The child with burns: extent by age, fluids and output, dressings and pain

What it is

Children, especially toddlers, are burned mostly by scalds. Their skin is thinner, so the same heat burns deeper, and their large surface area for their weight means they lose fluid and heat faster than adults. The nurse gives first aid, helps estimate the burned area with an age-adjusted method, runs and monitors the fluid plan the doctor orders, keeps the child warm, treats pain before procedures, cares for the wounds, starts early feeding and supports the child and family.

What it requires

• Children with burns of about 10 to 15 % or more of body surface usually need prompt IV fluid resuscitation per paediatric protocol.
• Superficial (epidermal) burns are not counted in the burned surface.
• Burned-area estimates by referring services are often too high; overestimation leads to too much fluid.
• Urgent care for deep, large, electrical or chemical burns, burns of face, hands, feet or genitals, or possible inhalation injury.

How it is applied (and why)

1. Stop the burning and cool with cool running water for about 20 minutes, keeping the rest of the child warm — cooling limits depth.
2. Assess airway and breathing first and watch for inhalation injury — small airways are more vulnerable to obstruction.
3. Help estimate the burned area with an age-adjusted chart — child body proportions differ from an adult's.
4. Start and check IV fluids exactly as ordered, timed from the burn, not from arrival — half of the volume is due in the first 8 hours.
5. Measure urine output every hour (urinary catheter per order) and report it against the target — output guides the fluid rate.
6. Keep the child warm: cover, warm the room, limit exposure during dressings — small children lose heat quickly.
7. Assess pain with an age-appropriate scale and give analgesia before dressings, plus distraction — burn care is painful.
8. Do dressings per protocol, with clean technique, watching for signs of infection — children are prone to sepsis.
9. Start feeding early per the nutrition plan and involve the family in care and play — burns raise energy needs for months.

In nursing practice

• Too little fluid harms organs; too much (fluid creep) causes swelling, compartment syndrome and lung oedema.
• Children's urine-output target per kilogram is higher than an adult's; use the target in the order.
• Many children develop post-traumatic stress, anxiety or low mood in the first year: early psychological support helps.
• When the burn pattern does not fit the story, record the findings and follow the institutional maltreatment protocol.

Common mistakes

• Ice or home remedies on the burn, or cooling the whole child until cold.
• Starting the fluid clock at arrival instead of at the time of the burn.
• Counting superficial redness in the burned area.
• Dressing changes without analgesia beforehand.

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Burns (fact sheet) (World Health Organization, 2025); A primer on burn resuscitation (Bacomo FK, Chung KK), J Emerg Trauma Shock (Europe PMC (open access), 2011); Technical and Medical Aspects of Burn Size Assessment and Documentation (Giretzlehner M et al.), Medicina (Kaunas) (Europe PMC (open access), 2021); Burns in Early Childhood: Age-Specific Causes, Risks, Management, and Implications (Pelizzo G et al.), Children (Basel) (Europe PMC (open access), 2025).

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Representative model, for educational purposes only.