These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full CAHS clinical disclaimer.


To guide staff with the assessment and management of burns.


  • Burns are a leading cause of injury in children
  • All patients with burns requiring admission must be discussed with both the burns registrar and burns consultant. 


  • Assessing an acute burn can be difficult for clinicians and the appearance can change during the first 72 hours.7
  • Clinical photography can facilitate communication and assessment of injury
  • Photographic consent must be obtained and documented. 
  • All injury presentations (including burns) in children under 2 years must have an Early Childhood Injury Proforma completed (MR301.3) (internal WA Health only)


  • Time and place the burn occurred
  • Type of burn: thermal (most common), electrical, chemical (the substance causing the burn, duration of contact), radiation or friction
  • First aid done at the scene
  • Any further treatment prior to arrival in hospital
  • Other injuries
  • Immunisation status: tetanus


Total Body Surface Area (TBSA)

  • Use the Burns Body Surface Area Sheet (PDF 162kb)
  • Do not include areas of erythema
  • Note: the palmar surface of the child’s hand = 1% BSA as a rough estimate

Depth - see Burns depth assessment table below

  • Superficial: only involve the epidermis
  • Partial: involve whole epidermis and part of the dermis – can be divided into superficial (papillary layer of the dermis) and deep (reticular layer of the dermis).
  • Full thickness: involve epidermis and entire dermis.


  • Note pattern of burns
  • Consider non-accidental injury (NAI) if history inconsistent with the examination findings, delay in presentation, other concerning injuries e.g. unusual / unexplained bruises.

Specific information 

  • Burns in special areas (e.g. face, neck, hands, feet, perineum)
  • Assess for inhalation burns: singed nasal / eyebrow hairs, swelling of mouth / face, stridor, hoarse voice, cough, respiratory distress, any facial, oral or neck burns, black sputum.
  • Circumferential or almost circumferential burn areas. 



  • Airway: consider early intubation for inhalation burns, remember C-spine precautions in trauma.
  • Breathing: always give oxygen in severe or inhalation burns.
  • Circulation: If signs of shock, resuscitate with Sodium Chloride 0.9%, 10-20mL/kg bolus. Reassess after first fluid bolus and repeat as required. 
  • Consult Intravenous Fluid Therapy.

First aid 

  • Stop the burning process
  • Cool the burn with cool running water for 20 minutes. Do not use ice
  • Remove clothing and nappy, taking care not to rip any adhered skin. Cut around adhered clothing if required
  • Remove jewellery
  • Keep the patient normothermic 36-37°C
  • First aid is effective for 3 hours from the time of burn injury.7
  • If outside hospital, do not apply any burns gels - burns can be covered with Acticoat for transfer. Do not use Fixomull.


  • Review analgesia given prior to arrival
  • Intranasal fentanyl should be the 1st line analgesia
  • If IV cannula already in situ, IV morphine can be given
  • Oral analgesia: paracetamol, ibuprofen, oxycodone
  • Be aware NSAID use in burns may be associated with risk of necrotising fasciitis5,6
  • Consult Burns - Analgesia and dosing.

Assess for concurrent injuries

  • Perform a head to toe examination for concurrent injuries – consider the possibility of NAI.
  • Whilst conducting survey take note of estimated BSA % and document on the chart.

Further management

Minor burn or burn with elevated concerns

Discuss with Emergency department senior doctor and Burns registrar/consultant to consider admission for:

  • Special area burns (e.g. face, neck, hand, feet, perineum)
  • Full thickness burns
  • Suspicion of NAI

Wound care

Major burn or burns of high concern

Consult with Burns registrar/consultant for inpatient admission:

  • 5% TBSA or greater
  • Full thickness
  • Inhalation burns.
  • Facial burns
  • Other special burn areas e.g. neck, hands, feet, perineum
  • Concurrent injury or co-morbidities.
  • Circumferential burns (potential need for escharotomy).
  • Chemical and electrical burns
  • Infected burns.
  • Infants
  • Suspicion of NAI.

Rehydration and maintenance

Consult the following guidelines:

Wound care while waiting for transfer to PCH Burns Service

  • Ensure adequate analgesia is provided
  • Consult Burns - Dressing.
  • Elevate burnt area
  • Apply loose dressings over Acticoat that allow access to the peripheries for neurovascular observations
  • Regular neurovascular observations.


Admission follow up or admission with PCH Burns Service

  • Discuss with Emergency Department Senior Doctor and Burns Registrar
  • Consider admission when burns meet the above ‘Major Burn or Burns of High Concern’ criteria
  • All burn patients should be followed up by the PCH Burns Service. 


  1. AMH Children’s Dosing Companion (July 2021) Australian Medicines Handbook Pty Ltd
  2. Textbook of Paediatric Emergency Medicine 3rd Edition Cameron P, Browne GJ, Mitra B, et al (2018) Publisher: Elesevier Edition updated
  3. Nelson Textbook of Pediatrics: 21st Edition Robert M. Kliegman, St Geme JW, Blum MJ et al. 2020 Publisher: Elsevier
  4. McWilliams TL, Twigg D, Hendricks J, et al (2019) The Implementation of an infection control bundle within a Total Care Burns Unit. Burns 47 (2021), 569-571
  5. Aronoff DM, Bloch KC. Assessing the relationship between the use of nonsteroidal anti-inflammatory drugs and necrotizing fasciitis caused by group A streptococcus. Medicine. 2003 Jul;82(4):225-235.
  6. Zerr, D., Rubens, C. NSAIDS and Necrotizing Fasciitis, The Pediatric Infectious Disease Journal: August 1999 - Volume 18 - Issue 8 - p 724-725
  7. Children’s Health Queensland Hospital and Health Service, Management of a paediatric burn patient. Updated: February 2021, Cited 2 Nov 2021. Available from: Management of a paediatric burn patient (health.qld.gov.au)

Endorsed by: Co-Director, Surgical Services  Date: Nov 2021
     Amendment date: Dec 2023

 Review date:  Nov 2024

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