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Pediatric Rule of Nines to Estimate Extent of Burns

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What Is the Pediatric Rule of Nines?



Emergency medical technicians (EMTs) and paramedics are among the health care providers who make use of a system for quickly estimating the extent of burns. When the patient is a child, the pediatric rule of nines is frequently employed to give a rough estimate of the body surface area (BSA) that has been burned. Keep in mind that this system cannot be used to determine the severity of burns, rather only the extent of them. Note also that there is a rule of nines system for estimating the extent of burns in adult patients. But, the percentages are slightly different for the head and the legs for adults.

Looking at the Body in Sections



The central concept of the rule of nines is to view the body in sections that represent approximately 9% of the BSA. The legs of infants and children are smaller relative to an adult body. And, the head is relatively larger. This is why the measurement system we are reviewing here is sometimes referred to as the pediatric rule of nines or the rule of nine for children.

Pediatric Rule of Nines for Infants



The body of an infant for the purpose of quickly estimating the extent of burns is as follows:

Head - 18%
Each arm - 9%
Chest - 9%
Abdomen - 9%
Upper back - 9%
Lower back - 9%
Groin - 1%
Each leg - 13.5%

Note: The chest and abdomen amount to the front torso. The upper and lower back amount to the back torso.

So, we have 18% for the head, plus 18% for both arms, plus 18% for the front torso, plus 18% for the back, plus 1% for the groin, plus 27% for both legs. 18 + 18+ 18 + 18 + 1 + 27 = 100% body surface area (BSA).

If the chest and the right arm of a baby were burned, we would say that about 18% of the BSA is burned, according to the pediatric rule of nines.

Estimating the Extent of Burns in Children



Although children are pediatric patients, they are not infants. Therefore, there are differences in the percentages of the pediatric rule of nines for them. They are as follows:

Head - 12%
Each arm - 9%
Chest - 9%
Abdomen - 9%
Upper back - 9%
Lower back - 9%
Groin - 1%
Each leg - 16.5%

Note: The chest and abdomen amount to the front torso. The upper and lower back amount to the back torso.

So, we have 12% for the head, plus 18% for both arms, plus 18% for the front torso, plus 18% for the back, plus 1% for the groin, plus 33% for both legs. 12 + 18+ 18 + 18 + 1 + 33 = 100% body surface area (BSA).

The pediatric rule of nines, just like the rule of nines for adults, has recently changed slightly. These are the percentages in use in 2012.

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