We present a case report of a 10-year-old girl who sustained significant facial burns after microwaving a frozen stress ball; just one example of a "trend" which quickly gained popularity without disclaiming the harmful risks. The management and outcome of a significant contact burn linked to an uncensored online activity is described, highlighting important considerations of facial burn management and discussing the broader implications for pediatric safety in the ever-evolving digital age.

Burn injuries have far-reaching physical, psychological, and social consequences for children and their families. The posttraumatic stress experienced by primary caregivers of burn-injured children can significantly influence the child's recovery process and overall prognosis while imposing a psychological toll on the caregiver. Exploring the posttraumatic stress of caregivers is therefore of critical clinical and practical importance. This study aimed to systematically evaluate the prevalence of posttraumatic stress among primary caregivers of pediatric burn survivors and identify the key factors that contribute to it. We conducted a cross-sectional study of the primary caregivers of children who were hospitalized for burn injuries between January 2024 and June 2025. Caregivers were assessed using the Posttraumatic Stress Disorder (PTSD) Checklist-Civilian Version (PCL-C), which categorizes 17 symptoms of posttraumatic stress within three dimensions. To identify independent risk factors associated with PCL-C scores, we employed both univariate and multiple linear regression analyses. A total of 240 primary caregivers were included in the study; these caregivers had a mean (SD) PCL-C score of 41.22 (5.09). Among the three PCL-C dimensions, reexperiencing symptoms was the most prevalent, followed by hyperarousal symptoms and avoidance symptoms. Multiple linear regression analysis revealed the following independent PTSD risk factors: the severity of the child's burn injury (β = 0.122, P = 0.001); the caregiver's place of residence (β = 0.116, P = 0.04), educational level (β = 0.123, P = 0.02), and marital status (β = 0.125, P = 0.02); the monthly per capita household income (β = 0.109, P = 0.02); and witnessing the burn incident (β = 0.127, P = 0.005). The final regression model explained 59.5% of the variance in scores (F = 27.10, P < 0.001). Primary caregivers of children with burn injuries experience a high prevalence of posttraumatic stress, which is influenced by a combination of child-related, caregiver-related, and incident-related factors. Health care providers should develop individualized interventions addressing these specific factors to support caregiver mental health and ultimately improve outcomes for both children and their families.

Background:Burn injuries impose substantial burdens in low- and middle-income countries, where prolonged hospitalization occurs due to limited specialized centers, resources, and surgical delays. This study examines factors associated with prolonged length of stay (LOS) and treatment costs relative to catastrophic health expenditure (CHE) thresholds among burn patients treated at a tertiary center in Ethiopia.Methods:Burn patients treated at the Addis Ababa Burn, Emergency, and Trauma Center from January 2023 to 2025 were prospectively enrolled in this observational cohort study. Univariable and multivariable analyses were performed to evaluate factors associated with LOS for the overall cohort and by age subgroup and treatment costs were compared with CHE thresholds.Results:Among 196 patients (55.6% men; mean age 17.6 y), the mean LOS was 33.5 ± 28.8 days. Electrical (36.4%) and flame (35.2%) injuries predominated in adults versus scalds in children (73.1%). Total body surface area and sex distribution were similar across groups, but pediatric burns were more superficial and required fewer surgical procedures (0.6 versus 1.4). The number of procedures and systemic infections remained independently associated with log-transformed LOS in adjusted analyses for all groups (all P < 0.05). LOS independently predicted cost. Facility and out-of-pocket costs averaged 24,428 and 7283 Ethiopian birr, respectively, with out-of-pocket spending by subgroup approaching or exceeding CHE thresholds.Conclusions:Prolonged LOS after burn injury in Addis Ababa is driven by clinical severity and complications, escalating costs toward catastrophic levels. Prevention strategies and age-tailored clinical pathways may shorten LOS, reduce costs, and strengthen financial risk protection in low-resource settings.

What Is the Safe and Optimal Dosing of Epinephrine in Tumescent Solution for Pediatric Burn Patients?

ObjectiveTo analyse physical fitness trajectories in paediatric burn survivors from discharge to 2 years post-injury, compare them with an age- and gender-matched control group, and identify baseline demographic and clinical determinants.DesignProspective and longitudinal cohort study.ParticipantsThe study included participants with burn injuries (burn group, n = 45), aged 10-17 years, with burns involving ≥25% of total body surface area, and an age- and gender-matched group of healthy children (control group, n = 45).Main measuresParticipants underwent standardised fitness assessments at discharge and 24 months later. Health-related physical fitness was quantitatively assessed using the validated EUROFIT physical fitness test battery.ResultsLongitudinal analysis revealed significant improvements in seven of nine fitness domains for participants with burn injuries over two years (pFDR < 0.001). Despite these gains, these participants exhibited persistent fitness deficits compared to healthy controls across all domains at follow-up (all p < 0.001). Among those with burn injuries, greater total body surface area (β = -0.007, p = 0.03) and third-degree burn percentage (β = -0.57, p < 0.001) predicted lower overall fitness, while longer rehabilitation predicted higher fitness (β = 0.50, p < 0.001). No baseline clinical factors significantly predicted the rate of fitness change over time (all interaction p > 0.05).ConclusionPaediatric burn survivors demonstrated significant improvements in physical fitness over 2 years but failed to close the performance gap with their healthy peers. Injury severity and rehabilitation duration were strong determinants of fitness level, but they did not predict the rate of improvement.

Management of burn wounds is challenging. Dressing changes, especially in paediatric burn patients, are a major concern. To address these challenges, numerous methods and advanced dressing materials have been developed. Collagen, a biocompatible material easily derived from natural sources, has emerged as a promising option. The primary goals are early wound healing, reduced pain sensitivity, and fewer dressing changes in the paediatric population. A prospective observational study was conducted among 38 paediatric patients, under 12 years of age, with scald burns. The study was conducted from 1st January 2024 to the end of October 2024. When a patient was admitted with scald burn, the wound was cleaned with normal saline and collagen materials were applied over the wound. This was followed by paraffin impregnated gauze and dry dressing. The first dressing was opened on day 5 and followed by dressing every 3 to 4 days until the wound healed. Thirty-three out of 38 patients (87%) were discharged within 12 days. Infection was found in 5 patients. No adverse reaction due to the application of collagen was observed. Collagen-based dressing is an important dynamic for burn wound management. Frequent change of dressing is avoided, with a significant impact on pain and psychological trauma among the paediatric population.

Burns in children are an emergency condition that can lead to shock, infection, functional limitations, and both physical and psychological discomfort. Comprehensive management involves pharmacological approaches, including the use of analgesics to reduce pain and antibiotics to prevent or treat infections and related complications. This condition is a concern for nurses because comprehensive and holistic nursing care can reduce complications and prevent mortality. This study aims to examine the effectiveness of evidence-based nursing care in improving comfort among children with burn injuries. This research uses a literature review method analyzing scientific articles from Google Scholar published from 2020 to 2025. The results indicate that children’s comfort improves through optimal pain management, early infection detection, exudate removal, and family education, as well as through therapeutic interventions such as honey therapy, Negative Pressure Wound Therapy (NPWT), physiotherapy, and wound care to support functional recovery. In addition, multidisciplinary collaboration among nurses, surgeons, nutritionists, and rehabilitation specialists has been shown to accelerate healing and reduce stress in children. These findings confirm that structured, responsive, and collaborative nursing care plays a significant role in enhancing comfort and accelerating the recovery process of pediatric burn patients. Overall, strengthening the implementation of essential nursing care can speed up the healing process and reduce both the physical and emotional burden experienced by children with burn injuries

Persistent immune dysregulation consistent with chronic low-grade inflammation in paediatric burn survivors.

Following global Phase III trials, a single-arm expanded access program at 23 burn centers in the United States (2019-2024) provided centers with additional experience treating adult and pediatric burn patients with NexoBrid and maintaining burn care preparedness for mass casualty incidents. Eligible patients included children (<18years old) and adults (≥18years old) with deep thermal burns covering up to 30% total body surface area. NexoBrid application was followed by standard care. Patients were monitored weekly until wound closure, and again after 3 and 12months. Outcomes included incidence and time to eschar removal, need for surgical excision or escharotomy, length of hospital stay, wound closure, and Modified Vancouver Scar Scale. A total of 239 patients (215 adult, 24 pediatric) received NexoBrid, with 142 (131 adult, 11 pediatric) completing the 12-month follow-up. Mean ages were 41 and 11years, respectively. Mean treated target wound area was approximately 6% of total body surface area, with 38 circumferential burns. Eschar removal was achieved in 95% of adults and 100% of pediatric patients within 4hours. Surgical excision was performed in 4% of adults, but not in pediatric cases. No escharotomies were needed. Median length of stay was 10days. Wound closure occurred by 22days (adults) and 28days (pediatric). Safety data were consistent with previous trials. NexoBrid demonstrated comparable outcomes versus previous Phase III trials and potential efficacy in preventing burn-induced compartment syndrome.

The intraoperative carbon footprint of burn surgery: A prospective case-level analysis.

Burning questions: ED management of pediatric burns at a non-burn health care system.

Previous studies have shown that a length of stay (LOS) of one day per percent total body surface area (TBSA) burn is expected in children with burn injuries, with variability by mechanism. Recent practice has shifted towards earlier discharge and outpatient management. We predicted that an updated multi-institutional analysis of LOS/TBSA burn would demonstrate a downward trend. A retrospective study from five pediatric burn centers conducted between March 2022 and February 2025 of burn patient demographics and clinical course metrics. LOS/TBSA burn ratios were calculated and compared across multiple variables using χ2 and Kruskal-Wallis tests. p <0.05 was considered statistically significant. Among 1,543 unique patients, 57.4% were male and the median age was 2.52 years [interquartile range (IQR), 1.32-7.1]. Burn etiology was most commonly scald burn (55.3%), as well as flame/fire-related burns (10.7%), and other mechanisms (34.0%). Most burns were small, with 56.0% of patients presenting with TBSA burn <5% and 27.4% of patients with TBSA burn 5% to 10%. Inhalation injury was rare (2.7%). Median LOS/TBSA for all burn patients was 0.6 days (IQR, 0.33-1.2). Patients with accidental injuries had significantly shorter median LOS/TBSA than those with nonaccidental injuries [0.61d (IQR, 0.33-1.14) vs. 1.31d (IQR, 0.50-2.31); p<0.001]. Median LOS/TBSA also varied significantly by mechanism of burn injury [cald 0.48d (IQR, 0.29-0.88) vs. fire-related 0.90d (IQR, 0.50-1.60) vs. other 1.00d (IQR, 0.50-2.00); p<0.001]. Data from this multi-institutional cohort of pediatric burn patients reports updated burn injury demographics and establishes that the median LOS/TBSA burn is less than the previously established one-day/TBSA burn. Focus on earlier discharge and frequent outpatient visits likely decreased median LOS/TBSA. Factors such as nonaccidental etiology and fire-related burn led to higher predicted LOS/TBSA, and these families should be counseled accordingly. Total burn care delivered, rather than inpatient census, should be used to set standards for pediatric burn centers. (J Trauma Acute Care Surg. 2026;00: 00-00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). Level II.

The development of a value-based healthcare burns core set for children after burn injury.

"It's calm on the outside but going absolutely stir crazy on the inside": A qualitative insight into the emotional dimensions and support for parent-administered at home paediatric burn dressing changes.

Systemic inflammation after pediatric burn injury frequently causes fever, complicating early recognition of infectious complications. Improved risk-stratification may help identify patients at risk for adverse clinical events during hospitalization. This study aimed to develop and validate a machine learning (ML)-based model using a Random Forest (RF) algorithm to predict fever and related adverse outcomes in hospitalized pediatric burn patients. We conducted a retrospective analysis of 595 pediatric burn patients admitted to a tertiary center between 2012 and 2022. Extracted data included demographics, burn characteristics, clinical interventions, laboratory values, and outcomes. RF models were trained to predict three key endpoints: fever (>38.5°C), transfer to pediatric intensive care unit (PICU), and need for surgical intervention. To address missing data and class imbalance, we employed multiple imputation techniques and generated synthetic data through bootstrap sampling to improve model robustness. The patient cohort had a mean age of 4.27 (range: 0.2-18.1) years and an average total body surface area (TBSA) of 5.49 (range: 0.3-45.0). The RF models demonstrated high predictive accuracy, with F1-scores of 0.81±0.037 (fever), 0.88±0.091 (PICU transfer), and 0.81±0.027 (surgery). Area Under the Curve (AUC) values were 0.96, 0.97, and 0.95, respectively. Feature importance analysis identified younger age, lower body weight, female sex, and head and neck burn location as key predictors. These ML-based RF models demonstrate strong potential for early risk-stratification of fever and high-risk trajectories in hospitalized pediatric burn patients, guiding monitoring intensity, diagnostic vigilance, and resource planning. Prospective evaluation is needed to determine whether model-informed workflows improve outcomes.

Children represent 20% of all burn admissions annually; 20-30% are related to abuse or neglect. Our institution Child Protective Services (CPS) recently decided to stop following and interpreting hair toxicology results for pediatric burn patients. Drug use/exposure is an important risk factor for child abuse/neglect. The goal of this study was to evaluate the value of hair toxicology testing to identify child abuse or neglect. Medical records of pediatric patients ≤14 years admitted between 1/1/2019 and 2/29/2024 were reviewed. Demographics, burn injury information, suspicion of child abuse/neglect on admission, routine urine drug screening tests, hair toxicology results, and reporting to the State Health and Human Services (HHS) were collected. Descriptive statistics were obtained. Univariate analyses were performed to assess the utility of hair toxicology with p < 0.05 considered significant. Two hundred ninety-eight patients were included; child abuse was suspected in 31.5%; hair toxicology performed for 75.2% and positive for 35.7%. Hair toxicology was more likely to be performed when child abuse was suspected on admission (81.9% vs. 72.1%, p = 0.044), and to be positive (40.4% vs. 20.6%, p < 0.001). Suspicion on admission was associated with higher HHS involvement (95.7% vs. 24%, p < 0.001). HHS was more likely to be involved when hair toxicology was performed (54% vs. 24.3%, p < 0.004) and positive (96.3% vs. 28.4%, p < 0.001). Hair toxicology screening for pediatric burn patients is still a valuable tool to help clinicians report suspected abuse/neglect not otherwise detected on admission using other tools.

Microstomia, or small oral aperture, often results from facial burns. This condition appears as scars form within the oral tissue and at the oral commissures, narrowing the oral opening, and leading to mobility, speech, respiratory difficulties, emotional distress, and social interaction challenges. This study examines the presence of reported burn microstomia and its related clinical factors. Pediatric and adult data from a multicenter longitudinal database from 2003 to 2005 were analyzed to determine the frequency of microstomia at discharge. Summary statistics were used to describe clinical characteristics, demographics, and burn location in pediatric and adult burn survivors. Clinical and burn characteristics were then tested to determine if there was an association with the development of microstomia. Data revealed 4.7% (n = 10) of adult burn survivors (n = 214) and 11% (n = 10) of pediatric burn survivors (n = 91) presented with microstomia at hospital discharge. Those with microstomia had significantly larger TBSA burns, higher rate of inhalation injury, more days on ventilation, and higher rate of adjacent contractures. No differences were found when considering age, sex, race, ethnicity, etiology of burn, or discharge location. Burn size and length of time requiring ventilation were predictive of microstomia. Knowledge of these risk factors suggests that therapists should focus on early microstomia prevention, even during times of ventilation, especially in those with larger burn injuries. The high incidence of adjacent contractures demonstrates the impact of cutaneokinematic skin recruitment and suggests that areas beyond the perioral should be considered when developing a treatment and prevention program for microstomia following a burn injury.

Accurate and timely depth assessment in paediatric burn wounds is essential for appropriate treatment and optimal results. The current golden standard in care is clinical assessment and the laser Doppler imager (LDI), which have limitations, respectively, in either accuracy or cost. Infrared thermography has emerged as a possible easy and cost-effective alternative for burn depth assessment in adults. We conducted a prospective cohort study to evaluate the FLIR ONE Pro camera using thermography in paediatric burns. Here, it is demonstrated that it has potential as an inexpensive and portable supportive tool in assessing burn depth in paediatric patients, particularly in settings where LDI is unavailable. In this cohort, effect size and diagnostic accuracy results were comparable to the LDI for diagnosing superficial partial thickness burns. However, measurement variability, and practical objections to the FLIR system remain. Further research with large cohorts are warranted to determine the feasibility of this technology, and to develop proper measurement timing.

Interactive versus passive virtual reality on upper limb pain, function, and range of motion in pediatric thermal burns, a randomized controlled trial.

HighlightsWhat are the main findings?Paediatric isolated hand burns occur in younger children and are more often caused by contact or friction injuries.Hand involvement did not independently prolong length of stay; however TBSA, flame injury, surgery, and rural residence independently did.What are the implications of the main findings?Length of stay is driven by injury severity and management rather than hand burn location.The impact of hand burns may relate more to functional and rehabilitation needs than acute admission duration.Background: Hand burns are a key criterion for immediate referral to tertiary burn centres in Australia, New Zealand, and internationally, yet few studies have examined how paediatric burn epidemiology, surgical management, and length of stay (LOS) differ according to the extent of hand involvement. The objective of this study was to describe and compare the demographic profiles, burn injury characteristics, and clinical management between three groups: children with (1) burns involving only the hands, (2) burns involving the hands and other sites, and (3) burns not involving the hands who were admitted to the paediatric Burns Service of Western Australia (BSWA) over a 10-year period. Methods: This cross-sectional study included all burn admissions to the state paediatric burn unit between July 2012 and June 2022. Descriptive statistics and univariate regression used to compare groups. A multivariate log-linear regression model was used to assess the independent association between hand involvement and length of hospital stay, adjusting for identified confounders. T Results: Children with burns isolated to the hands were younger, had a smaller percentage of total body surface area (%TBSA), were more likely to have sustained contact or friction burns, and were more likely to undergo skin grafting procedures compared to those with burns involving the hands and other sites, and those with burns not involving the hands. Despite these differences, hand involvement was not identified as an independent predictor of initial LOS. Conclusion: Paediatric patients with hand burns did not have longer initial hospital admissions than those without hand involvement. Future research needs to assess longer term impacts of hand burns.