Max 1000 mg/dose · Max 4000 mg/day · Duration: PRN · 10–15 mg/kg/dose q4–6 h PRN — max 60 mg/kg/day or 4 g/day (whichever lower); first-line for outpatient burn pain (ABA, NICE, WHO)
• **First aid:** cool running water **20 min** within 3 h of injury — NOT ice (vasoconstriction), NOT butter/oils/home remedies; remove rings/jewelry; keep child warm otherwise (WHO, NICE, ABA).
• **TBSA:** use **Lund-Browder chart** for children (rule of 9s underestimates in infants) — **palm method:** child's palm + fingers ≈ **1% TBSA**; document depth and % for every referral decision (ABA, EBA, AAP).
• **Minor burn definition:** typically **<10% TBSA** partial thickness, no special-site involvement, no inhalation/chemical/electrical injury, reliable caregivers — outpatient or brief ED care (ABA, NICE).
• **Dressings:** clean with saline; **non-adherent** dressing (e.g. paraffin gauze, hydrogel); silver-impregnated dressings for partial thickness per local burn protocol — change per dressing type; **no routine topical antibiotics** on clean burns (NICE NG30, ABA).
• **Analgesia:** PO **paracetamol** 10–15 mg/kg q4–6 h PRN ± **ibuprofen** 5–10 mg/kg q6–8 h PRN — reassess before dressing changes; severe pain despite oral agents → escalate pathway (ABA, NICE, WHO).
Enter weight on Kids to calculate doses
Tetanus + burn center referral / admission • procedure
Duration: As indicated · Tetanus per immunization status; urgent burn center consult if ABA criteria met — antibiotics **not routine** unless infection (ABA, NICE, AAP)
• **Tetanus:** assess vaccination history — give Tdap/Td booster if indicated; **TIG** for tetanus-prone wound with incomplete primary series (≥3 doses) per immunization schedule (AAP Red Book, WHO wound management).
• **Burn center referral (ABA criteria, peds):** partial/full **>10% TBSA**; face, hands, feet, genitalia, perineum, major joints; circumferential; inhalation; chemical or electrical; suspicion of **non-accidental injury** (ABA, EBA, NICE).
• **Hospital admission from minor pathway:** unreliable caregivers, pain not controlled orally, concern for progression, social factors, or inability to change dressings at home (ABA, NICE).
• **Antibiotics:** **not indicated** for clean uninfected burns — treat only established infection (cellulitis, purulence, rising fever >48 h post-injury) per local SSTI guidelines; prophylactic topical antibiotics not recommended (NICE NG30, ABA).
• **Chemical burns:** copious irrigation (water/saline per agent); remove contaminated clothing; consult poison control — do not neutralize acids/bases on skin (ABA, WHO).
Clinical notes
• Depth & TBSA: classify superficial / partial / full thickness; estimate % with Lund-Browder (peds) ± palm method (1% TBSA) — document mechanism and time of injury (ABA, EBA, WHO).
• First aid: cool running water 20 min; remove jewelry; keep warm; no ice, butter, or adhesive dressings on fresh burns (WHO, NICE, ABA).
• Dressings: non-adherent ± silver per local protocol; elevate burned limbs; no routine topical antibiotics on clean burns (NICE NG30, ABA).
• Tetanus: update immunization per schedule; TIG if tetanus-prone wound and under-immunized (AAP Red Book, WHO).
• Escalate to resuscitation pathway if >10% TBSA, special sites, inhalation/chemical/electrical injury, circulatory compromise, or inadequate oral analgesia (ABA, NICE).
• ABA — Pediatric burn care and referral criteria (2024)
• EBA — European Burn Association practice recommendations (2023)
• WHO — Burns fact sheet and first aid (2024)
+ 2 more
• AAP — Thermal injuries in children (2024)
• NICE NG30 — Burns and scalds assessment and initial management (2022)
