The Needs of a Pediatric Burn Patient
If your client, or someone you know, has been seriously injured by a burn, this article can help you better understand burns and how a life care plan will quantify the recommendations of the physicians to build a strong foundation for your 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. Ron Smolarski has the specialized training, graduate education, forensics and rehabilitation experience (over 40 years), and is skilled in courtroom testimony, which will 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 than 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; an inhalation injury because of electrical injury; or 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: the 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, and 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, and 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 is very expensive but easy to be used and provides a barrier for infection.
Ron Smolarski’s knowledge of the causes and available treatments for burn victims allows him to quantify the recommendations of the Physician to set a strong foundation for your case. Mr. Smolarski works with Physiatrists to address the complete care of the child. He details the Child’s needs into a well-defined and clear report, which 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 fourth degree burns may result in amputations and the need for prosthetics. An Anaplastologist may be needed for prosthetic to the face.
Psychological – A significant number of burned children will likely suffer depression, anxiety, posttraumatic stress. Younger children often become clingy, fearful, cry often, have headaches, stomachaches, miss school, and experience bullying.