What are the Differences? - Treatment of Burns in Children Compared to Treatment in Adults

Abstract

Burns in children are very common. In this article we would like to focus on those aspects of wound care and surgical treatment in burns which are special in the paediatric population. Especially in small children it is crucial to correctly estimate a burned area and to delay appropriate fluid resuscitation. Pain management in children is very important, we therefore recommend standing pain orders managed by the nursing team. Wound care should be as little stressful as possible and enable an excellent evaluation of the wound. Surgical coverage is needed in less than 40% of all scald paediatric injuries and should be done with unmeshed split thickness skin from the scalp. In major and massive burns in children one should opt for an aggressive excision of all deep burned areas within the first 4 to 5 days and for a temporary wound coverage before replacing it with meshed autologous skin transplantations and/or keratinocyte sheet grafts. Finally, rehabilitation is very important, it starts at the day of trauma and needs a multidisciplinary approach. Parents have to be involved early, need to be well taught and well trained to guarantee excellent long-term results in a growing child.

Key words

Child - scald injury - skin graft - minor burns

References

• 1 Andronicus M, Oates RK, Pet J. et al . Non-accidental burns in children.  Burns. 1998;  24 552-558
• 2 Bassey PQ, Arons RR, DiMaggio DJ. et al . The vulnerabilities of age: burns in children and older adults.  Surgery. 2006;  140 705-717
• 3 Benjamin D, Herndon DN. Special considerations of age: the pediatric burned patient. In: Herndon DN (ed). Total Burn Care 2nd edn. London: Saunders 2002 pp 232-241
• 4 Carvalja HF. Burns in children and adolescents: initial management as the first step in successful rehabilitation.  Pediatrician. 1990;  17 95-107
• 5 Crawford BS. An unusual skin donor site.  Br J Plast Surg. 1964;  17 311-313
• 6 Deitch EA, Wheelahan TM, Rose MP. et al . Hypertrophic burn scars: an analysis of variables.  J Trauma. 1983;  23 895-898
• 7 Deitch EA, Rutan RL. The challenges of children: the first 48 hours.  J Burn Care Rehabil. 2000;  21 424-430
• 8 Edgerton MT, Hansen FC. Matching facial color with split thickness grafts from adjacent areas.  Plast Reconst Surg. 1960;  25 455-464
• 9 Hildreth MA, Herndon DN, Desai MH. et al . Reassessing caloric requirements in pediatric burn patients.  J Burn Care Rehabil. 1988;  9 616-618
• 10 Hildreth MA, Herndon DN, Desai MH. et al . Current treatment reduces calories required to maintain weight in pediatric patients with burns.  J Burn Care Rehabil. 1990;  11 405-409
• 11 Holland AJ, Martin HC, Cass DT. Laser Doppler imaging prediction of burn wound outcome in children.  Burns. 2002;  28 11-17
• 12 Jackson DM, Topley E, Cason JS. et al . Primary excision and grafting of large burns.  Ann Surg. 1960;  152 167-189
• 13 Janzekovic Z. A new concept in the early excision and immediate grafting in burns.  J Trauma. 1970;  10 1103-1108
• 14 Kloeti J, Pochon JP. Split skin grafts from the scalp.  Prog Pediatr Surg. 1981;  14 111-122
• 15 Klos L, Shwayder T. Cutaneous manifestations of child abuse.  Ped Derm. 2006;  23 311-320
• 16 Langer S, Hilburg M, Drücke D. et al . Analysis of burn treatment for children at Bochum University Hospital.  Der Unfallchirurg. 2006;  109 862-866
• 17 Lund C, Browder N. The estimation of areas of burns.  Surg Gynecol Ostet. 1944;  72 352-358
• 18 Meuli M, Lochbühler H. Current concepts in pediatric burn care: general management of severe burns.  Eur J Pediatr Surg. 1992;  2 195-200
• 19 Reeves SU, Warden G, Staley MJ. Management of Pediatric Burn Patient. In: Richard LR, Statley MJ (eds) Burn Care and Rehabilitation, Principles and Practice. Philadelphia, F. A. Davis 1994 pp 505-509
• 20 Uden G, Hakansson A, Karlsson ED. Burn injuries in small children, a population-based study in Sweden.  J Clin Nurs. 2006;  15 129-134

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