Paediatric Burns

Total burn surface area (TBSA) and burn type (degree) define burn injuries, which can be thermal, radiation, chemical, or electrical. TBSA is calculated using standard charts that show dorsal and ventral views of the body divided into discrete sections with established percentages of TBSA. The intensity and duration of contact with heat determine the degree and depth of skin injury.

A first-degree burn is defined as an injury to the epidermis. Second-degree or partial-thickness burns are more severe damage to the dermis. Full-thickness (third-degree) burns include many skin layers and may cause damage to subcutaneous tissue and peripheral nerve fibers. According to the American Burn Association's guidelines, burns are light, moderate, or severe.

Incidence of Paediatric Burns

Nearly 1.5 million people in the United States annually suffer burn injuries. Burn injuries are the fourth highest cause of unintentional mortality in children, accounting for 5,500 deaths per year. Approximately 70,000 people are hospitalized for burn injuries, with children and adolescents accounting for over half of the victims. Thirty-eight percent of individuals hospitalized for burn injuries are under the age of 15 years. Children and adolescents are disproportionately impacted, accounting for two-thirds of all fatalities and having a male-to-female ratio of 2:1. Fire and burn injuries are the third most significant cause of mortality in youth (up to the age of 19), trailing only motor vehicle accidents in children aged 1-4 years. Most pediatric fire-related deaths occur due to smoke inhalation rather than an acute burn injury.

Children under five account for more than half of all pediatric burn injuries. The method in which children are wounded, as expected, differs according to the child's developmental level. For example, scalds from liquid spills and bathing account for 75-80 percent of newborn burn injuries. Ninety-five percent of burns occur within the first two years of life. Toddlers are vulnerable to pulldown liquid, food accidents, and boiling tap water as their motor abilities develop. Preschool and school-aged children are frequently hurt while playing with lighters, matches, and kitchen appliances (microwaves and stoves).

Medical Assessment and Treatment

Burn therapy is divided into three overlapping phases: the emergency phase, the acute phase, and the rehabilitation phase. At the site, emergency care includes removing the injured person's heat source. Standard first-aid procedures are followed to provide an unobstructed airway and to assess pulmonary, hematologic, and shock status. Continued examination and stabilization of respiration happens upon admission to the emergency room. Endotracheal tube insertion may be necessary. A central line provides fluids, and a bladder catheter is inserted to measure output. Capillary function improves in the days following damage, and a "fluid shift" occurs.

Complications such as pulmonary edema and congestive heart failure are possible. Vital signs, heart functions, temperature, and IV fluids are all monitored. Gastrointestinal (GI) functions significantly decline or halt, and patients with more than 20% TBSA burns may require a nasogastric tube. Once the patient is stabilized, the focus shifts to the wound(s). The acute period of therapy (e.g., repeated IV placements, dressing changes, wound washing, grafting) is frequently the most stressful and traumatic.

Severe infection is a considerable risk during this stage. Antibiotics, autografting (transplanting skin from undamaged portions of the patient's body to the location of the injury), and nutritional assistance are all part of the treatment. Eschar (burned tissue) must be removed surgically. Debridement treatments, which include the forceful removal of devitalized tissue, are performed one to two times every day. Wound infection is treated using topical medicines. Full-thickness burns recover in 3-4 weeks, whereas partial-thickness burns heal in 3-5 weeks.

Physiological dressings (transplanted skin from cadavers or animals or artificial preparations) may be necessary. These dressings are just temporary and will be rejected by the body. Autografting is a treatment for severe burns. This technique is frequently performed in stages based on the wound healing rate and donor material availability. To reduce scarring, patients often use pressure dressings and garments. Medical, surgical, physical therapy, dietary, and self-care procedures continue during rehabilitation. Reconstructive procedures frequently necessitate multiple hospitalizations over several years.

Psychosocial Assessment and Treatment

Various premorbid (pre-burn) risk factors for children with burn injuries have been identified. These include the child's psychological qualities and stability, those of the family, and demographic and environmental influences. A thorough evaluation of the child's premorbid cognitive, behavioral, developmental, educational, peer, and family functioning status is critical. This information will directly inform intervention strategies during inpatient hospitalization and provide vital information to guide posthospital discharge psychological follow-up.

The child's mental state, nutritional intake, adherence to treatment, intense itching associated with the healing process, pain management, symptoms related to the trauma of the burn experience, body image concerns, management of behavior perceived to be complicated by burn unit staff, and finally, issues regarding career and family adjustment to the recovery experience are all significant concerns.

Correction of electrolyte imbalances and continuous orientation processes that involve the use of visual aids (e.g., clocks, calendars), as well as the kid being allocated the same staff members throughout therapy, are characteristic of disorientation management. Sleep and sensory deprivation linked with extended stays in the ICU might culminate in an intensive care unit (leU) psychosis. Behavioral techniques, such as contingency management, have been demonstrated to improve caloric and fluid intake, lowering the requirement for tubal and intravenous feedings.

Concerning adherence, carers, and children are trained to identify impediments to self-care (wound care, pressure garment use), generate alternative solutions, make family decisions, and employ creative solutions. Contingency management strategies have also been demonstrated to be beneficial in increasing adherence.

For younger children, behavioral interventions such as response interruption and distraction have typically been beneficial in diverting their focus away from itching and towards more developmentally appropriate activities. Posttraumatic stress disorder and accompanying issues such as depression-anxiety symptoms and acting-out behavior are frequent.

Timely intervention with proven therapy is required. Social skills training may be beneficial in educating kids who have suffered disfiguring burn injuries on how to cope with the disfigurement and deal with peer teasing and other reactions when interacting in public places. Body image problems are more common among wounded teenagers, and cognitive-behavioral therapies are available to help them.

Several drug and psychological treatment protocols are available for the sensible management of pain due to the growing recognition that adequate pain management is a standard of care in both the acute and rehabilitative phases of treatment for all individuals who have sustained burns. Finally, the support of the kid who has been burned's family and carers is critical. Throughout the hospitalization and rehabilitation process, it is critical to meet the needs and concerns of all family members, especially siblings.

During the posthospitalization period, the kid and family may face the reality of partial recovery and deal with concerns such as persistent scars and functional limitations. Family stress and school reintegration issues are frequently noted, and therapies for these are likely beneficial.

Conclusion

Burn injuries are the fourth highest cause of unintentional mortality in children, accounting for 5,500 deaths per year. Children and adolescents are disproportionately impacted, accounting for two-thirds of all fatalities and having a male-to-female ratio of 2:1. First-aid procedures are followed to provide an unobstructed airway and assess pulmonary, hematologic, and shock status. Treatment includes antibiotics, autografting, and nutritional assistance.

Rehabilitation includes medical, surgical, physical therapy, dietary, and self-care procedures. Psychosocial assessment and treatment are essential for posthospital discharge psychological follow-up. Contingency management and behavioral interventions can help improve caloric and fluid intake, adherence to treatment, pain management, body image concerns, and career and family adjustment. Timely intervention with proven therapy, social skills training, body image problems, pain management, and family and carers support is essential for successful recovery.