Step 1: Estimate burned area with Lund–Browder
Count partial- and full-thickness burns only, not simple redness. The child's palm with fingers is about 1% TBSA, which helps for scattered burns. Lund–Browder adjusts the head and leg percentages for age because a young child's head is proportionally larger.
Fixed regions at every age: neck 2%, anterior trunk 13%, posterior trunk 13%, each buttock 2.5%, genitalia 1%, each upper arm 4%, each forearm 3%, each hand 2.5% and each foot 3.5%.
| Age | Head | Each thigh | Each lower leg |
|---|---|---|---|
| Under 1 year | 19% | 5.5% | 5% |
| 1–4 years | 17% | 6.5% | 5% |
| 5–9 years | 13% | 8% | 5.5% |
| 10–14 years | 11% | 8.5% | 6% |
| 15 years | 9% | 9% | 6.5% |
| Adult size | 7% | 9.5% | 7% |
Step 2: Parkland resuscitation fluid
For burns of 10% TBSA or more, calculate the 24-hour lactated Ringer total as 4 mL × kg × %TBSA. Give the first half over the first 8 hours from the time of the burn, not from arrival. If time has already passed, give the first half over the hours left in that 8-hour window. Give the second half over the next 16 hours.
Many centers start at 3 mL/kg/%TBSA for children. Either way, the formula is only a starting rate: titrate to urine output.
Step 3: Add maintenance fluid in children under 30 kg
Children under 30 kg also need maintenance fluid with dextrose (D5 with 0.45–0.9% saline) on top of the Parkland volume, calculated by Holliday–Segar as an hourly rate:
- Up to 10 kg: 4 mL/kg/h
- 10–20 kg: 40 mL/h plus 2 mL/kg/h for each kg over 10
- Over 20 kg: 60 mL/h plus 1 mL/kg/h for each kg over 20
Worked example: 20 kg child with 20% TBSA
A 20 kg child, seen soon after the burn, with 20% TBSA partial-thickness burns (for example the whole anterior trunk 13%, right upper arm 4% and right forearm 3%).
| Item | Calculation | Result |
|---|---|---|
| Parkland 24-hour total | 4 × 20 kg × 20% | 1,600 mL lactated Ringer |
| First half | 800 mL over the first 8 h | 100 mL/h |
| Second half | 800 mL over the next 16 h | 50 mL/h |
| Maintenance with dextrose | 40 + 2 × (20 − 10) | 60 mL/h |
| Target urine output | 1 mL/kg/h (under 30 kg) | 20 mL/h |
- If the child arrived 2 hours after the burn, the first 800 mL would run over the remaining 6 hours instead of 8.
- Children 30 kg or more get no added maintenance line, and their urine output target is 0.5 mL/kg/h.
- Adjust the rate hourly to urine output and avoid over-resuscitation, which can cause compartment syndromes and pulmonary edema.
Analgesia and first aid
Intranasal fentanyl 1.5 mcg/kg (max 100 mcg) or IV morphine 0.1 mg/kg; for the 20 kg example that is 30 mcg of fentanyl or 2 mg of morphine.
Cool the burn with running water for 20 minutes within 3 hours of the burn; avoid ice and hypothermia. Remove jewelry and cover with plastic film or a clean non-adherent dressing. Check tetanus status and consider abuse: immersion lines, glove or stocking pattern, or a delay in care.
Under 10% TBSA, oral fluids are usually enough, with IV maintenance if the child is not drinking. Burn depth is often underestimated early, so reassess within 24 to 48 hours.
Burn center referral criteria (ABA)
Refer to a burn center for any of the following. Small superficial partial-thickness burns without these features can be managed as outpatients with follow-up in 24 to 48 hours.
- Partial-thickness burns over 10% TBSA
- Any full-thickness burn
- Burns of the face, hands, feet, genitals, perineum or major joints
- Inhalation, electrical or chemical injury, or possible abuse
Use the free tool
Age-adjusted burned area (Lund–Browder), Parkland fluids and burn center referral.
Open Burns →Common questions
What is the Parkland formula for children?
4 mL × weight in kg × %TBSA of lactated Ringer over 24 hours: half in the first 8 hours from the burn, half over the next 16. Many centers start at 3 mL/kg/%TBSA in children. Children under 30 kg also get dextrose-containing maintenance fluid.
When do children need formal burn resuscitation?
From 10% TBSA. Under 10% TBSA, oral fluids are usually enough, with IV maintenance if the child is not drinking.
What urine output should I aim for?
1 mL/kg/h in children under 30 kg and 0.5 mL/kg/h in those 30 kg or more. Adjust the fluid rate hourly.
Does the 8-hour clock start at arrival?
No. Timing starts from the time of the burn. If a child arrives late, give the first half of the Parkland volume over the hours remaining in the first 8.
Sources
Lund CC, Browder NC. The estimation of areas of burns. Surg Gynecol Obstet 1944;79:352–358. Baxter CR, Shires T. Physiological response to crystalloid resuscitation of severe burns. Ann N Y Acad Sci 1968;150:874–894. American Burn Association. Guidelines for burn patient referral (2022). ISBI Practice Guidelines for Burn Care. Burns 2016;42:953–1021.
For education only, not medical advice. Always confirm against current guidelines and your local protocols. Pedemy is independent and not affiliated with or endorsed by the organizations cited.