Pediatric burn chart: Lund-Browder assessment tool for children

Key takeaways

A pediatric burn chart sizes a child’s burn using age-specific body surface area percentages rather than adult values.

The Lund-Browder chart is the reference standard, because a child’s head is proportionally larger and the legs smaller.

Applying the adult Rule of Nines to a child skews the TBSA figure, and every fluid calculation that follows it.

Burns over 10 percent TBSA usually need a specialist burn center, and facial, circumferential, or suspected non-accidental injuries go regardless.

Digital forms attach the completed chart to the client record, so the numbers travel with the referral.

Assessing a burn in a child asks for speed and precision at the same time. Children’s proportions shift as they grow, so an adult assessment tool applied to a toddler returns the wrong number. A pediatric burn chart tells you how much of a child’s body surface area (TBSA) is burned. That figure then drives the fluid volumes and the referral decision.

This guide covers the Lund-Browder method, the age-banded percentages behind it, and the depth classification that decides what counts toward TBSA. It also puts a number on what the adult Rule of Nines gets wrong in a small child.

What is a pediatric burn chart and why do children need one?

A pediatric burn chart is a burn assessment form built around a child’s proportions. It pairs a body diagram with age-specific percentage tables, so you can shade the burned area and convert it into a TBSA figure. That figure decides treatment urgency and fluid resuscitation volume.

It gives you one structured way to record and total the burn, much as patient intake forms standardize the rest of the clinical record.

Children are not small adults. A newborn’s head is about 19% of total body surface area, while an adult’s is 9%. Their legs run the other way, taking up proportionally less. Use an adult tool on a child and you will misjudge severity in one direction or the other. The pediatric chart corrects for those differences with age-adjusted tables.

Every emergency department and pediatric ward should keep one printed and laminated, within reach of the bedside.

Why the adult Rule of Nines doesn’t work for children

The Rule of Nines is a quick mental calculation for adult TBSA. Head and neck are 9%, each arm 9%, chest 18%, abdomen 18%, each leg 18%, and the perineum 1%. It holds up in adults because adult proportions barely move.

In children, it fails, and the size of the error changes with age.

• Infant (0-1 year): head = 19%, legs = 13.5% each
• Toddler (1-4 years): head = 17%, legs = 14% each
• School age (5-9 years): head = 13%, legs = 16% each
• Older child (10-15 years): head = 11%, legs = 17% each, close to adult proportions

Use the adult rule on a toddler with burns to both legs and you overestimate TBSA by 8 percentage points. Run it on a scalded infant’s head instead and you underestimate by roughly 10. The Lund-Browder chart removes the guesswork with age-banded percentages.

Those percentage points turn into milliliters fast. Take an 18-month-old weighing 11 kg with scalds to both legs, and work the Parkland formula at 4 mL per kilogram per percent TBSA:

• Lund-Browder (14% per leg): 28% TBSA, so 1,232 mL over the first 24 hours
• Adult Rule of Nines (18% per leg): 36% TBSA, so 1,584 mL over the first 24 hours

That is 352 mL of extra fluid for a child who weighs 11 kg, on top of maintenance. Over-resuscitation carries its own risks, including edema and compartment pressure. The chart is what keeps the first number honest.

The Lund-Browder chart: The gold standard for pediatric burn assessment

The Lund-Browder chart is the evidence-based reference for pediatric TBSA estimation. It has two parts. One is a body diagram showing anatomical regions. The other is a percentage table with columns for newborn, 1, 5, 10 and 15 years, plus adult.

Shade every burned area on the diagram, then read across the age column that matches the child. Total the percentages for each shaded region to get TBSA burned. Only partial-thickness and full-thickness burns are counted, so superficial burns stay out of the total.

Age-specific body surface area percentages (Lund-Browder):

Watch how the percentages migrate as the child grows. An infant’s leg is 13.5% of TBSA, and by 15 it has reached the adult 18%. The same table is printed on every pediatric burn chart, so it stays in front of you during the assessment.

How to complete the assessment, step by step

Work through the form in the same order every time. Recording it in your medical records system keeps that order consistent across the whole team.

1. Identify the child’s age band. A 3.5-year-old is assessed against the “Age 5” column. Anyone older than 15 uses the adult column.
2. Examine the child and find every burned area. Count partial-thickness and full-thickness burns only, and leave superficial burns unshaded.
3. Shade the burned regions on the body diagram. Outline each burned zone on the diagram that matches the age band.
4. Read the age-specific percentage column. For each shaded region, note the percentage from that row and column.
5. Add the percentages together. Head, arms, chest, abdomen, legs and perineum sum to the total TBSA burned.
6. Classify each burned area by depth. Depth sets treatment urgency, and only partial and full thickness count toward TBSA.

Write the TBSA figure somewhere it cannot be missed, because fluid calculations and referral decisions both hang off it. One mistake at this step follows the child through the next 24 hours.

Burn depth classification: What to include in your TBSA count

Burn severity is classified by depth, and depth decides what enters the TBSA total.

The partial versus full thickness call is the one that changes the plan. Partial-thickness burns heal with wound care and close infection control, while full-thickness burns usually need surgery. Record the depth split, not only the total, so the receiving team can triage.

Age-banded body diagrams: Infant through older child

The downloadable template carries separate body diagrams for four age bands:

• Infant (0-1 year): proportionally large head, small legs
• Toddler (1-4 years): head still prominent, legs starting to lengthen
• School age (5-9 years): head and legs approaching parity
• Older child (10-15 years): adult proportions nearly reached

Each diagram sits on the same sheet as its own percentage table, which makes it hard to shade one age band and total another. The regions are labelled the same way throughout, so a team that trains new staff on a body regions worksheet will recognize every landmark.

Pediatric burn referral and transfer criteria

Once TBSA is calculated, the referral thresholds decide whether the child needs a specialist burn center. Standard pediatric criteria combine TBSA, burn location and the child’s age.

• TBSA 10% or more: refer to a specialist burn center
• TBSA 5-9%: may be managed locally by an experienced team, after discussion with the burn center
• TBSA under 5%: usually manageable in primary care or a general ED, if not circumferential, facial or perineal
• Circumferential burns: always refer, whatever the percentage, because of compartment syndrome risk
• Face, hands, genitalia or joints: refer for specialist input, since function is at stake
• Suspected non-accidental injury: refer immediately and follow safeguarding procedure
• Age under 2 years: lower the threshold, as 5-10% TBSA may warrant specialist assessment

Most specialist burn services sit inside plastic surgery departments, and they want the depth breakdown as well as the headline percentage. Send the reasoning with the child. A short diagnosis letter can carry the TBSA, the depth split and the mechanism of injury.

Smaller burns come back to general practice for dressing changes and scar review. The original chart needs to travel with the child in both directions. Clear documentation supports continuity of care and protects you if the assessment is questioned later.

How Pabau keeps burn assessments in one clinical record

In most departments the burn chart is paper. It gets photographed, filed, and then hunted down at the follow-up appointment. Practice management software like Pabau moves that whole loop into the patient record, where the assessment is already being written.

Digital forms let a clinician complete the burn chart in the record itself and attach the shaded diagram. TBSA, depth and the referral decision are stored as one structured note. Nothing is transcribed twice, so the number the receiving team reads is the number you recorded.

Pabau Scribe, our AI scribe, writes the assessment up while you are still with the child. Follow-up wound checks continue in the same clinical progress notes. Three things change day to day:

• The assessment is visible to the whole team at once, with no transcription step in between
• Automated workflows trigger the referral letter and specialist notification as soon as TBSA crosses the threshold
• Wound review appointments and healing photographs sit against the original chart, so progress is easy to read

Keep burn charts and referrals in one record

Pabau’s digital forms hold the completed burn chart in the client record, then carry TBSA and depth straight into the referral letter. Wound reviews and photographs stay attached to the same assessment.

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Conclusion

The chart earns its place in the first ten minutes, before anyone has calculated a fluid rate. Get the age band right and the rest of the resuscitation has a sound foundation. Get it wrong and every downstream number inherits the error.

So print the template, laminate it, and put it where a child would actually be assessed. Then decide where the completed chart lives afterwards, because a photograph in someone’s phone gallery is not a clinical record. Book a demo to see how Pabau keeps pediatric burn assessments, referrals and follow-up in one place.

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Frequently asked questions