In the case of third degree burns, the tissue necrosis extends through the entire dermis and possibly into the subcutaneous fat. These burns are painless due to nerve damage and may exhibit brown, yellow, red, white, gray or black coloration. Fourth degree burns extend through all layers of the skin and into muscle and bone. The burned area may resemble a skeleton with inelastic charred skin and sclerosed veins. For children under one year of age the head is eighteen, each arm is nine, each leg is fourteen and the front and back of the torso is each eighteen percent TBSA respectively.
Children present special physiologic challenges to burn care.
First, infants have difficulty with thermoregulation. Therefore, the surrounding environment should be kept at just above body temperature. Second, an infant has reduced glucose stores, which predisposes them to hypoglycemia. This calls for routine blood sugar testing during resuscitation. Third, a young child's thin skin is susceptible to damage at lower temperatures than an adult.