# Pediatric burns

Assess inhalation injury, treat pain and poor perfusion, and coordinate the burn destination.

Population: Pediatric. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See the linked OCEMS source for revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/pediatric-burns/
Official source: [SO-P-095 — Burn (Thermal, Electrical, Chemical) - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-P-95%20Burn%204-2024_0.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- A normal SpO₂ does not exclude carbon monoxide toxicity.
- Do not give fluids blindly to water-reactive chemicals; scene/exposure identification matters.

## Source documents

- [SO-P-095 — Burn (Thermal, Electrical, Chemical) - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-P-95%20Burn%204-2024_0.pdf)

## First actions

- For enclosed-space burns or smoke exposure, provide high-flow oxygen as tolerated. Pulse oximetry can be misleading with carbon monoxide exposure.
- Cool a burn that remains symptomatic. For wheeze or suspected smoke inhalation, the source lists albuterol 5 mg in 6 mL by continuous nebulization as tolerated.

## Pain and circulation

- For pain with systolic BP above 80: morphine 0.1 mg/kg IV/IM (maximum 5 mg), OR fentanyl 2 mcg/kg IN/IV/IM (maximum 50 mcg). Each may repeat once after 3 minutes, with total limits of 10 mg morphine or 100 mcg fentanyl.
- Base contact is required at age 2 or younger. Avoid medication injections and IV/IO placement through burned skin.
- For BP at or below 80 or signs of shock, use non-burned access and saline 20 mL/kg IV/IO, maximum 250 mL, with base contact. May repeat twice for three total boluses.

## Burn-center criteria

- Contact base, pediatric-capable preferred, for suspected inhalation injury, electrical/lightning injury, or chemical burns.
- Other triggers include face/hands/feet/genitalia/perineum involvement, circumferential burns, complicating disease, second-degree burns above 10% TBSA, or any third-degree burn.

## Chemical and electrical injuries

- Brush off residual dry chemical before irrigation. Use copious continuous water/saline when appropriate, but identify water-reactive chemicals before applying fluids.
- Small electrical skin wounds can conceal deep injury. Follow the source’s high-voltage ALS escort and rhythm-monitoring guidance. Report mechanism, TBSA/depth, airway findings, pain treatment, and fluid response.