What are the guidelines for pediatric burn care?

From the Guidelines

For burn care in a child, immediately run cool (not cold) water over the burn for 10-15 minutes to stop the burning process and reduce pain, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. When caring for a child with burns, it is essential to prioritize their unique needs due to their thinner skin, which can make burns potentially more severe.

• Remove clothing and jewelry from the burned area unless it's stuck to the skin to prevent constriction and vascular ischemia 1.
• Cover the burn with a clean, non-stick bandage or sterile gauze to prevent infection and promote healing.
• For minor burns (redness, slight swelling), apply aloe vera gel or petroleum jelly and give acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) for pain, as these are well-tolerated and generally recommended for burn pain 1.
• Seek immediate medical attention for burns that are larger than 3 inches, on the face, hands, feet, genitals, or major joints, or if the burn appears deep (white, charred, or leathery), as these may require surgical intervention to prevent permanent disability 1.
• Also, get medical help for electrical burns or chemical burns, as these can lead to significant complications, including inhalation injury and carbon monoxide poisoning 1.
• Never apply butter, oil, ice, or cotton balls to burns as these can worsen damage.
• Keep the burn clean and change dressings daily to promote healing and prevent infection. The American Burn Association recommends that patients with second- or third-degree burns involving the face, hands, feet, and genitals and those involving >10% body surface area (5% in children) be treated in a specialized burn center 1. In children, the Lund-Browder chart is the most accurate method for total body surface area (TBSA) quantification, and fluid resuscitation should be tailored to the individual child's needs, taking into account their TBSA and weight 1.

From the Research

Burn Care in Children

• The treatment of burns in children involves various topical agents, including silver nitrate, silver sulfadizine, and mafenide acetate 2
• These agents are used to prevent infection and promote wound healing, and may be used in combination with other treatments such as antibiotics and skin grafts 3
• However, some children may experience allergic reactions to these topical agents, which can be serious and require prompt treatment 4

Topical Agents

• Silver sulfadizine is a commonly used topical agent for burn care, but can cause allergic reactions in some children 4
• Mafenide acetate is another topical agent used in burn care, which can also cause allergic reactions 4
• The use of these topical agents should be carefully monitored in children to minimize the risk of allergic reactions 2, 3

Wound Care

• Debridement, granulation tissue protection, and bacterial control are important aspects of wound care in children with burns 3
• Topical agents such as mafenide acetate can be effective in promoting wound healing and preventing infection 3
• The use of dressings and other wound care products should be tailored to the individual child's needs and carefully monitored to promote optimal healing 2, 3