Pediatric Emergencies
A child’s skin is thinner, body smaller, and reaction to injury more intense than an adult’s — meaning that even minor burns or trauma can quickly turn dangerous. Every second matters, and every move should be deliberate.
🧠 Why Children Are More Vulnerable
Unique Risks
- Thinner skin → deeper burns from shorter heat exposure.
- Smaller body surface area → faster fluid and heat loss.
- Curiosity + mobility → higher risk of accidents.
- Delayed recognition by caregivers.
🔥 Burns in Children
Common Causes
| Cause | Example |
|---|---|
| Scalds | Hot water, soup, tea (most common in toddlers) |
| Flame burns | House fires, clothing ignition |
| Contact burns | Hot irons, stoves, motorcycle exhausts |
| Electrical burns | Exposed wires, sockets |
| Chemical burns | Bleach, acids, detergents |
💡 Scalds are the most frequent cause — especially in children under 5 years.
Assessment: Severity and Extent
1. Depth of Burn
| Type | Skin Layers | Appearance | Pain |
|---|---|---|---|
| Superficial (1st°) | Epidermis only | Red, dry, no blisters | Painful |
| Partial thickness (2nd°) | Dermis involved | Blistered, moist | Very painful |
| Full thickness (3rd°) | All skin layers destroyed | Dry, leathery, white or charred | Painless (nerve endings destroyed) |
2. Extent of Burn (Total Body Surface Area – TBSA)
In adults, we use the “Rule of Nines,” but in children, Lund and Browder chart is more accurate. For a quick estimate: Child’s palm (including fingers) = ~1% TBSA
⚠️ Classification by Severity
- Minor: <10% TBSA (partial thickness)
- Moderate: 10–20% TBSA
- Severe: >20% TBSA or any full-thickness, electrical, chemical, or airway burn
🚨 Emergency Management – “ABCDE + F”
| Step | Action | Details |
|---|---|---|
| A – Airway | Look for inhalation injury | Soot, singed hair, hoarseness → early intubation |
| B – Breathing | Give 100% oxygen | Treat carbon monoxide exposure |
| C – Circulation | IV fluids (Parkland formula) | 4 mL × weight (kg) × %TBSA (½ in 8 h, rest in 16 h) |
| D – Disability | Pain relief | IV opioids, not IM (poor absorption) |
| E – Exposure | Remove clothing/jewelry | Keep warm — risk of hypothermia |
| F – Fluids & First Aid | Cool burn under running water for 10–20 min | Do not apply toothpaste, butter, or oil |
💡 First aid cooling must be started early but not with ice water — it worsens vasoconstriction.
💧 Fluid Management Example
A 20 kg child with 20% burns: → 4 × 20 × 20 = 1600 mL in first 24 hours Give: 800 mL in first 8 hours; 800 mL in next 16 hours Always use Ringer’s lactate, monitor urine output (≥1 mL/kg/hr).
🧴 Wound Care
Proper Handling
- Clean gently with saline.
- Debride blisters if large or tense.
- Apply silver sulfadiazine cream or honey dressing (antibacterial).
- Cover with sterile non-adherent dressing.
- Tetanus prophylaxis if not up-to-date.
- Antibiotics only if signs of infection (fever, pus).
⚠️ Complications
- Hypovolemic shock
- Sepsis
- Hypothermia
- Contractures (especially around joints)
- Psychological trauma
Early physiotherapy prevents stiffness and deformities.
🩸 Trauma in Children
Leading Cause of Death
Trauma is the leading cause of death in children beyond infancy. Common types: head injuries, fractures, chest and abdominal trauma.
🧠 Initial Assessment — ABCDE Approach
| Step | Key Points |
|---|---|
| A – Airway | Clear airway, cervical spine protection |
| B – Breathing | Assess chest movement, oxygen saturation |
| C – Circulation | Check for bleeding, capillary refill, pulses |
| D – Disability | Assess neurological status (AVPU, pupils) |
| E – Exposure | Fully examine for hidden injuries; prevent hypothermia |
💀 Common Pediatric Trauma Scenarios
- Head Injury: Leading cause of trauma death. Look for: loss of consciousness, vomiting, seizures, unequal pupils. CT scan if severe; watch for raised ICP. Avoid overhydration — worsens brain edema.
- Fractures: Greenstick fractures common (bones more flexible). Immobilize with splint before transport. Check neurovascular status before and after splinting.
- Chest Trauma: May cause pneumothorax or hemothorax. Give oxygen; insert chest tube if needed.
- Abdominal Trauma: Blunt trauma → liver/spleen injury. Look for tenderness, distension, shock. Manage conservatively unless perforation suspected.
💊 Pain Management
Relief Strategies
- Paracetamol or ibuprofen for mild pain.
- IV morphine or fentanyl for severe trauma or burns.
- Pain relief improves cooperation and healing.
🧬 Prevention Tips
Safety First
- Keep hot liquids and irons out of reach.
- Use socket covers and safe stoves.
- Supervise children near roads, balconies, or water.
- Educate caregivers on first aid and safety measures.
💭 Key Takeaways
- Burns: Cool, cover, calculate fluids, control infection.
- Trauma: ABCDE always — stabilize before transfer.
- In children, shock develops faster, and skin burns deeper.
- Early, careful management saves both life and function.
- Prevention and parental education remain the best therapy.