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Pediatric burn fluid resuscitation (Parkland / modified Brooke)

Pediatric weight in kg (accepts lb or g). Drives the crystalloid dose and the Holliday-Segar maintenance volume.

Percent total body surface area with partial- or full-thickness burn, estimated by the Lund-Browder chart in children (NOT the Rule of Nines). Superficial/erythema is excluded.

Independent clinical validation: pending

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How it is calculated

Pediatric Parkland: 24-h lactated Ringer's = 3 mL x weight(kg) x %TBSA; give half in the first 8 hours (timed from the burn), the rest over the next 16 hours. Pediatric modified Brooke uses the same 3 mL x weight x %TBSA. Holliday-Segar maintenance (children, added on top of resuscitation): 100 mL/kg/day for the first 10 kg, +50 mL/kg/day for each kg from 10-20 kg, +20 mL/kg/day for each kg above 20. Combined 24-h total = pediatric Parkland resuscitation + maintenance. %TBSA counts second- and third-degree burn only (Lund-Browder chart in children).

Limitations and notes

Therapy/dosing formula, not a severity score — it outputs a STARTING crystalloid volume that is then titrated to urine output, not a risk band; interpretation is intentionally empty. Fluid is lactated Ringer's (LR). Give HALF of the 24-h resuscitation volume in the first 8 hours and the remaining half over the next 16 hours, with the clock started at the TIME OF THE BURN, not arrival — late presentation compresses the remaining first-8-h volume into fewer hours (the rate changes, not the volume). %TBSA counts second- and third-degree (partial + full thickness) burn only and, in children, must be estimated with the age-adjusted Lund-Browder chart, NOT the Rule of Nines (a child's head is a much larger fraction of BSA). The exact Lund-Browder per-segment percentages by age are [NEEDS SOURCE] (summarized from tertiary burn references; the primary 1944 table was not fetched). Pediatric Parkland and pediatric modified Brooke both use 3 mL/kg/%TBSA, so their 24-h volumes converge; the ADULT coefficients differ (Parkland 4 mL, modified Brooke 2 mL) and are NOT emitted here to avoid over-dosing a child. For CHILDREN, Holliday-Segar maintenance fluid — commonly a 5%-dextrose-containing fluid (limited glycogen stores -> hypoglycemia risk) — is added ON TOP of the LR resuscitation volume (adults get no separate maintenance); the surface-area Galveston/Cincinnati formulas instead fold maintenance in but require height/BSA and are not computed here. Titrate to urine output: children commonly 1.0-1.5 mL/kg/h (an alternative split is 1 mL/kg/h if <30 kg and 0.5 mL/kg/h if >=30 kg; infants sometimes ~1-2 mL/kg/h); adults ~0.5 mL/kg/h (2024 ABA CPG) — sources disagree by ~0.5 mL/kg/h, so the range is carried, not silently reduced to one number. FLUID CREEP (over-resuscitation) is a documented harm; the 2024 ABA CPG lowered the ADULT starting coefficient to 2 mL/kg/%TBSA to counter it, but that CPG is adults-only and does NOT license a 2 mL pediatric starting rate — a graded pediatric CPG for the starting coefficient is [NEEDS SOURCE]. Some references retain 4 mL/kg/%TBSA for children (relying on maintenance to cover baseline needs); centers differ, so the coefficient is institution-specific. Every computed volume is a starting estimate to be titrated, never a fixed prescription. Weight bounds (0.5-150 kg) are input-validity limits, not cited clinical thresholds.

Accepted input ranges

  • Body weight — 0.5–150 kg
  • %TBSA burned (2nd + 3rd degree) — 0–100 %

References

  1. Mehta M, Tudor GJ. Burn Fluid Resuscitation. StatPearls Publishing; updated 2023. (Parkland peds 3 mL, modified Brooke adult 2/peds 3 mL, LR, half in first 8 h, Lund-Browder, urine-output targets.)Source
  2. Baartmans MG, et al. Parkland Formula. StatPearls Publishing. (4 mL adult / 3 mL pediatric; half in first 8 h from injury; pediatric maintenance addition; urine 1.0-1.5 mL/kg/h in children.)Source
  3. Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957;19(5):823-832. (100/50/20 mL/kg/day maintenance.)PMID 13431307
  4. Romanowski KS, Palmieri TL. Pediatric burn resuscitation: past, present, and future. Burns Trauma. 2017;5:26. (Pediatric maintenance addition; dextrose for infants; SA-based formulas.)PMID 28879205DOI 10.1186/s41038-017-0091-y
  5. Cartotto R, Johnson LS, Savetamal A, et al. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. J Burn Care Res. 2024;45(3):565-589. (Adult starting rate 2 mL/kg/%TBSA to counter fluid creep; UOP 0.5 mL/kg/h; scope adults >=20% TBSA.)PMID 38051821DOI 10.1093/jbcr/irad125
  6. Institutional pediatric burn protocol assessment (modified Parkland 3 mL/%TBSA/kg/day; resuscitation triggers TBSA >=15% if <10 kg, >=20% if >=10 kg; mean UOP 1.74 mL/kg/h). J Burn Care Res 2025 abstract.Source

Version and changelog

v1.0.0 · Fluids and resuscitation

  • 2026-07-25 v1.0.0 — Initial release: pediatric Parkland + modified Brooke (3 mL/kg/%TBSA) with first-8-h split and Holliday-Segar maintenance.

Important

For use by qualified health professionals as an informational and educational aid. It supports clinical judgment and does not replace it. Verify every result independently before making a clinical decision. This is not a medical device.