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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Burns assessment and safeguarding

Paediatrics and child health · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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Airway, respiratory or circulatory burn emergency

Stridor, hoarseness, soot, facial or enclosed-space flame exposure, respiratory distress, carbon-monoxide symptoms, shock, electrical arrhythmia or a tight circumferential burn can deteriorate rapidly despite a modest visible skin injury.

Action: Stop the burning process, use ABCDE, give 100% oxygen for suspected smoke or carbon-monoxide exposure, call anaesthesia and the burn service early and prepare airway control before swelling advances. Remove constricting items, cool the burn under cool running water for 20 minutes while keeping the child warm, cover loosely, provide weight-based analgesia and obtain urgent surgical help for threatened limb or chest perfusion.

Synopsis

Give effective burn first aid without inducing hypothermia, recognise inhalation and circumferential emergencies, assess depth and body-surface area using paediatric methods, refer to specialist burn care appropriately, and undertake a rigorous, child-centred safeguarding assessment.

  • Stop the burning process and remove loose hot or contaminated clothing, nappies and jewellery, but leave material firmly adherent to skin.
  • First-line burn first aid is cool running water for 20 minutes as soon as possible and within 3 hours; cool the wound while warming the rest of the child.
  • Do not use ice, very cold immersion, butter, toothpaste, creams or chemical neutralisation.
  • After cooling, lay cling film lengthwise or use a clean non-fluffy covering; do not wrap a limb circumferentially and do not apply cling film to the face.
  • Use ABCDE before wound detail and give 100% oxygen for suspected inhalation or carbon-monoxide exposure.
  • Estimate size with a paediatric Lund and Browder chart; the child's palm including fingers is about 1% TBSA for small or scattered areas.
  • Describe depth, colour, blanching, moisture, sensation, blisters, site, circumferential extent and distal neurovascular status; reassess because depth evolves.
  • Reference-standard TBSA assessment is a specialist paediatric Lund and Browder calculation after first aid and cleaning, excluding simple erythema.
  • Refer all child burns at least 2% TBSA, all full-thickness and all circumferential burns; discuss special sites, chemical, electrical, friction, cold injury and neonatal burns.
  • Any suspected non-accidental burn should reach a burn unit or centre for expert assessment within 24 hours and follow the local safeguarding pathway immediately.
  • Take a precise separate history, record developmental ability and scene details, examine the whole child, document verbatim statements and obtain consent for clinical photographs under policy.
  • Healing care needs analgesia, dressings, tetanus review, nutrition, physiotherapy or occupational therapy, scar follow-up and family psychological support.

Key red flags

Hoarse voice, stridor, soot, singed nasal hair, facial burns, carbonaceous sputum or an enclosed-space fire suggests inhalation injury; normal early examination does not exclude progressive oedema.

Confusion, headache, collapse or lactic acidosis after smoke exposure warrants 100% oxygen and carbon monoxide or cyanide assessment; standard pulse oximetry cannot identify carboxyhaemoglobin.

A circumferential deep burn with increasing pain, pallor, delayed refill, weak pulses, tense swelling or impaired ventilation requires immediate burn-surgical review for eschar release.

Electrical injury can cause deep muscle damage and arrhythmia with little skin change; chemical exposure continues until the agent is removed or irrigated appropriately.

All full-thickness burns, all circumferential burns and burns of at least 2% total body surface area in a child meet the national minimum referral threshold.

Burns to face, hands, feet, perineum or genitalia, chemical or electrical mechanism, any neonatal burn, an unwell child or failure to heal within two weeks needs specialist discussion or referral.

Investigation priorities

01
First-line ABCDE and core temperatureFirst stepFirst line

Identify airway, respiratory, circulatory and hypothermia threats before detailed wound care.

02
First-line paediatric Lund and Browder chartFirst line

Calculate partial- and full-thickness burn area using age-adjusted body proportions.

Management branches

Immediate first aidCool the burn, warm the child

A thermal injury has occurred within the previous three hours.

  1. Stop the source and remove loose clothing, nappies and jewellery.
  2. Cool under cool running water for 20 minutes while preventing whole-child hypothermia.
  3. Cover loosely after cooling and give prompt analgesia.
  4. Move directly to ABCDE and emergency support if any life threat is present.
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Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • British Burn Association National Burn Care Referral GuidanceCurrent hosted national thresholds by child TBSA, depth, site, mechanism, physiology and non-accidental injury.
  • British Burn Association 2023 burn-care standardsUK service standards for referral, initial management, paediatric multidisciplinary and psychosocial care.
  • NHS burns and scalds first aidTwenty-minute cool-water first aid, removal of loose items, loose covering and emergency triggers.
  • NICE CG89 child maltreatmentUpdated UK thermal-injury alerting features including non-mobility, protected sites, implement and forced-immersion patterns.
  • RCPCH Child Protection Evidence burns reviewSystematic evidence on abusive and non-abusive scald and contact-burn distributions and clinical context.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting review
A burn in a non-mobile child, sharply demarcated symmetrical immersion, glove or stocking distribution, buttock or perineal scald, implement shape, delay or unsuitable explanation requires maltreatment to be suspected.
JurisdictionUnited Kingdom