Children, particularly those under the age of 4 years, have had a worse prognosis following burns than have adults. Recent publications have shown that survival from severe burns has improved in adults but there has been no corresponding paediatric data. Now such data have been provided from a burns unit in Boston, USA (Robert L Sheridan et al. Archives of Pediatrics and Adolescent Medicine 2000;154:245–9).

 They reported their results for two seven year periods, 1974–80 and 1991–97. In the first period 678 children were admitted with burns and in the second 1150. Nine children who died within 24 hours were excluded from further analysis. Burns were categorised according to percentage of total body surface area involved: mild (<40%), moderate (40–59%), or severe (60% or greater). The proportions in these categories were 80%, 10%, and 10% in 1974–80 and 92%, 4%, and 4% in 1991–97. Mortality in the three categories was 0.6%, 8%, and 33% during the first period and 0%, 0%, and 14% in the second.

 In the earlier period most deaths (91%) were caused by late sepsis and multiple organ failure; in the later period only 33% of deaths were attributed to that cause. Between 1991–97, 676 (59%) of the children admitted were less than 4 years old and 17 of these had severe burns but none died. Between 1974–80, 43% of the deaths had been in this age group.

 Improved management of burns in children has resulted in much improved survival, especially in younger children.