Pediatria pre prax 2/2015

Burn injury in children

Paediatric burns represent more than 30% of all burn injuries in Slovakia. The most frequently affected age groups are children up to 2 years and from 2 to 4 years old. The majority of paediatric burn injuries occur at home and are caused by hot liquids (scalds). The thickness of children´s skin is thinner than that of adults; therefore the burns caused by the same source are in children deeper than in adults. The most effective kind of first aid is immediate cooling of the burned area by tap water, or other kind of clean water. The burn shock develops in children in less extensive burns than in adults; in age groups less than 2 years it can develop in burns affecting 5 to 7% of the body surface area (BSA), and in age groups from 2 to 4 years in burns affecting 7 to 10% of the BSA. Burn severity is evaluated according to age, burn extent, burn depth and localisation. Treatment of minor (small) paediatric burns includes primary diagnosis and surgical wound care under aseptic conditions. Subsequent dressing changes are provided at outpatient clinic in regular intervals until final wound closure. All other burns as well as deep burns require hospital treatment. Severe and critical burns have to be hospitalized in specialized burn centres, where they should be transferred either directly from the accident site within 2 hours post injury, or following primary management in local hospitals preferably not later than 48 hours post burn. Comprehensive burn care of extensive burns requires multidisciplinary approach including intensive/resuscitation care, burn wound care along with surgical interventions aiming at timely removal of necrotic tissues and wound coverage/closure by temporary and/or permanent skin substitutes. Prevention and/or treatment of various complications, nutritional and metabolic support and rehabilitation are of utmost importance as well. Long-term after care of healed wounds, follow-up of scars remodellation together with scar hypertrophy prevention is important following final wound closure. In cases of scar contractures causing impaired joint movement and functions surgical reconstructive procedures are indicated.

Keywords: paediatric burns, diagnostic, burn severity assessment, burn shock treatment, comprehensive care of the burned child.