Paeds · acute-care-resuscitation-and-toxicology
Burns assessment, resuscitation and safeguarding
Also known as Paediatric burn assessment · Paediatric burn resuscitation · Modified Parkland in children · Lund and Browder burn assessment · Burns safeguarding
A fellowship approach to the burned child inside an organised burn-care system. Stop the burning process and cool with running water for 20 minutes within 3 hours of injury, estimate percent total body surface area with an age-adjusted Lund and Browder chart, recognise the threatened airway and inhalation injury, start modified-Parkland fluid resuscitation at or above 10 percent TBSA and titrate to urine output, run safeguarding in parallel, apply the burns-centre referral criteria, and hand over safely.
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Target exams
Red flags
- A threatened airway in an enclosed-space fire: singed nasal or facial hair, soot in the mouth, voice change, drooling or stridor demand early definitive airway before swelling closes it
- Carbon monoxide or cyanide exposure from an enclosed fire: confusion, reduced conscious state, lactataemia or a high carboxyhaemoglobin need oxygen and a low threshold for cyanide antidote
- A burn of 10 percent TBSA or more: this child needs formal modified-Parkland fluid resuscitation calculated from the time of injury, not observation alone
- A circumferential full-thickness burn of a limb or the chest: threatened perfusion or ventilation needs urgent burns-centre and escharotomy referral, not delay
- An inconsistent history, a delay in presentation, a stocking-glove or immersion distribution, or a burn in a non-mobile infant: run safeguarding in parallel while you resuscitate
- A button battery that has passed the oesophagus or is stuck: this is a time-critical emergency needing urgent endoscopy within hours, not observation
Life stages
Care settings
Clinical exam formats
Board mappings
- Acute Care
- Current 2026 PREP curriculum — Learning Objective 2.2.1: Recognise, prioritise and manage an acutely ill infant, child or young person
- Current 2026 PREP curriculum — Learning Objective 2.2.3: Perform acute resuscitation and advanced life support
- Current 2026 PREP curriculum — Learning Objective 2.4.4: Assess and manage infants, children and young people with potential cardiac, respiratory or neurological emergencies or acute sepsis
- Current 2026 PREP curriculum — Learning Objective 2.4.5: Manage transfer of an unwell newborn, infant, child or young person
- Current 2026 PREP curriculum — Learning Objective 2.4.1: Assess and manage infants, children and young people with child protection concerns
- Renewed curriculum for first-year trainees from 2027 — Learning goal 11: Acute care and procedures
- Renewed curriculum for first-year trainees from 2027 — Learning goal 17: Acute care
- Clinical Applications
- Medical Sciences
- Long Cases
- Short Cases
- 3. Professional skills and knowledge: Clinical procedures
- 4. Professional skills and knowledge: Patient management
- 6. Leadership and team working
- 7. Patient safety, including safe prescribing
- 8. Safeguarding: Child protection
- General Paediatrics: Resuscitates, stabilises and treats extremely unwell babies, children and young people, liaising with specialist teams, as necessary
- General Paediatrics: Assumes the role of Acute Paediatric Team Leader
- Foundation of Practice (FOP)
- Theory and Science (TAS)
- Applied Knowledge in Practice (AKP)
- Clinical
- History
- Communication
- Video
- General Pediatrics Content Outline — Domain 7: Emergency and Critical Care
- General Pediatrics Content Outline — Universal Task 1: Physiology and Pathophysiology
- General Pediatrics Content Outline — Universal Task 3: Diagnosis
- General Pediatrics Content Outline — Universal Task 4: Management and Treatment
- General Pediatrics EPA 7: Recognizing a Severely Ill Patient, Providing Initial Management, and Mobilizing Resources Needed for Continued Care
- Patient Care 3: Organize and Prioritize Patient Care
- Patient Care 4: Clinical Reasoning
- Patient Care 5: Patient Management
- Systems-Based Practice 1: Patient Safety
- Interpersonal and Communication Skills 2: Interprofessional and Team Communication
- Medical Expert
- Pediatrics: Foundations EPA #1 — Recognizing deteriorating and/or critically ill patients and initiating stabilization and management
- Pediatrics: Core EPA #2 — Resuscitating and stabilizing critically ill patients
Overview & Definition
A burn is an injury to the skin and deeper tissues caused by thermal, electrical, chemical or radiation energy. In a child the same injury behaves differently from the same injury in an adult, because a smaller body loses fluid and heat faster, the head and legs take up a different share of body surface area, and the history is often shaped by the developmental stage and the caregivers around the child. The burned child is therefore managed inside an organised burn-care system that runs from pre-hospital first aid through a burns centre and a rehabilitation pathway, and your job at the bedside is the front of that system. [1] [3]
The acute encounter has one rhythm. You stop the burning process, cool the burn, and keep the child warm. You run a primary survey adapted for the burn, looking hardest for the threatened airway and inhalation injury. You estimate the percent total body surface area burned, or TBSA, with an age-adjusted chart, and you judge depth at the bedside. You start formal fluid resuscitation for the larger burn and titrate it to urine output. In parallel with all of this, you keep safeguarding open, because a burn in a child is a sentinel event that is inflicted, neglected or accidental more often than is comfortable. [2] [9]
[2] [8]Most children present with a small scald or contact burn that needs cooling, analgesia, a dressing and follow-up. A minority present with a major burn that needs the full resuscitation pathway and a burns centre. The skill the examiner is testing is the triage between the two: which child can go home, which needs admission, and which needs a retrieval and a burn surgeon in the next hour. That triage rests on three numbers (the percent TBSA, the depth, and the time of injury) and one judgement (is the story consistent with the burn). [1] [10]
The first five minutes of a paediatric burn call
- 1
Stop and cool
Stop the burning process, remove clothing and jewellery, and cool with running water for 20 minutes within 3 hours of injury while keeping the rest of the child warm.
- 2
Airway and oxygen
Assess for inhalation injury; singed hair, soot, voice change or stridor mean call airway expertise and plan an early definitive airway.
- 3
Assess size and depth
Estimate percent TBSA with an age-adjusted Lund and Browder chart, exclude erythema, and judge depth at the bedside.
- 4
Resuscitate and analgesia
Gain access, give weight-based analgesia, and start modified-Parkland Hartmann for 10 percent TBSA or more plus maintenance in the young child.
- 5
Refer and safeguard
Apply the burns-centre referral criteria, run safeguarding in parallel, document objectively, and agree the destination with retrieval.
References12ShowHide
- [1]Hettiaratchy S, Papini R Initial management of a major burn: I--overview BMJ, 2004.PMID 15217876
- [2]Hettiaratchy S, Papini R Initial management of a major burn: II--assessment and resuscitation BMJ, 2004.PMID 15242917
- [3]Cuttle L, Fear M, Wood FM, et al. Management of non-severe burn wounds in children and adolescents: optimising outcomes through all stages of the patient journey The Lancet Child and Adolescent Health, 2022.PMID 35051408
- [4]Cuttle L, Kempf M, Kravchuk O, et al. The efficacy of Aloe vera, tea tree oil and saliva as first aid treatment for partial thickness burn injuries Burns, 2008.PMID 18603378
- [5]Colson CD, Alberto EC, Milestone ZP, et al. EasyTBSA as a method for calculating total body surface area burned: a validation study Emergency Medicine Journal, 2023.PMID 36639224
- [6]Choi J, Patil A, Vendrow E, et al. Practical Computer Vision Application to Compute Total Body Surface Area Burn: Reappraising a Fundamental Burn Injury Formula in the Modern Era JAMA Surgery, 2022.PMID 34817552
- [7]Stevens JV, Prieto NS, Ridelman E, et al. Weight-based vs body surface area-based fluid resuscitation predictions in pediatric burn patients Burns, 2023.PMID 35351355
- [8]Toon MH, Maybauer MO, Greenwood JE, et al. Management of acute smoke inhalation injury Critical Care and Resuscitation, 2010.PMID 20196715
- [9]Mullen S, Begley R, Roberts Z, et al. Fifteen-minute consultation: Childhood burns: inflicted, neglect or accidental Archives of Disease in Childhood - Education and Practice, 2019.PMID 29934360
- [10]Kazis LE, Sheridan RL, Shapiro GD, et al. Development of clinical process measures for pediatric burn care: Understanding variation in practice patterns Journal of Trauma and Acute Care Surgery, 2018.PMID 29140950
- [11]Krom H, Benninga MA, Bosman DK, et al. The incidence and complication rate of pediatric battery ingestion in the Netherlands European Journal of Pediatrics, 2026.PMID 41563491
- [12]Gee Kee EL, Kimble RM, Cuttle L, et al. Scar outcome of children with partial thickness burns: A 3 and 6 month follow up Burns, 2016.PMID 26546385