When skin is damaged, it can no longer assist the body in protecting against infection, prevention of body fluid loss, manufacturing vitamin D, or regulating body temperature. Therefore, burn injuries are extremely threatening to the young child’s fragile, developing body. Weeks or months of painful, invasive treatment and recovery place much stress on pediatric burn victims. Resulting scars lead to significant anxieties about appearance and social acceptance through which support from family and friends is imperative.
Measuring and Assessing a Pediatric Burn
A burn is categorized based on the layers of skin that it impacts. The superficial integumentary layer is known as the epidermis and the inner, thicker layer is the dermis. First degree burns impact only the epidermis while second degree burns extend to the dermis. A third degree, or full thickness burn, destroys both layers of skin. The damage of fourth degree burns reaches all the way to the underlying muscle and bone. For the purposes of this paper, third degree burns are the focus. Some of the most likely causes of these full thickness burns are scalding liquids, extended contact with hot objects, flames, as well as electrical and chemical sources. They are dry, leathery, and may be deep red, white, yellow, black, or brown in appearance. Initially, the patient will feel little pain as nerve fibers may be damaged (Children’s Hospital of the King’s Daughters [CHKD], 2007).
The extent of a burn wound is also noted by its coverage of the victim’s total body surface area (TBSA). In adults this is usually referred to as the ‘rule of nines,’ meaning the body is divided into parts equaling approximately nine percent of TBSA. However, because of the cephalocaudal and proximodistal growth during childhood, the distribution of percentages is altered. The head, chest, and abdomen account for greater percentages (Chemical Hazards Emergency Medical Management [CHEMM], 2011).
Stabilizing the Patient
Children with severe burns covering greater than 20% TBSA will likely struggle with breathing and need to be intubated. This is also very common for patients with chest, neck, and facial burn wounds. A small tube connected to a ventilator is placed down the patient’s throat. This aids in maintaining an open airway and stabilizing their breathing.
Dehydration is another immediate risk factor for burn victims. Due to different distribution of body fluids and smaller circulating volume, fluid loss is greater in children than adults with the same burn percentage. Intravenous (IV) fluids are administered as soon as possible to prevent hypovolemic shock and restore the depleted fluid and electrolyte balance. This high fluid intake will also likely require placement of a urinary catheter. Pain medication, sedatives, and antibiotics are also administered through the IV.
Burn victims require a higher calorie and protein intake than the average person. Since it is impossible for a child to eat as much as they...