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Burn disease in young children. Features of burn disease in children features of burns

Most clinicians believe that young children tolerate burns much worse than adults. General phenomena in their body develop with a smaller area of ​​damage than in adults; mortality is high. Burns covering an area of ​​5–8% of the child’s body surface cause signs of shock and require general treatment; over 20% are life-threatening.

Meanwhile, organizing proper treatment and care for a burned child- quite a difficult task.

The reasons for the more severe course of burns in children, as well as the difficulties associated with their treatment and care, are explained by some anatomical and physiological characteristics of childhood, characteristic of the first 5–6 years of life. At school age, children become more independent, more conscious, the body matures, and care becomes easier.

After a severe widespread burn, a child may experience irritability, poor sleep, bedwetting, absent-mindedness and other emotional, volitional and mental disorders for a long time.

Despite significant advances made in the treatment of burnt victims, the number of children dying from complications is still very high.

The outcome of the burn primarily depends on the extent and depth of the thermal injury. Children tolerate superficial burns relatively easily. If the burn does not exceed 70% of the body surface, the child usually recovers. The situation is completely different with deep third and fourth degree burns. In these cases, death can occur even in a relatively small area, and the younger the child, the more severe the burn disease and the less likely there is for a favorable outcome.

Anatomical and physiological characteristics of the child’s body that influence the course of burns and complicate their treatment

Reasons that aggravate the severity of burns Reasons that make caring for a child difficult
1. Thinness of the skin, poor development of the protective keratinizing layer of the skin, poor resistance to the destructive effects of heat and electric current. 1. Helplessness of the child, the need for constant supervision, maintenance, and pedagogical influence.
2. The relationship between the child’s body weight and the area of ​​his skin per one and the same unit of mass is different from that of an adult. A burn of 5% of the body surface in a child corresponds to a burn of 10% in an adult. 2. Poor development of the network of subcutaneous veins and difficulties associated with their puncture and transfusion treatment.
3. Different relationships between different body segments than in an adult. In a child, the head makes up 20%, in an adult - 9% of the body surface. Burns to the face and head are common in children. They have a severe course. The supply of skin available for borrowing and grafting is reduced because the head and face cannot be used as donor sites. 3. Great motor activity of the child, not controlled by the intellect, leading to the pulling out of the probe, catheter, needle from the vein, and breakage of the plaster cast.
4. Incomplete growth, underdevelopment of some organs, weakness of compensatory and protective mechanisms. The child’s body is unable to cope with the increased demands that a burn causes, so an irreversible condition quickly develops. There is increased sensitivity to certain medications, instability of thermoregulation, poor resistance to infection, and a tendency to develop complications that are not typical for an adult. 4. Good blood supply, looseness and tenderness of soft tissues, leading to the rapid development of edema when a bandage is applied to injured tissues. Swelling can cause compression of blood vessels and poor circulation in the parts of the limb located below the bandage.
5. Greater need for oxygen and proteins. Rapid onset of metabolic disorders and exhaustion. 5. The child’s inability to analyze his feelings and pinpoint what is bothering him. At the same time, a violent reaction to pain is typical.
6. Tendency to rapid development of connective tissue. There is often excess growth of scar tissue at the site of a healed burn. This scar is itchy and ulcerates easily. 6. The child’s negative attitude towards the need for treatment and hospital stay. The child is overwhelmed by fear and the desire to return to the familiar home environment of his mother.
7. Continued growth of the child's body. After the burn has healed, scars have a restraining effect on bone growth, cause the formation of secondary deformations in the joints and shortening of the limb. 7. The child’s inability to demonstrate volitional efforts to achieve a faster recovery - reluctance to eat unusual foods, do therapeutic exercises, be in a forced position, etc.
— 8. Tendency to contract acute contagious childhood infectious diseases that require compliance with a special epidemiological regime.
— 9. Mild development of complications from the respiratory and digestive system in a sick child if the sanitary and hygienic diet in the department is not observed.

Currently, deep burns covering an area of ​​more than 30% of the body surface are considered critical for infants and toddlers; for older children - deep burns exceeding 40% of the body surface in size.

The cause of death in the vast majority of children is infection, which causes general infection of the body and death even before plastic closure of the wounds becomes possible.

“Burns in children”, N.D. Kazantseva

Every small child actively and very actively studies the world around him. Parental instructions do not always protect the baby from dangerous curiosity; as a result, the child can receive various injuries.

Body burns in children are among the most common and quite severe traumatic injuries to the skin and soft tissues. Most often, children aged 2-3 years suffer from burns.

Parents should definitely know how to provide first aid for a thermal burn in a child.

Burn hazard for children

A burn is a traumatic injury to the skin and surrounding tissue caused by exposure to heat or a chemical, electricity, or hot sunlight. At home, chemical burns in children occur extremely rarely; the most common damaging factors are hot liquids (boiling water, soup), open fire or heated household items (iron, oven).

One-year-old babies often grab and overturn containers with hot water, boiling water, or sit in them. In the first case, the typical location of burn lesions is the upper body, face, abdomen, arms and hands, in the second - the buttocks, external genitalia and the back of the lower extremities (for example, feet).

The physiological features of the structure of children's skin are such that a first or second degree burn can be caused by not very hot liquid. Imperfect compensatory and regulatory abilities of the child's body can lead to burn disease. In this condition, the normal functioning of all organs and systems of the body is disrupted, even leading to death.

Symptoms of thermal burns of varying degrees

Any child, even with a small burn, cries and screams loudly, but with extensive burns the baby is apathetic and inhibited. Intact skin is pale, sometimes cyanotic, and the pulse is rapid. The appearance of thirst and subsequent vomiting indicates the occurrence of burn shock.

Depending on the depth of tissue damage, the following degrees of burns are distinguished:

  • 1st degree – severe redness (hyperemia) of the burn site, swelling, burning and severe pain of the skin;
  • 2nd degree - blisters (blisters, bullae) with a transparent yellowish liquid form in the thickness of the skin at varying depths;
  • 3rd degree – damage and death (necrosis) of the skin in all layers with the formation of a gray or black scab;
  • 4th degree – charring of the skin, ligaments, muscles and bones.

The severity of a child’s condition with a thermal burn depends on his age, the area of ​​the burned surface and the depth of the lesion. The younger the child, the larger the area of ​​damage, the more severe the burn, and the longer the recovery will take.


First aid for a burn in a child

Correctly and timely first aid provided determines the prognosis of the development of the disease. What should you do if your baby is scalded by boiling water, burned on a hot iron, or the skin at the site of the burn swells with bubbles or even peels off?

First of all, the victim’s parents do not need to panic; they should pull themselves together and follow the following algorithm of actions:

  1. interrupt contact with high-temperature or chemical agents, remove wet clothing;
  2. cool the affected surface with a gentle stream of running cool (not ice) water for 15-20 minutes (possibly longer), until a feeling of numbness of the skin occurs;
  3. apply a sterile gauze bandage to the affected surface;
  4. give the child painkillers, both in tablets and in other forms (rectal suppositories, intramuscular injections - if you have the appropriate skills).

It is important to immediately call an ambulance or take your child to a children's hospital.

Before the medical team arrives or until the victim is taken to a medical facility, it is necessary to give him water to drink to avoid dehydration. It is preferable to use saline solutions, mineral water without gas.

Features of the treatment of burns in children of different ages

Infants and children under 1 year of age, as well as children with burns of more than 2% of the body or with injuries to the face, upper respiratory tract, eyes, external genitalia, are treated for burns exclusively in an inpatient setting. Thermal burns in children are treated at home, provided that the degree of burn is not higher than the first, rarely the second, and the area of ​​damage does not exceed 2%.

In a medical institution, primary surgical treatment is carried out: the wound surface is washed using minimally traumatic methods using antiseptic solutions. The blisters are opened at the base, their contents are released, the lid of the bubble is not removed.

An aseptic dressing is applied. Emergency immunization against tetanus is carried out in children who have not been vaccinated according to the vaccination schedule.

Drug treatment

  • antiseptic solutions and sprays: Miramistin, Chlorhexidine, Dioxidine;
  • antibacterial ointments: Oflomelid, Levomekol, Levosin, Sinthomycin emulsion, tetracycline, gentamicin ointment, etc.


The burn surface can be treated using special anti-burn dressings, already impregnated with an antiseptic and having a sponge structure. Such dressings do not stick to the wound and are easy to apply and remove.

Procelan ointment helps to numb the wound surface. Panthenol-based products accelerate the healing of burn wounds and tissue regeneration: Bepanten, Dexpanthenol.


If the wound begins to scar, you can smear it with homeopathic ointment Traumeel S. Antihistamines will reduce the itching of the healing wound. For general anesthesia and elimination of fever symptoms, non-steroidal anti-inflammatory drugs are used that are approved for use in children, according to age: Ibuprofen, Paracetamol.


Folk remedies

1st degree burns without compromising the integrity of the skin can be treated with folk remedies only after consultation with a doctor. How to treat a baby if the child slightly burns his hand, for example, with an iron?

After cooling the wound, it is necessary to ensure that there are no bubbles or burn channels penetrating deep into the underlying tissue. Then you can smear the burn area with sea buckthorn oil and repeat this procedure several times a day. The anti-inflammatory and regenerating effect of this remedy will help speed up the healing process.

Aloe juice has a similar effect. A fresh aloe leaf must be cut lengthwise into flat parts, anoint the damaged surface with the cut, and leave on the wound under a gauze bandage for an hour and a half (repeat the procedure 2 times a day).


 Aloe juice has a wound healing and regenerating effect, so it is very effective in treating burn wounds

To speed up healing, you can try grated raw potatoes with honey. Peel a medium-sized potato, grate it on a fine grater, add a teaspoon of honey, use as a compress for 15-20 minutes, 2-3 times a day.

Folk remedies and pharmaceutical drugs can be alternated. However, if after a week of home treatment there is no improvement, the wound has acquired an unpleasant odor, or purulent discharge appears, you should urgently consult a doctor.

  • immediately after an injury, apply an anti-burn agent - first you need to cool the affected area well;
  • apply raw egg white to the burn surface, because the risk of wound infection increases;
  • treat the burned area with any oil, Vaseline-based cream, sour cream or kefir, since oil will clog skin pores, and dairy products contain acid, which will further injure the skin;
  • tear off the clothing that has stuck to the burns - this will injure the wound even more;
  • cool the burn site with ice - in addition to the burn wound, you can also get frostbite in the surrounding tissues;
  • open the resulting blisters yourself - the risk of bacterial flora attaching increases;
  • when dressing, use cotton wool and adhesive tape, apply tight bandages - these materials stick to the wound and, when changing the bandage, injure the surface;
  • smear the burn area with alcohol or aqueous solutions of aniline dyes (brilliant green, iodine).

Minor 1st-2nd degree burns usually go away in 7-10 days. The healing rate of a burn can be reduced if you follow all the doctor's instructions.

The healing injured area must be protected from sunlight, cold and other thermal irritants. The delicate new thin tissue is very sensitive to temperature changes, reacting to frost or heat with peeling and numbness.

Burn injuries in children of any age are always the fault of the parents. It’s easy to protect your baby from thermal effects - just don’t let him out of sight.

Do not leave an unfinished cup of hot coffee on the table within the child’s reach, hide matches, do not allow the child into the kitchen while the oven is running, always test the bath water with your hand, do not trust the thermometer, and do not iron clothes near the child. These simple precautions may save your baby's health and life.

Refer to life-threatening injuries that occur as a result of local exposure to high temperatures on body tissues. The most common cause of burns is contact with the skin of hot liquids (boiling water, tea, coffee). In second place is touching hot objects, in third place are flame burns.

Severe thermal damage leads primarily to direct cell damage due to coagulative necrosis of varying depth and extent.
Vasoactive substances are released, which lead to increased vascular permeability and loss of fluid and protein from the vascular bed.

Rapidly developing fluid deficiency is aggravated by exudation through the wound surface and the formation of edema in the interstitial space. Further loss of fluid occurs through evaporation from the wound surface, imperceptible perspiration losses through the lungs, with tachypnea almost always occurring, and also due to loss through the gastrointestinal tract, the so-called third space.

All lost fluid leaves the vascular bed, and losses reach a maximum in the first three to four hours after the burn. They are often underestimated, especially in young children. After a moderate burn, the intravascular deficit is already 20-30% of the blood volume within an hour!

The severity of the burn is determined depending on the degree of damage and the percentage of the burn.

It should be borne in mind that the palmar surface of the victim makes up approximately 1% of the body surface. You can calculate the burn percentage using the rule of nines.

9% have:

  • head and neck;
  • breast;
  • stomach;
  • half of the back surface;
  • one hip;
  • one lower leg and foot.

In children, a more accurate calculation of the percentage of burn can be made using the Lund and Browder chart.

Depending on the depth of the lesion, degrees of thermal burns are distinguished.

  • I degree is accompanied by skin hyperemia, moderate swelling, pain;
  • II degree - there is a detachment of the epidermis (bubbles with clear liquid appear), severe pain;
  • III A degree. The skin is not affected to its full depth (partial necrosis of the skin, elements of the dermis are preserved). It is characterized by:
    — the germ layer of the skin is partially preserved,
    — the burn bladder is filled with liquid with a yellowish tint;
    — burn wound is pink, wet;
    - decreased pain and tactile sensitivity;
  • III B degree. There is skin damage to the entire depth with the formation of a necrotic scab. At this degree:
    - all layers of the skin are affected;
    - a dense, gray-brown or brown scab with areas of white “pork” skin is formed;
    — thrombosed vessels and fragments of the epidermis are visible;
    - no pain sensitivity;
    — burn blisters with hemorrhagic contents;
  • IV degree. With this degree, not only the skin, but also the underlying tissues (muscles, tendons, joints) become dead.

A severe burn (more than 10% of the body surface) and subsequent changes are considered a burn disease, which is characterized by the development of shock, toxemia, and septicotoxemia.

Burn disease in children is more severe the younger the child is.

Clinical picture.

When more than 10% of the body surface is burned (in children under 3 years of age 5% of the surface), burn shock develops. Hypovolemia, blood deposition, and decreased cardiac output come to the fore. A decrease in CVP to zero indicates true hypovolemia, and an increase in the norm indicates relative hypovolemia, due to the weakness of the pumping function of the heart.

There are 3 degrees of burn shock:

First degree burn shock.

The child's condition is moderate. Drowsiness, pale skin, chills, and thirst are observed. Pulse satisfactorily filled, tachycardia, central venous pressure decreased. Compensated metabolic acidosis. Diuresis is sufficient.

Second degree burn shock.

The condition is serious. Conscious. The child is lethargic and sometimes excited. There is chills, severe pallor of the skin, and cyanosis. Severe tachycardia. BP is moderately reduced. Thirst is expressed, there may be vomiting. Metabolic acidosis. Hourly diuresis is reduced.

Third degree burn shock.

The child's condition is extremely serious. Consciousness is impaired or absent. Pronounced pallor, marbling of the skin, cyanosis. Shortness of breath, pulse may not be detected or may be threadlike. Sharp tachycardia, muffled heart sounds. Blood pressure is reduced, body temperature is low-grade. Significant decrease in central venous pressure, increase in peripheral resistance. Hourly diuresis is reduced to 2/3 - 1/2 of the age norm. Hemoconcentration and metabolic acidosis are noted.

To determine the severity of a burn injury, the damage index is determined, which is determined in this way: 1% burn of the I-II degree. - 1 unit, 1% burn III A - 2 units, 1% burn III B. — 3 units, 1% burn IV degree. — 4 units.

With a damage index of up to 10 units. - mild degree of burn, 10-15 units - moderate degree, 15-30 units - severe degree, more than 30 units - very severe.

Treatment.

Emergency measures at the scene:

  1. Abundantly washing the skin or dousing it with cold water (at least 15 0 C) until the pain disappears or significantly weakens.
  2. Anesthesia. For moderate burns, analgesia is administered with non-narcotic analgesics with diazepam (seduxen) intramuscularly.
    In case of severe burn injuries, pain is treated with narcotic analgesics - promedol 1% solution 0.1 ml/year.
  3. Apply an aseptic bandage (for extensive burns, cover with a sterile sheet) moistened with a 0.5% solution of novocaine with furatsilin (1:5000) 1:1. Before applying a bandage, the location, area, and depth of skin damage is accurately determined.
  4. In case of severe burn, provide access to the vein and begin physical infusion therapy. solution 20-30 ml/kg per hour.
  5. In the presence of shock, glucocorticoids are administered: prednisolone 2-5 mg/kg or hydrocortisone 5-10 mg/kg intravenously.

What not to do in case of burns:

  • Ice should not be applied directly to the burn surface, as this can increase the area of ​​tissue damage through frostbite;
  • The burn surface should never be lubricated with substances containing fat (lard, Vaseline, sunflower oil);
  • Also, you cannot apply various indifferent substances (ointments, powders, flour);
  • When removing clothing, do not tear it off the burnt surface, but cut it with scissors;
  • Do not touch the burn surface with your hands.

For burns of the respiratory tract due to smoke or hot air:

  1. Take the victim out of the enclosed space.
  2. Give the patient humidified 100% oxygen through a mask at a rate of 10-12 l/min.
  3. Patients with stage III respiratory failure. or with no breathing should be intubated and transferred to mechanical ventilation.
  4. If clinical death occurs, perform cardiopulmonary resuscitation.
  5. Anesthesia and infusion therapy listed above.
  6. For shock - glucocorticoids.
  7. For laryngo and bronchiospasm - 2.4% aminophylline at a rate of 2-4 mg/kg.

Treatment in a hospital in the first 24 hours.

For superficial burns of more than 40%, or deep burns of more than 20%, it is necessary to:

  • Nasotracheal intubation and start mechanical ventilation;
  • Access to the central vein;
  • Place a tube in the stomach;
  • Bladder catheterization;
  • Monitor central hemodynamics and oxygen balance.

The goal of infusion therapy during shock is to restore plasma volume and basic vital functions. The required fluid is calculated depending on age, body weight, and area of ​​the burn. During infusion therapy, body weight should be monitored every 6 hours to avoid overhydration.

In the first 24 hours after injury, crystalloids are administered at the rate of 3-4 ml/kg per burn area (as a percentage). The first half is administered in the first 8 hours, the second in the next 16 hours.

If the serum albumin level is below 40 g/l or burn shock occurs. an infusion of colloidal solutions (albumin, fresh frozen plasma) is prescribed 8 hours after injury. If hydroxyethyl starch was not used at the prehospital stage, then they are prescribed in the hospital. Refortam or Stabizol is used at a dose of 4-8 ml/kg intravenously.

Adequate analgesia is indicated with a 1% solution of promedol at a dose of 0.1 ml per year of life, every 4 hours.

Carbon monoxide should be measured in all patients with inhalation burn injury. Such patients are given 100% oxygen until the carboxyhemoglobin level in the blood drops to 10%.

Stages of burn surface treatment:

  • Clean the burn surface;
  • Remove the walls of the bubbles;
  • Treat the burn wound with sterile saline or antiseptic solutions;
  • Blisters on the palms and soles are not opened;
  • Lubricate the damaged surface with silver sulfadiosine cream or treat the surface with Levomekol or Levosin.
  • Apply a sterile bandage.
  • Antibiotic therapy is not prescribed for prophylactic purposes. If there are indications for prescribing, then they can be prescribed only after the child has been brought out of shock.

In conclusion, I would like to note that the treatment of burns I-II degrees. with an area of ​​up to 2% in infants, and up to 4% in older children can be treated on an outpatient basis. If there are manifestations of shock, hospitalization with adequate pain relief and infusion therapy is required.

Burns are more common in children under 3 years of age. I-II degree burns on a child’s delicate skin are caused by liquids that are not even very high in temperature.

The severity of the condition of the injured child depends on the area of ​​the burn surface, the depth of the burn and the age of the child.

Deep and extensive burns pose a great danger to the life of a child who develops a burn disease. Burn disease has phases: burn shock, acute toxemia, septicotoxemia and convalescence.

Burn shock develops at 10% of a deep burn in an adult or 25% of a superficial burn.

A child with a II degree burn. Burn shock should be expected at 20%, and with a deep burn and a smaller area.

4. Types of cold injury.

Frostbite – tissue damage caused by prolonged exposure to low temperatures (below 0 degrees). A distinction is made between general freezing and local frostbite of the body.

Cold, acting on tissue, causes vasoconstriction, which leads to impaired blood circulation in this area of ​​​​the skin, manifested by pale skin.

If exposure to cold is not stopped in a timely manner and assistance is not provided, tissue necrosis may occur due to vascular thrombosis.

Depending on the depth of tissue damage, there are 4 degrees of frostbite.

First aid for frostbite.

    Do not rub frostbitten areas with snow - there is a risk of skin damage and infection.

    An aseptic (I-II stage) or thermally insulating (III-IV stage) bandage is applied to the frostbitten surface of the body. The patient is gradually warmed up in a moderately warm room. A bandage applied outside should not be removed in a warm room.

Layers of insulating bandage:

    Aseptic dressing

    Thermal insulating material

3. The victim is given a warm drink

2 Frostbite periods:

a) pre-reactive

b) reactive

    First aid is the treatment of frostbite in pre-reactive period. Clinically, during this period there is a slight tingling sensation, mild pain, and objectively there is coldness, paleness of the skin, and anesthesia. Reactive the period begins after the frostbitten tissues have been warmed. In the pre-reactive period, it is impossible to determine the depth of the lesion.

First aid in the pre-reaction period.

    Termination of the effect of cold.

    Warming the limb for 1 hour.

    Restoration of blood circulation - local and general methods.

    Thermal insulating bandage.

    Hot tea, cardiac medications, intravenous antispasmodics heated to 37 0.

    Peridural block.

    Disaggregant therapy – heparin.

    Anticoagulant therapy – aspirin, heparin.

    Detoxification of the body.

    General alkalization - soda intravenously.

Treatment of frostbite during the reactive period:

(general complex therapy)

    Warming the limb, restoring blood circulation in it.

    Local treatment:

AtI – IIArt. Warming begins in a general or local bath, in which the water temperature rises from 20 to 40 degrees in 1 hour. At the same time, massage the limb from the periphery to the center. Continue the massage until the skin warms and turns pink. Then the affected areas are wiped with alcohol and covered with a dry aseptic bandage wrapped in a thick layer of cotton wool. The limbs are given an elevated position. Novocaine blockades are carried out according to Vishnevsky, physiotherapeutic procedures: for stage I. UHF and UV

AtIIst. The skin is treated with alcohol, burst blisters are removed or they are trimmed at the base. The bubbles on the brushes do not come off because... they have a durable epidermal coating, which allows you to practically do without a bandage.

With frostbiteIIIst. – the blisters are removed, aseptic or ointment dressings (with neutral ointments) are applied, or an open method of treatment is used.

If suppuration develops, it is treated according to the principle of treating purulent wounds.

After granulations appear, bandages with Vishnevsky ointment, antibiotics, and sulfonamides are applied.

Treatment of frostbiteIVArt. is necrotomy, dissection of dead tissue and necrectomy - removal of them. The operation is performed without anesthesia, usually on the 7th day. The operation of choice is amputation, or disarticulation at the joint, within healthy tissue.

3. Resuscitation and intensive care.

4. Prevention of tetanus and purulent infection.

5. Measures to improve regeneration processes - high-calorie nutrition, blood transfusions.

6. Measures to improve cardiovascular activity (physical therapy, cardiac drugs)

7. Agents that improve the functioning of parenchymal organs - 20 -40% glucose IV.

8. Fight against intoxication (oxygen therapy).

9. Anticoagulant therapy – heparin IV, IM.

– a type of injury that occurs when tissue is damaged by physical and chemical factors (thermal energy, electricity, ionizing radiation, chemicals, etc.). The clinical picture of burns in children depends on the influencing factor, localization, depth, extent of tissue damage and includes local (pain, hyperemia, swelling, blistering) and general manifestations (shock). The main tasks of diagnosing burns in children are to determine the nature of the burn injury, the depth and area of ​​damage, for which infrared thermography and measuring techniques are used. Treatment of burns in children requires anti-shock therapy, cleaning the burn surface, and applying bandages.

General information

Burns in children - thermal, chemical, electrical, radiation damage to the skin, mucous membranes and underlying tissues. Among the total number of people with burn injury, children make up 20–30%; Moreover, almost half of them are children under 3 years old. The mortality rate due to burns among children reaches 2-4%, in addition, about 35% of children remain disabled annually. The high prevalence of burns in the pediatric population, the tendency to develop burn disease and severe post-burn disorders make the prevention and treatment of burn injury in children a priority in pediatric surgery and traumatology.

The peculiarities of children's anatomy and physiology are such that the skin of children is thinner and more delicate than that of adults, has a developed circulatory and lymphatic network and, therefore, has greater thermal conductivity. This feature contributes to the fact that exposure to a chemical or physical agent, which in an adult causes only superficial damage to the skin, leads to a deep burn in a child. The helplessness of children during injury causes longer exposure to the damaging factor, which also contributes to the depth of tissue damage. In addition, imperfection of compensatory and regulatory mechanisms in children can lead to the development of burn disease even with damage to 5-10%, and in infancy or with a deep burn - only 3-5% of the body surface. Thus, any burns in children are more severe than in adults, since in childhood disorders of blood circulation, metabolism, and the functioning of vital organs and systems occur more quickly.

Causes and classification of burns in children

Depending on the damaging agent, burns in children are divided into thermal, chemical, electrical and radiation. The occurrence of thermal burns in children in most cases is caused by skin contact with boiling water, steam, open fire, melted fat, or hot metal objects. Young children are most often scalded by hot liquids (water, milk, tea, soup). Often, burns in children occur due to the negligence of parents when they immerse the child in a bath that is too hot or leave them to warm up with heating pads for a long time. At school age, various pyrotechnic fun, lighting fires, “experiments” with flammable mixtures, etc. pose a particular danger to children. Such pranks with fire, as a rule, end in failure, since they often lead to extensive thermal burns. Thermal burns in children usually affect the integumentary tissue, but burns of the eyes, respiratory tract and digestive tract can also occur.

Chemical burns are less common and usually occur when household chemicals are not stored correctly and within the reach of children. Young children may accidentally spill acid or alkali on themselves, spill powdery substances, spray dangerous chemicals, or drink caustic liquids by mistake. When aggressive chemicals are ingested, a burn to the esophagus in children is combined with a burn to the oral cavity and respiratory tract.

The causes of electrical burns in young children are malfunction of electrical appliances, their improper storage and operation, the presence in the house of electrical outlets accessible to the child, and exposed exposed wires. Older children usually get electrical burns when playing near high-voltage lines, riding on the roofs of electric trains, or hiding in transformer boxes.

Radiation burns in children are most often associated with skin exposure to direct sunlight for a long period of time. In general, thermal burns in children account for about 65-80% of cases, electrical burns - 11%, and other types - 10-15%.

Within the framework of this topic, the features of thermal burns in children will be considered.

Symptoms of thermal burns in children

Depending on the depth of tissue damage, thermal burns in children can be of four degrees.

First degree burn(epidermal burn) is characterized by superficial damage to the skin due to short-term or low-intensity exposure. Children experience local pain, hyperemia, swelling and a burning sensation. At the site of the burn, slight peeling of the epidermis may be observed; superficial burns in children heal in 3-5 days on their own, completely without a trace or with the formation of slight pigmentation.

Second degree burn(superficial dermal burn) occurs with complete necrosis of the epidermis, under which clear liquid accumulates, forming blisters. Swelling, pain and redness of the skin are more pronounced. After 2–3 days, the contents of the bubbles become thick and jelly-like. Healing and restoration of the skin lasts about 2 weeks. With second degree burns in children, the risk of infection of the burn wound increases.

Third degree burn(deep dermal burn) can be of two types: IIIa degree - with preservation of the basal layer of the skin and IIIb degree - with necrosis of the entire thickness of the skin and partially the subcutaneous layer. Third degree burns in children occur with the formation of dry or wet necrosis. Dry necrosis is a dense scab of brown or black color, insensitive to touch. Wet necrosis has the appearance of a yellowish-gray scab with a sharp swelling of the tissue in the burn area. After 7-14 days, the scab begins to be rejected, and the complete healing process is delayed for 1-2 months. Epithelization of the skin occurs due to the preserved germ layer. IIIb degree burns in children heal with the formation of rough, inelastic scars.

IV degree burn(subfascial burn) is characterized by damage and exposure of tissues lying deeper than the aponeurosis (muscles, tendons, blood vessels, nerves, bones and cartilage). Visually, with fourth-degree burns, a dark brown or black scab is visible, through the cracks of which the affected deep tissues are visible. With such lesions, the burn process in children (wound cleansing, formation of granulations) proceeds slowly, local, primarily purulent, complications often develop - abscesses, phlegmons, arthritis. IV degree burns are accompanied by a rapid increase in secondary changes in tissues, progressive thrombosis, damage to internal organs and can result in the death of the child.

Burns of I, II and IIIa degrees in children are regarded as superficial, burns of IIIb and IV degrees - as deep. In pediatrics, as a rule, there is a combination of burns of various degrees.

Burn disease in children

In addition to local phenomena, burns in children often develop severe systemic reactions, which are characterized as burn disease. During a burn disease, there are 4 periods - burn shock, acute burn toxemia, burn septicopyemia and recovery.

Burn shock lasts 1-3 days. In the first hours after receiving a burn, children are excited, react sharply to pain, and scream (erectile phase of shock). Chills, increased blood pressure, increased breathing, and tachycardia are noted. In severe shock, body temperature may drop. 2–6 hours after the burn, children enter the torpid phase of shock: the child is adynamic, inhibited, makes no complaints and practically does not react to the environment. The torpid phase is characterized by arterial hypotension, rapid thready pulse, severe pallor of the skin, severe thirst, oliguria or anuria, and in severe cases, vomiting “coffee grounds” due to gastrointestinal bleeding. First degree burn shock develops in children with superficial damage to 15-20% of the body area; II degree – for burns of 20-60% of the body surface; III degree - more than 60% of the body area. Rapidly progressing burn shock leads to the death of the child on the first day.

With further development, the period of burn shock is replaced by a phase of burn toxemia, the manifestations of which are caused by the entry of decay products from damaged tissues into the general bloodstream. At this time, children who have received burns may experience fever, delirium, convulsions, tachycardia, arrhythmia; in some cases, coma. Against the background of toxemia, toxic myocarditis, hepatitis, acute erosive-ulcerative gastritis, secondary anemia, nephritis, and sometimes acute renal failure can develop. The duration of the period of burn toxemia is up to 10 days, after which, with deep or extensive burns in children, the septicotoxemia phase begins.

Burn septicotoxemia is characterized by the addition of a secondary infection and suppuration of the burn wound. The general condition of children with burns remains serious; complications are possible in the form of otitis media, ulcerative stomatitis, lymphadenitis, pneumonia, bacteremia, burn sepsis and burn exhaustion. During the recovery phase, the processes of restoration of all vital functions and scarring of the burn surface predominate.

Diagnosis of burns in children

Diagnosis of burns in children is made on the basis of anamnesis and visual examination. To determine the area of ​​the burn in young children, Lund-Browder tables are used, taking into account the change in the area of ​​​​various parts of the body with age. For children over 15 years of age, the rule of nine is used, and for limited burns, the rule of the palm is used.

Children with burns need to have their hemoglobin and blood hematocrit examined, a general urine test, and a biochemical blood test (electrolytes, total protein, albumin, urea, creatinine, etc.). In case of suppuration of a burn wound, the wound discharge is collected and bacteriologically inoculated for microflora.

It is mandatory (especially in case of electrical injury in children) to be performed and repeated in the dynamics of the ECG. In the case of a chemical burn of the esophagus in children, esophagoscopy (EGD) is necessary. If the respiratory tract is affected, bronchoscopy and lung radiography are required.

Treatment of burns in children

First aid for burns in children involves stopping the action of the thermal agent, freeing the affected area of ​​skin from clothing and cooling it (by washing with water, an ice pack). To prevent shock at the prehospital stage, the child can be given analgesics.

In a medical institution, primary treatment of the burn surface, removal of foreign bodies and scraps of epidermis are carried out. Anti-shock measures for burns in children include adequate pain relief and sedation, infusion therapy, antibiotic therapy, and oxygen therapy. Children who have not received appropriate preventive vaccinations are given emergency immunization against tetanus.

Local treatment of burns in children is carried out by closed, open, mixed or surgical methods. With the closed method, the burn wound is covered with an aseptic bandage. For dressings, antiseptics (chlorhexidine, furatsilin), film-forming aerosols, ointments (ofloxacin + lidocaine, chloramphenicol + methyluracil, etc.), enzyme preparations (chymotrypsin, streptokinase) are used. The open method of treating burns in children involves refusing to apply bandages and managing the patient under conditions of strict asepsis. It is possible to switch from a closed method to an open one to speed up the recovery process, or from an open to a closed one if an infection develops.

During the rehabilitation period, children with burns are prescribed exercise therapy, physiotherapy (Ural irradiation, laser therapy, magnetic laser therapy, ultrasound),

Prevention of burns in children, first of all, requires increased responsibility on the part of adults. A child should not be allowed to come into contact with fire, hot liquids, chemicals, electricity, etc. To do this, in a house where there are small children, safety measures must be provided (storing household chemicals in an inaccessible place, special plugs in sockets, hidden electrical wiring, etc.). d.). Constant supervision of children and a strict ban on touching dangerous objects are required.