolescents; (5) infants and toddlers are more likely to suffer from scald

burns; (6) inhalation injury can rapidly result in upper airway

obstruction; (7) infants and toddlers can quickly dehydrate from second-

and third degree burns.

Impact of burn injuries with kids The skin is the largest organ of the body, and in children,

its surface area is proportionately larger than in adults. Skin acts as a barrier against bacteria and evaporative

water loss from underlying tissues. Serious burn injuries place greater stress on the child’s

body systems than any other type of injury causing: short-term complications….Dehydration, hypothermia,

infection, and damage to internal organs. Long-term effects include severe physical and

emotional scarring. Burn survivors frequently require prolonged hospital stays as well as extensive, painful rehabilitation.

Causes and Types of Burn Injuries Pediatric burn injuries can be divided into 6

major categories according to etiology: scalds contact burns flame burns, electrical burns chemical burns radiation burns

Contact Burns

Scalds account for up to 85% of severe

pediatric burns. Most scalds involve toddlers. Hot tap water is the most common

cause of scalding, followed by hot beverages and cooking liquids.

Contact burns occur when the child touches a hot

object, such as a stove or iron.

The skin initially adheres to the hot object, prolonging the time of contact.

Flame burns are distinct from contact burns in that they involve

actual contact with flames. Traumatic injuries and airway damage often

accompany flame burns. Common Problems: Altered mental status,

hypoxemia, and shock due to tissue destruction and fluid loss are other common problems.

Children burned in house fires are at risk for inhalation injury causing upper airway obstruction and carbon monoxide poisoning requiring high concentration or hypobaric oxygen.

Electrical Burns caused by:

contact with electricity in any form. Most pediatric electrical burns involve household

current, which has a comparatively low voltage. typically occur when

a toddler chews on an electrical cord or a child puts an object into an electrical outlet.

High-voltage injuries R/T to lightning strikes or contact with live power lines are likely to involve older children.

These injuries may cause airway damage, seizures, injury to deep muscles, fractures due to severe muscle spasms, and disturbances in cardiac function, such as asystole or fibrillation.

Chemical Burns When a child handles or swallows a caustic substance. In children, chemical burns usually involve household products,

such as drain cleaner or automotive battery acid. Alkaline agents cause liquefaction necrosis, a process that

turns tissue fats and proteins to soap, damaging all tissue layers.

Acid agents cause coagulation necrosis, which damages superficial layers of tissue. Ingestions of corrosive substances can result in esophageal perforation.

Radiation Burns almost always caused by overexposure

to sun. Sunburns are usually first-degree burns

involving erythema, occasionally second-degree burns with

vesiculation may result in areas of very thin skin.

Assessment and Management of Burn Injuries

The severity of the burn the type of burn the depth of the burn through the skin layers the extent of the burn as a rough percentage

of the child’s total body surface area the location of the burn special circumstances that require routing

to a burn center.

Assessment Type Depth

R/T how deeply they penetrate the skin layers. Color may help you determine the depth of a burn

1st degree 2nd degree

burns destroy the pigment layer at the junction of the epidermis and dermis, exposing the reddish hemoglobin

3rd degree Third-degree burns are avascular and may appear

yellow due to the presence of carotene 4th degree

1st degree First-degree (superficial). painful burns involving the epidermis. The patient will exhibit hyperesthesia, edema,

and erythema without vesiculation. Common Example:

Sunburn

2nd degree Second-degree (partial thickness). Penetrate the epidermis and involve

part of the dermis. The patient will exhibit hyperesthesia,

edema, and vesiculation; broken vesicles are red, moist, and very painful.

Often caused by scalds.

3rd degree Third-degree (full thickness). typically result from:

flame or contact injuries, destroying the full thickness of the skin and

sometimes exposing fat or muscle tissue. Color may vary from yellow or pallid to black and

charred, with a dry, waxy, or leathery appearance. people with these burns often cannot feel/repond

to a pinprick because nerve endings have been destroyed

4th degree These burns destroy the epidermis and

dermis, damaging underlying muscle, tendon, bone, and fat tissue.

High-voltage electrical injuries may cause fourth-degree burns. Electrical shocks, lightening

Prevention R/t Age Groups

Birth to 1 year Install smoke alarms in or near bedrooms, check them monthly and change batteries

twice a year. * Never microwave bottles--it heats unevenly. * Never leave children unattended while food is being prepared. * Never store anything flammable on stovetop. * Never eat or drink hot foods or liquids while holdingor carrying an infant. * Test all warm liquids and foods before feeding. * Shorten electrical cords by coiling them; do not allow them to dangle. * Do not use tablecloths. * Always keep cooking utensil handles turned to back of stove. * Keep highchairs, chairs, and playpens away from stoves and counters. * Walkers are dangerous, remove wheels or do not use. * Use safety plugs in all unused outlets. * Limit time in sun--babies burn easily, use sunscreen (at least 30 SPF). *

Birth to 1 year cont. Only use cool mist vaporizers, keep them a safe distance from crib.

* Allow three feet between a space heater and anything flammable.

* Keep candles, potpourri, matches, cigarettes, etc., out of reach.

* Run cool water first for tub, then warm until desired temperature.

* Test tub water with wrist, elbow, or special thermometer.

* Face child away from faucet and toward opposite end of tub.

* Set water heater temperature at 120 degrees F.

* Store chemicals/cleaners in original containers and out of reach or locked up.

* Keep baby equipment out of direct sunlight; metal and plastic parts can cause burns.

* Always dress your baby in non-flammable sleepwear.

Toddlers--From One to Three Years

* Never leave children unattended in kitchen while food is cooking.

* Never allow a child to stand on chair near the stove while you are cooking.

* Never leave hot iron unattended on ironing board.

* Never store snacks on or above stove, children may try to get them.

* Never leave cigarettes, matches, lighters, etc., in reach of children.

* Never store flammable items on stovetop.

* Never allow electrical appliances in or near bathtub.

* Never leave a child alone in the house.

* Install functioning smoke alarms in or near bedrooms; check them monthly and change batteries twice a year.

* Establish a three-foot "No Zone" around all hot appliances: stove, fireplace, barbecue, heaters, etc.

* Do not allow young children to pour or handle hot liquids or food.

* Do not allow children to play with pots and pans, they cannot tell when they are hot or not.

* Do not use tablecloths; children can pull hot foods, candles, potpourri, etc. onto them.

Toddlers--From One to Three YearsCont.

Always have shoes on your child when outside; hot sidewalks, sand, cigarettes, campfires, etc. can cause burns.

* Store chemicals and cleaners in original containers and out of reach or locked up. Never store in pop bottlers or other "drink type containers."

* Install safety plugs in all unused outlets.* Use button or knob covers for stove.* Always keep cooking utensil handles turned to the back to stove and use back burners to cook.* Keep electrical cords short by coiling them; do not allow them to dangle.* Keep water heater temperature at 120 degrees F.* Run cool tub first, then add warm until desired temperature.* Monitor while taking a bath. Do not leave alone.* Always use sunscreen, (at least 30 SPF) when outside, even on cloudy days.* Use safety decals on bottom of tub, to prevent falls.* Do not keep flammable liquids in your home.* Use only cool mist vaporizers, and keep them a safe distance from bed or crib.* Use space heaters that have an automatic shut off switch for accidental tip over.* Always use non-flammable sleepwear.

Preschool--Three to Five Years

Continue adequate supervision.* Discourage game playing, (hide and seek, tag, etc.) around heat or fire sources such as stoves,

heaters, barbecues, fireplaces, etc.* Keep matches and lighters out of reach, and purchase only child-resistant lighters.* If you smoke, never leave lit cigarettes unattended.* Begin to educate your child on fire safety, escape routes, and the "stop, drop, and roll"

technique.* Practice and reinforce these fire safety rules often with your child.* Do not give hot foods or liquids to your child, allow items to cool.* Do not carry hot foods or liquids and your child at the same time.* Do not attempt to carry hot foods or liquids with toddlers underfoot.* Do not use tablecloths, as they are too easily pulled off.* Keep fire extinguishers in your home, check the pressure often.* Be a good role model, children mimic adults.* Never allow children to handle fireworks.* Use only flame-retardant and noncombustible costumes for Halloween.* Teach children that matches and lighters are tools for adults, and when they are older you will show

them how to use them properly.

Grade School

Teach your child how to call 911 and what to say.* Instruct your child on using matches and lighters safely and responsibly.* Begin to instruct your child on safe cooking methods: * Wear short or close fitting sleeves to avoid catching on fire. *Turn pot handles to back. If grease fire starts: cover the pan, turn off burners, do not try to move pan.* Never put water on grease fire.* Lift lids away from you, to allow steam to escape.* Use oven mitts to move pans or lift lids.* No playing around while cooking.* Place microwave at level safe for your child to use.* Teach microwave safety:

Use move mitts to remove items, containers get hot.

Grade School

Instruct about coiling cords or using short ones, and the "no dangle" rule.* Teach children not to "warm up" by or near fireplaces, heaters, or fires.* Teach your child electrical safety: * Do not climb on electrical poles or towers.* Do not climb over fences that surround electrical substations.* Do not fly kites near electric power lines.* Do not attempt to retrieve kite if caught in power lines.* Do not climb trees near power lines.

Teach your child proper use of extension cords: do not overload, do not run under carpets, run behind furniture, etc.* Use only flame-retardant and noncombustible costumes for Halloween.* Be a good role model.* Involve children in planning and practicing safety and fire drills.* Always dress in non-flammable sleepwear.

Teenage Safety

Allow lawnmower engines to cool before refueling. Work on cars outdoors only, gasoline vapors may ignite. Never open radiator cap if car overheats, allow to cool. Use caution with hair dryers and long hair, hair can be pulled into motor and catch fire. Use caution with curling irons. Avoid too much sun--use adequate sunscreen and/or clothing. Use caution when using hobby glues and finishes; vapors can ignite or cause loss of

consciousness. Inquire about fire and safety issues for any new job. Do not use fireworks. Use matches and lighters with caution. Never throw aerosol cans in a fire, they can explode. Never ignite vapors from aerosol cans, they can explode. Never use gasoline to start a fire. Never smoke while refueling a car. Never smoke while using an aerosol can (hairspray, paint, etc.). Always use ashtrays for cigarettes and matches. Do not wear loose clothing around open flames. No fooling around or fighting while cooking.

Teenage Safety

Learn what to do when smoke alarm goes off: * Yell FIRE! Warn anyone who may be home.* Follow preplanned escape routes.* Do not try to save anything (CDs, jewelry, pets, etc.) except yourself.* If you see smoke, keep low, crawl, take short breaths or use wet cloth over nose or mouth.* Feel doors, if hot, do not open, find alternate route.

Do not re-enter until told to do so by an adult.

Teenage Safety cont. Babysitting Safety:

Know contact phone numbers.escape plan.Never leave child alone.Don't smoke.Ask about cooking privileges.Never carry hot foods or liquids and a child at the same time.No loose or large sleeves while cooking.Never leave child alone in the kitchen.Do not allow child under foot while cooking.If bathing a child, gather all supplies prior to bath.Run cold water first, then add warm.Test water with wrist or thermometer.If you need to leave bathroom, take child with you.

Burn Tx: Varies according to type and location Keep child warm Assess ABC’s

Developmental Freud - birth to 1year

B/c infants derives pleasure largely from the mouth eating and sucking.

Most burns to this age group are r/t to formula that is too hot, or chewing on cord or getting a liquid spilled on them.

Developmental Toddlers 1 to 3 years

Erickson “Autonomy vs. Shame and Doubt” Motor skills are more developed and gaining

more control over their actions. They like to get into everything in site and do not understand the results of their actions fully yet.

Grabbing, exploring.

Developmental Preschool 3 to 6 years old

Piaget “ preoperational’ Cognitive ability in increasing rapidly, but with

out the logic to back actions and thoughts up. They don’t totally understand the consquences

for their actions

Developmental School age child

Piaget ”concrete operational” Can understand the rational for their actions

Developmental Teenagers/adolescents

Piaget “formal operational” Mature thinking. The know and understand

actions and consequences, how to react to situations (most)

What Can you Do.. Lets do ti for the Kids! Show support and interest in pediatric burn care and treatment. Contact local agencies to plan and implement a scald/burn

awareness day Build a community coalition Encourage media coverage (to increase awareness).

In Closing Although the hazards of motor vehicles, poisons, and small

parts seem to be well understood by parents, there seems to be no comparable understanding of the potential for burns and scalds.

This is b/c of such the variety of child product interactions and the vastly broad ranges of child development stages.

Thus prevention requires a constant vigilance during a variety of settings.So maybe this is what makes scalds and burns so intervention resistant? YOU be the judge

THANK YOU FOR YOUR TIME.

References Nursing Care pediatric Trauma Patient

By Patricia A. Maloney-Harmon,2003 Saunders Publications. Maternal Newborn Care

Marcia l London,Prentice Hall Publishers 2003

www.shiners.org Shiners Hospitals Pediactric Rehabilitation Journal 2002, volume,5 no. 1