Parkland formula paediatrics
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Parkland Formula in Paediatrics
The Basic Formula
The modified Parkland (Baxter) formula is:
4 mL x weight (kg) x % TBSA burned = total volume (mL) of Lactated Ringer's over 24 hours
- First half given in the first 8 hours (from time of burn, not time of arrival)
- Second half given over the next 16 hours
Intravenous resuscitation is indicated in children with burns >10% TBSA (vs. >15% in adults).
Key Paediatric Difference: Maintenance Fluids
Unlike adults, children must receive maintenance fluids in addition to the resuscitation volume. This is because:
- Children have a larger surface area to body mass ratio, leading to greater insensible fluid losses
- Their immature kidneys need higher fluid volumes for adequate resuscitation
- Omitting maintenance can cause dangerous hypoglycaemia
Maintenance is calculated using the Holliday-Segar method, typically given as dextrose-saline:
| Weight band | Maintenance rate |
|---|---|
| First 10 kg | 100 mL/kg/24 h |
| Next 10 kg (10-20 kg) | 50 mL/kg/24 h |
| Each kg >20 kg | 20 mL/kg/24 h |
- Bailey and Love's Short Practice of Surgery, 28th Ed.
Limitation of Parkland Formula in Children
Sabiston's Textbook of Surgery notes that the standard adult Parkland formula tends to underresuscitate children with minor burns and overresuscitate large burns because it does not account for TBSA variability as the paediatric patient develops. Two paediatric-specific formulas are preferred in specialist burn centres:
Paediatric-Specific Formulas
Cincinnati Formula
| Age group | Formula |
|---|---|
| Young children | 4 mL/kg/% TBSA burn + 1500 mL/m² total BSA of LR. Half in first 8 h, half in next 16 h. First 8 h: add 50 mEq/L sodium bicarbonate. Third 8 h: add albumin (12.5 g of 25% albumin per litre). Give 5% dextrose as needed. |
| Older children | 4 mL/kg/% TBSA burn + 1500 mL/m² total BSA of LR. Half in first 8 h, remainder in 16 h. 5% dextrose as needed. |
Galveston Formula (body surface area-based)
5000 mL/m² burn area + 2000 mL/m² total BSA of LR
- Half in first 8 h, remainder in 16 h
- Add 12.5 g of 25% albumin per litre of crystalloid
- 5% dextrose as needed
The Galveston formula uses BSA rather than weight, which better accounts for the changing TBSA-to-mass ratio in children.
- Sabiston Textbook of Surgery, 21st Ed. (Table 42.4)
Rule of Nines: Paediatric Modification
The standard adult rule of nines does not apply to children. Because the head is proportionally larger and legs smaller in young children, the Lund and Browder chart should be used. Age-specific TBSA percentages must be applied (see Fig. 42.8 in Sabiston).
Monitoring
Fluid resuscitation is dynamic - rigid adherence to formulae is not appropriate. The primary monitor is urine output:
| Weight | Target urine output |
|---|---|
| <30 kg | 1 mL/kg/h |
| >30 kg | 0.5 mL/kg/h |
If urine output drops with signs of hypoperfusion (tachycardia, cool peripheries, raised lactate), give a bolus of 10 mL/kg. Avoid over-resuscitation, which leads to fluid creep, pulmonary oedema, and abdominal compartment syndrome.
Timing Note
Resuscitation starts from the time of burn, not time of arrival. Any prehospital delay must be accounted for when calculating the rate for the first 8-hour window.
- Bailey and Love's Short Practice of Surgery, 28th Ed.
- Sabiston Textbook of Surgery, 21st Ed.
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