Paediatric Burn Fluid Resuscitation Calculator
Paediatric Burn Fluid Resuscitation Calculator
Resuscitation volume plus maintenance, which is the difference that matters in children: on a 14 kg child with a 20% burn, maintenance is 59% of the 24-hour total and omitting it halves the fluid.
Paediatric burn fluid, 24 hours
Resuscitation + maintenance14 kg child, 20% TBSA burn, 3 mL/kg per per cent, maintenance included
Formula
Maintenance (Holliday-Segar) = 100 mL/kg/day for the first 10 kg + 50 mL/kg/day for the next 10 kg + 20 mL/kg/day thereafter
Resuscitation: half in the first 8 hours from the time of the burn, which is the 24-hour resuscitation volume ÷ 16 per hour
- why maintenance is added in children and not in adults
- a small child has limited glycogen reserve and a high surface-area-to-weight ratio, so the resuscitation volume does not cover ordinary requirements. A paediatric burn centre protocol adds dextrose-containing maintenance for children under 6 years, stating that they “have increased dextrose requirements”, and does not titrate it to urine output. Scotland’s national guideline adds maintenance with glucose at every age and subtracts oral intake millilitre for millilitre
- the same Holliday-Segar arithmetic as elsewhere on this site
- 100, 50 and 20 mL/kg/day across the three weight bands. It is reproduced here rather than only linked because the two volumes are added on this page, and it agrees exactly with the paediatric maintenance fluid calculator — 1,200 mL/day at 14 kg from both. Note that this is the daily 100/50/20 form rather than the hourly 4-2-1 form, which gives 96/48/24 and is not quite the same number
- the clock starts at the burn
- Scotland’s guideline states the first period as “24 hours from the time of burn injury” and subtracts the lag from injury to presentation from the first 8 hours. Dividing the 24-hour resuscitation volume by 16 gives the same hourly rate as giving half of it over 8 hours, which is how several protocols write it
- the rates, and that the ABA guideline does not cover children
- the American Burn Association’s 2023 guideline recommends starting at 2 mL/kg/% but restricts itself to adults with burns of 20 per cent TBSA or more, and excluded a paediatric randomised trial from its review on the grounds that the population was not adult. A paediatric burn centre protocol uses 3 mL/kg/%, and Scotland’s national guideline uses 1.5 mL/kg/% of crystalloid followed by albumin
- when resuscitation starts
- Scotland’s guideline: consider intravenous resuscitation at 10 per cent TBSA or more, and it “must be administered for paediatric burns over 15%”. The paediatric burn centre protocol read here applies to partial or full-thickness burns of 15 per cent TBSA or greater. Superficial burns are excluded from the percentage in both
- urine output targets, and the disagreement between them
- a paediatric burn centre protocol gives 0.9 to 1.1 mL/kg/h under 30 kg and 0.4 to 0.6 mL/kg/h at 30 kg and above, with 1 to 2 mL/kg/h in myoglobinuria. Scotland’s guideline cites 0.5 to 1 mL/kg/h for young children and suggests 30 kg as the point at which adult values of 30 to 50 mL/h apply, while its own observations list says output should match the hourly maintenance rate — a third target inside one document. All three are printed; none is endorsed here
- over-resuscitation is a paediatric problem too
- Scotland’s guideline calls over-resuscitation “a common but potentially avoidable phenomenon in burn units” and names oedema, raised compartment pressures, acute respiratory distress syndrome and multi-organ dysfunction as the consequences. The computed volume is where to start, not what to give
Worked example
14 kg child, 20% TBSA burn, 3 mL/kg per per cent, maintenance included
Resuscitation = 3 × 14 × 20 = 840 mL over 24 hours
Half of it, 420 mL, in the first 8 hours from the burn — 52.5 mL/h, which is the same as 840 ÷ 16
Maintenance (Holliday-Segar) = 1,000 mL for the first 10 kg + 4 × 50 = 200 mL, so 1,200 mL/day. The same figure the paediatric maintenance fluid calculator returns for a 14 kg child
24-hour total = 840 + 1,200 = 2,040 mL
Maintenance is 59 per cent of that total. Switch it off and the figure falls to 840 mL — in a small child, omitting maintenance is not a refinement, it is most of the fluid
On the Parkland rate of 4 the resuscitation component rises to 1,120 mL and the total to 2,320 mL; on Scotland's 1.5 mL/kg/% the crystalloid component is 420 mL, but that protocol then gives albumin for the next 16 hours and is not a Parkland variant
A 25 kg child with the same 20 per cent burn: resuscitation 1,500 mL, maintenance 1,600 mL, total 3,100 mL — and maintenance is now 52 per cent rather than 59, because the two components scale differently with weight
Paediatric burn fluid protocols read for this page
| Source | First 24 h crystalloid | Maintenance | Threshold to start |
|---|---|---|---|
| Paediatric burn centre protocol, 2025 | 3 mL/kg/%TBSA of lactated Ringer’s, total ÷ 16 as the starting hourly rate, titrated to urine output | Dextrose-containing, under 6 years only, by the hourly 4-2-1 rule, not titrated | 15% TBSA, partial and/or full thickness |
| COBIS Scotland, paediatric, 2024 | 1.5 mL/kg/%TBSA of balanced crystalloid in the first 8 h, then human albumin solution at %TBSA × weight × 0.1 mL/h for 16 h | 100/50/20 mL/kg/day with glucose, oral intake subtracted millilitre for millilitre | Consider at 10%; must be given above 15% |
| American Burn Association, 2023 | Start at 2 mL/kg/%TBSA to reduce total volume | Not addressed | Adults with burns of 20% TBSA or more; children not addressed |
| Parkland, as published 1968 | 4 mL/kg/%TBSA, half in the first 8 h from the burn | Not part of the formula | Not specified |
How the two components scale with weight, at 20% TBSA and 3 mL/kg/%
| Weight | Resuscitation | Maintenance | Total | Maintenance share |
|---|---|---|---|---|
| 8 kg | 480 mL | 800 mL | 1,280 mL | 62% |
| 10 kg | 600 mL | 1,000 mL | 1,600 mL | 62% |
| 14 kg | 840 mL | 1,200 mL | 2,040 mL | 59% |
| 20 kg | 1,200 mL | 1,500 mL | 2,700 mL | 56% |
| 25 kg | 1,500 mL | 1,600 mL | 3,100 mL | 52% |
| 40 kg | 2,400 mL | 1,900 mL | 4,300 mL | 44% |
Why children get maintenance on top, and the rates disagree
Paediatric burn resuscitation differs from adult resuscitation in one structural way and several numerical ones. The structural difference is that the resuscitation volume does not cover a child’s ordinary fluid and glucose requirements, so maintenance fluid is given in addition. A small child has little glycogen reserve and a high surface-area-to-weight ratio, and one paediatric burn centre protocol read for this page adds dextrose-containing maintenance for children under six specifically because they have increased dextrose requirements. The maintenance component is not titrated against urine output; the resuscitation component is.
The share is larger than it looks. At fourteen kilograms with a twenty per cent burn on three millilitres per kilogram per percentage point, the resuscitation volume is 840 millilitres and the Holliday-Segar maintenance is 1,200 — fifty-nine per cent of the twenty-four-hour total. Because resuscitation scales linearly with weight while maintenance flattens at the ten and twenty kilogram steps, that share falls with size: sixty-two per cent at eight kilograms, fifty-two at twenty-five, forty-four at forty. Omitting maintenance in a toddler is not a refinement, it is most of the fluid, and that is why one protocol stops adding it above six years of age.
The numerical disagreements are larger than in adult practice. Four published first-day crystalloid rates were read for this page and they span a factor of nearly three: Parkland’s four, a paediatric burn centre’s three, the modified Brooke and American Burn Association’s two, and Scotland’s national guideline’s one and a half. The last of those is not a low Parkland — it is the crystalloid component of a protocol that moves to human albumin solution for the next sixteen hours, so taking the rate without the schedule would under-resuscitate. The ABA’s two millilitres per kilogram is frequently quoted for children and the guideline itself addresses adults with burns of twenty per cent or more, having excluded a paediatric randomised trial from its review because the population was not adult.
Two further points. The clock runs from the burn: Scotland’s guideline states the first period as twenty-four hours from the time of burn injury and subtracts the lag to presentation from the first eight hours. And the urine output targets disagree — nought point nine to one point one millilitres per kilogram per hour under thirty kilograms in one protocol, nought point five to one in another, with a third target inside the same document saying output should match the hourly maintenance rate. All of them are printed above with their sources. Over-resuscitation is a paediatric problem too: Scotland’s guideline calls it a common but potentially avoidable phenomenon in burn units and names oedema, raised compartment pressures, acute respiratory distress syndrome and multi-organ dysfunction. This page computes what the formulas yield and recommends nothing.
Frequently asked questions
Why do children need maintenance fluid on top of burn resuscitation?
Because the resuscitation volume does not cover their ordinary fluid and glucose needs. A small child has limited glycogen reserve and a high surface-area-to-weight ratio. One paediatric burn centre protocol adds dextrose-containing maintenance for children under 6, stating that they have increased dextrose requirements, and Scotland’s national guideline adds maintenance with glucose and subtracts oral intake millilitre for millilitre.
How much of the 24-hour total is maintenance?
More than half in a small child. At 14 kg with a 20 per cent burn on 3 mL/kg per per cent, resuscitation is 840 mL and Holliday-Segar maintenance is 1,200 mL — 59 per cent of the 2,040 mL total. The share falls with weight, to about 52 per cent at 25 kg and 44 per cent at 40 kg, because maintenance flattens at the 10 and 20 kg steps.
Does the American Burn Association’s 2 mL/kg rate apply to children?
The guideline does not say so. Its 2023 burn shock resuscitation recommendation addresses adults with burns of 20 per cent TBSA or more, and it excluded a paediatric randomised trial from its critical review on the grounds that the population was not adult. Published paediatric protocols read for this page use 3 mL/kg per per cent, or 1.5 mL/kg followed by albumin.
At what burn size does intravenous resuscitation start in a child?
Scotland’s national paediatric guideline says to consider it at 10 per cent TBSA or more and that it must be administered for paediatric burns over 15 per cent. A paediatric burn centre protocol read here applies to partial and/or full-thickness burns of 15 per cent TBSA or greater. Superficial burns are excluded from the percentage in both.
What urine output do paediatric burns aim for?
The sources disagree and all are printed on this page. A paediatric burn centre protocol gives 0.9 to 1.1 mL/kg/h under 30 kg and 0.4 to 0.6 mL/kg/h at 30 kg and above, with 1 to 2 mL/kg/h in myoglobinuria. Scotland’s guideline cites 0.5 to 1 mL/kg/h for young children, and elsewhere in the same document says output should match the hourly maintenance rate.
Related calculators
References
- Monroe Carell Jr. Children’s Hospital at Vanderbilt. Pediatric Burn Fluid Resuscitation, revised March 2025.
- Care of Burns in Scotland, NHS National Services Scotland. Paediatric Fluid Resuscitation, NSD610-006.06 version 2.0, 2024.
- Cartotto R, Johnson LS, Savetamal A, Greenhalgh D, Kubasiak JC, Pham TN, Rizzo JA, Sen S, Main E. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. J Burn Care Res. 2023. doi:10.1093/jbcr/irad125
- Agency for Clinical Innovation. ECAT paediatric assessment: burn. NSW Health. aci.health.nsw.gov.au/ecat/paediatric/assessment/burn
Not medical advice. For healthcare professionals and education. Reference intervals vary by laboratory and assay — always use your own laboratory's. Never base a dose or a treatment decision on this page alone. Full disclaimer at calcengines.com/disclaimer/