The Needs of a Pediatric Burn Patient
I am Ron Smolarski MA, CLCP of Beacon Rehabilitation, I sent you this to help educate you on some of the intricacies of handling a Pediatric Burn patient case.
There are approximately 120,000 children (300 per day) that require medical attention and 28,000 requiring hospitalization for their burns every year. Children under 6 were injured the most representing 60% of all burn related injuries to children.
Burn injuries are one of the two most expensive injuries and is the third most common childhood injury.
Life Care Planners must consider burn injuries that are influenced by severity, location, total body surface area, degree of burn, presence/absence of inhalation injury, comorbid trauma, and preexistent conditions.
Pediatric patients between the ages of 5 to 18 have the greatest chance of survival.
Cases involving children require different approaches and your Expert Life Care Planner needs to have the knowledge and experience that Beacon Rehabilitation can supply. I have the Specialized Training, Graduate Education, Forensics and Rehabilitation Experience (over 40 years) and courtroom testifying to make the difference in your case.
Classification of Burns are labeled as the following:
1. First Degree Burn – bad sun burn
2. Second Degree Burn – greater assault to the second layer of skin (dermis)
3. Third Degree Burn – destruction of the dermis (epidermis and hypodermis)
4. Fourth Degree burn – involving the skin, fat, muscles, nerves, tendons, vessels and bone – this may require flap coverage or amputation.
A. Minor burns – 10% of total body surface area unless burn involves (eyes, ears, face, neck, hands, joints, feet or perineum)
B. Moderate burns – 10% – 20% of total body surface area for children less then 10 years of age regardless of burn depth and 2% – 10% total body surface area when eye, ears, face, neck, hands, joints, feet or perineum are burned.
C. Major burns – 20% or more of body or less than 10% of total body surface area when (eye, ears, face, neck, hands, joints, feet or perineum) are burned also an inhalation injury as a result of electrical injury and if the child has a comorbid trauma and all burns with a premorbid illness.
Importance of skin
The skin is the largest organ of the body protecting the body from infection. Human skin is made up of two layers epidermis (10%) outer layer and the dermis (90%) the inner layer. The top layer (epidermis) determines skin color and protection. Dermis contains connective tissue, capillaries, collagen and elastic fiber – containing hair follicles, excretory glands, (sweat and sebaceous glands), sensory nerve endings, – deeper burns cause lasting changes in a child’s capacity to feel pain, sense of touch, temperature. All systems of the body can be compromised from a burn.
Burns cause significant pain, dehydration, infection, contractures, loss of range of motion, inhibit normal growth, distorted appearance.
Types of skin graft
1. Auto graft – using the child’s own skin
2. Allograft – cadavers skin, pig skin (temporary skin covering)
3. Mesh skin – meshing existing healthy skin
Four most common graft options
A. Full Thickness skin graft – thickest graft includes epidermis and dermis
B. Split – Thickness skin graft meshed – includes epidermis and part of dermis (placing skin in a machine to expand the graft)
C. Split – Thickness graft – sheet graft used for fingers, hands, face – cosmetic areas
D. Artificial skin – used when little available healthy skin is available, it’s very expensive but easy to be used and provides a barrier for infection.
My Knowledge of the causes and available treatments help quantify the recommendations of the Physician to set a strong foundation for your case. Working with the Physiatrist the complete care of the child can be addressed. My ability to put the Child’s needs into a well-defined and clear report makes it easy for the judge or jury to follow the technical expert testimony without feeling disoriented or overwhelmed.
Scarring – Burns that heal within 2-3 weeks do not usually result in scarring or impairment of function but change in color of skin may occur.
Scars can cause contractures (tightness and impair movement) and be cosmetically unattractive
Scarring may result in sensitivity to hot and cold temperatures, wet and dry climates changes, and neuropathic pain and may require lifelong reconstructive surgery procedures.
Z-Plasty/ Scar may be required to regain function for a burn scar contraction
Educational Issues – Cognitive decline may result from the trauma of the burn – from the ongoing pain, surgeries, medications, and original trauma.
Nutritional Issues – Glucose uptake is compromised; Cholesterol and lipoprotein concentration are decreased; protein breakdown of molecules; suppression of child’s immune system
Growth Issues – Lower heights and weights; Scar contractions limit growth
Prosthetics – Flame/fire/ chemicals/ electricity or forth degree burns may result in amputations and the need for prosthetics. An Anaplastologist may be needed for prosthetic to the face
Psychological – Significant number of burned children will likely suffer depression, anxiety, posttraumatic stress, Younger children often become clingy, fearful, cry often, have headaches, stomachaches, and miss school and experience bullying.