Pediatric burn fluid resuscitation (Parkland / modified Brooke)

Category: Fluids and resuscitation
Version: v1.0.1
Reviewed: Reviewed 6 Sep 2026
Validation: Validation pending

Body weight

kglbg

%TBSA burned (2nd + 3rd degree)

Time elapsed since the burn

hmin

Resuscitation fluid already given

LmL

24-hour resuscitation crystalloid (lactated Ringer’s) = 3 mL x weight (kg) x %TBSA. Pediatric Parkland and pediatric modified Brooke both use 3; the adult coefficients, 4 and 2, are deliberately not emitted. Give half in the first 8 h, timed from the burn, and the rest over the next 16 h. Holliday-Segar maintenance (100/50/20) is added on top at every weight, so the combined total is resuscitation plus maintenance. %TBSA counts 2nd- and 3rd-degree burn only, estimated by the age-adjusted Lund-Browder chart in children, never the Rule of Nines.

INPUTS AND RATES. Weight 0.5 to 150 kg; %TBSA 0 to 100; optional time since burn (0 to 24 h) and resuscitation fluid already given (0 to 10 L, all sources including pre-hospital, not maintenance, blood, or drug carriers). Supply BOTH optional inputs to get infusion rates. Pre-arrival fluid is deducted from the first-8-h allocation only, a founder decision of 2026-08-08, where the alternative deducts from the 24-h total; the remainder is spread over the hours left in each phase. Past 8 h no first-phase rate is emitted, and the remaining volume persists as a shortfall, since concealing that a child is behind is the more dangerous silence. Neither input alone produces a rate: defaulting fluid-given to zero would print a confident rate for a child arriving with a litre already run. THE CLOCK RUNS FROM INJURY, NOT ARRIVAL. A child arriving 3 h post-burn has 5 h of the first phase left, and late presentation compresses the rate, not the volume. THE COEFFICIENT IS CONVENTION. The 3 mL/kg/%TBSA coefficient is paediatric convention with no primary derivation in the 2016-2026 window. Starting coefficients across five ABA-verified paediatric burn centres run 2 to 4 with no modal value, and for the same 25 kg child with a 20% TBSA burn the centre estimates span 1500 to 3560 mL. This score returns the bottom of that spread, 1500 mL, or 3100 mL with maintenance. NO INHALATION MODIFIER IS APPLIED HERE: protocols that escalate for inhalation injury run as high as 6 mL/kg/%TBSA, and this score emits the unmodified coefficient, so that adjustment has to be made outside it. Delivered volumes cluster near 6.35 mL/kg/%TBSA. Treat every output as a starting estimate to titrate, never a fixed prescription. MAINTENANCE BELOW ABOUT 4 kg. The Holliday-Segar line over-estimates a term neonate, and over-estimating maintenance compounds fluid creep in the patient least able to absorb it. The two resuscitation figures are unaffected. Replace the maintenance line, and the combined total containing it, with the unit’s neonatal regimen before prescribing. This calculator accepts from 0.5 kg on purpose so a burned neonate is never refused. THE MAINTENANCE WEIGHT THRESHOLD. Maintenance is added at every weight here, which is the AWMF 2024 structure. Published centre practice spans below 20 kg to below 40 kg, or age under 1 year, or none at all, and the circulating 30 kg figure is the ABA position as the weight below which maintenance is added. No derivation exists for any of them, so follow local protocol where it differs. THE 8-H/16-H SPLIT derives from a canine experiment, Baxter & Shires 1968, read from the source: 50% TBSA flame-burn dogs, with plasma volume and functional extracellular fluid as the endpoints, and on its own figures the first 8 h carried two-thirds, not half. No human or paediatric re-derivation exists, and no guideline states the split. Titrate to the patient, not to the fraction. UNDER-RESUSCITATION IS A REAL FAILURE DIRECTION TOO. In the German Burn Registry (407 children, 30 centres) 86.5% received less than Parkland plus maintenance, and six of the seven deaths were under-resuscitated relative to it. Effect estimates are weak, so no warning threshold is built on either direction. URINE-OUTPUT TARGETS GENUINELY DISAGREE: children commonly 1.0 to 1.5 mL/kg/h, infants about 1 to 2, adults about 0.5, one published protocol 0.3 to 0.7 above 30 kg, and AWMF bands by developmental stage instead of weight. The optimal paediatric goal is settled-absent. AWMF Empfehlung 10, by consensus, is not to initially exceed 10 mL/kg/h in children with 10% TBSA or more; that is stated here, not enforced. Read urine output with blood pressure, lactate, and the clinical state. Oliguria in intra-abdominal hypertension is not hypovolaemia. NO PAEDIATRIC GUIDELINE COVERS THE STARTING RATE. The 2024 ABA CPG, whose adult starting rate is 2 mL/kg/%TBSA, scopes itself to adults with 20% TBSA or more. No paediatric equivalent exists, which is settled-absent, and ABRUPT’s delivered 4.6 mL/kg/%TBSA in 379 adults contradicts the 2 within the same organisation. Neither licenses a paediatric coefficient. THE LUND-BROWDER CHART ships as verified data, 19 segments across 6 age bands, after Lund & Browder 1944 as reproduced in the 2025 JTS worksheets. Every column sums to exactly 100, which most circulating charts do not: the common 101% chart traces to a typographic hand-value error. It does not account for obesity, breast tissue, pregnancy, or amputation, and simple erythema is excluded from %TBSA.

References

Baxter CR, Shires T. Physiological response to crystalloid resuscitation of severe burns. Ann N Y Acad Sci. 1968;150(3):874-894. (The Parkland primary. p883 derives the eight-hour/sixteen-hour schedule experimentally: in a 50% TBSA flame-burn canine model the best plasma-volume and functional-extracellular-fluid response came from 16-20% of body weight in the first eight hours after the burn, at 20 cc/kg/h, maintained with a further 8-10% of body weight as lactated Ringer's, at 5 cc/kg/h, across the next sixteen. A figure legend on the same page describes a treatment schedule split the same way.)PRIMARY SOURCE — not a secondary review, a restatement or a review finding, and that distinction is the point, because this is where the two-phase split is actually derived rather than merely repeated. Three qualifications travel with it and must not be dropped: the derivation is in DOGS at 50% TBSA flame burn with plasma volume and functional extracellular fluid as the endpoints, not a human outcome trial and not paediatric; the doses are expressed as PERCENT OF BODY WEIGHT, not as mL/kg/%TBSA, so the paper fixes the two-phase shape of the schedule and not the coefficient this calculator uses; and on the paper's own figures the first eight hours carry two-thirds of the 24-hour volume, not the half in clinical use.DOI 10.1111/j.1749-6632.1968.tb14738.x
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
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
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
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 28879205 DOI 10.1186/s41038-017-0091-y
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 38051821 DOI 10.1093/jbcr/irad125
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
US Department of Defense, Joint Trauma System. Burn Care Clinical Practice Guideline (CPG ID 12), Lund Browder Burn Estimate & Diagram worksheets: Infant (July 2025), Pediatric (June 2025), Adult (June 2025). Dated modern reproduction of the Lund-Browder chart and the source of the exact per-segment percentages shipped here; the adult worksheet prints a column total of 100, which is what makes the arithmetic self-checking.Provenance, fact by fact, because these did not come from one place. (1) The per-segment percentages and the three worksheet dates above are the ones recorded in this project's implementation reference note (docs/research/scores/burn-resuscitation.md) from the three JTS worksheets; they are FORM dates, not the CPG's. (2) The guideline identifier and its own date — Burn Care, CPG ID 12, dated 10 June 2025 — come from the JTS CPG index at jts.health.mil on 2026-08-03; that reference note carries no CPG-level date, so this one is not sourced from it. (3) The chart of record is Lund CC, Browder NC, 'The estimation of areas of burns', Surg Gynecol Obstet 1944;79:352-358. That paper was NOT obtained — the volume is not digitised in a reachable open repository — so the values here are attributed 'after Lund & Browder (1944), as reproduced in the JTS worksheets', never to the 1944 original directly, and whether the 19-row tabular layout is a 1944 artefact or a later worksheet reformatting is unconfirmed.Source
Lundin K, Alsbjorn B. The 101 percent in Lund-Browder charts - a commentary. Burns. 2013;39(4):819-820. (Traces the widely circulated 101% charts to a typographic error: one aspect of each hand is 1.25%, not 1.5%, so each hand is 2.5% and not 3%.)PMID 22980775 DOI 10.1016/j.burns.2012.08.016
Murari A, Singh KN. Lund and Browder chart - modified versus original: a comparative study. Acute Crit Care. 2019;34(4):276-281. (Open access; restates the 101% defect and the chart's clinimetric limitations.)DOI 10.4266/acc.2019.00647
Greenhalgh DG, Cartotto R, Taylor SL, et al. Burn resuscitation practices in North America: results of the Acute Burn ResUscitation Multicenter Prospective Trial (ABRUPT). Ann Surg. 2023;277(3):512-519. (379 adults >=20% TBSA across 21 centres; 24-h delivered volume 4.6 +/- 2.2 mL/kg/%TBSA; time 0 is the time of injury; mean 1553 +/- 1782 mL already given before arrival; states 4 mL/kg/%TBSA is accurate and a 2 mL/kg/%TBSA goal may not be feasible.)Cited here for the controversy it creates with the 2024 ABA CPG, not to settle it. Adult data; it licenses no paediatric coefficient.DOI 10.1097/SLA.0000000000005166
Pisano C, Fabia R, Shi J, et al. Variation in acute fluid resuscitation among pediatric burn centers. Burns. 2021;47(3):545-550. (Table 2 tabulates five ABA-verified paediatric burn centres plus the ABA column: maintenance IV fluid initiated below 30 kg per ABA, 20-40 kg across centres, one centre by age <1 year; source of the 25 kg / 20% TBSA five-centre spread of 1500-3560 mL.)DOI 10.1016/j.burns.2020.04.013
Vasileiadis V, Najem S, Reinshagen K, et al. Fluid management and outcomes in children with burns, German Burn Registry 2015-2022. Eur J Pediatr. 2024;183:5479-5488. (407 children <16 y with >=15% TBSA across 30 centres; 86.5% received less than Parkland plus Holliday-Segar maintenance; six of the seven children who died were under-resuscitated.)DOI 10.1007/s00431-024-05797-9
Stevens JV, Prieto NS, Ridelman E, et al. Weight-based versus body surface area-based fluid resuscitation predictions in pediatric burn patients. Burns. 2023;49(1):120-128. (110 children; Galveston underpredicts delivered volume; Fig. A.1 gives the Children's Hospital of Michigan algorithm with its time-of-injury clock, pre-arrival subtraction step and urine targets of 0.8-1.2 mL/kg/h at <=30 kg and 0.3-0.7 mL/kg/h above it.)DOI 10.1016/j.burns.2022.03.007
Palmieri TL, et al. Fluid Resuscitation of Severely Burned Children. ePlasty (PMC11166384). (States the adult 2 and 4 mL/kg/%TBSA coefficients, then that children require approximately 6 mL/kg/%TBSA burned, and that single-figure adult formulas may omit maintenance and 'underestimate needs in small children and overhydrate large children'.)NOT A RIVAL COEFFICIENT, and the most tempting way to misread it. Its approximately 6 looks like a contradiction of the 3 mL/kg/%TBSA this score emits — two paediatric figures differing by a factor of two, with the objection running toward UNDER-resuscitation of small children. That reading is wrong. Its approximately 6 is a TOTAL 24-hour volume including maintenance, restating Graves 1988, whose own recommendation is to supply maintenance and initiate resuscitation at 3. What this reference does establish, and what it is cited for, is the clause quoted above: a SINGLE-FIGURE formula underestimates small children and overhydrates large ones — which is an argument for the two-part maintenance-plus-resuscitation shape this score already implements, and against applying any flat single figure (including 6) at every weight.Source
Graves TA, Cioffi WG, McManus WF, Mason AD Jr, Pruitt BA Jr. Fluid resuscitation of infants and children with massive thermal injury. J Trauma. 1988;28(12):1656-1659. (43 children aged 1.5-108 months, 25-89% TBSB, all <=25 kg. Average TOTAL 24-h fluid 6.3 +/- 2.2 cc/kg/%TBSB; NET resuscitation fluid, i.e. total minus calculated maintenance, 3.91 +/- 2.2 cc/kg/%TBSB. Recommends supplying maintenance volume and initiating burn resuscitation at 3 cc/kg/%TBSB.)SCOPE — only the two summary figures and the recommendation sentence are claimed from this reference, and nothing beyond them. THIS IS THE REFERENCE THAT RESOLVES THE APPARENT 3-VERSUS-6 CONFLICT, because it reports both numbers from one cohort and names which is which: 6.3 is the TOTAL, 3.91 the resuscitation component after maintenance is removed. It is also the source that vindicates this score's structure rather than merely permitting it — maintenance supplied, resuscitation initiated at 3, which is what `calculate` emits. Pre-window (1988) by the 2016-2026 review's rule, so it is a primary of record, not in-window evidence.PMID 3199467 DOI 10.1097/00005373-198812000-00007
Merrell SW, Saffle JR, Sullivan JJ, Navar PD, Kravitz M, Warden GD. Fluid resuscitation in thermally injured children. Am J Surg. 1986;152(6):664-669. (177 children, mean burn 27% TBSA; mean TOTAL 24-h fluid 5.8 +/- 0.25 mL/kg/%TBSA.)Carried for one purpose: independent corroboration that the ~6 mL/kg/%TBSA figure circulating for children is a TOTAL delivered volume and not a resuscitation coefficient, which is what makes it consistent with Graves' 3 plus maintenance rather than a rival to it.PMID 3789292
Cartotto RC, Innes M, Musgrave MA, et al. How well does the Parkland formula estimate actual fluid resuscitation volumes? J Burn Care Rehabil. 2002;23(4):258-265. (n=31 adults >=15% TBSA; actual 24-h volume 6.7 +/- 2.8 mL/kg/%TBSA, exceeding the Parkland prediction in 84%; after the first 8 hours the infusion rate decreased 34% in 16 patients and increased 47% in 15, two-way ANOVA P<0.001.)ADULT, single centre, n=31, and PRE-WINDOW (2002) — it licenses nothing paediatric and is not in-window evidence. Carried for one fact only: the change in infusion rate at the 8-hour mark is BIDIRECTIONAL and patient-dependent, which is what falsifies reading the printed first-8-hour figure as a description of delivery. It is the only measurement of the two phases' behaviour this review located, and that scarcity is itself recorded as a settled absence.PMID 12142578
DGKCH, DGV, DGKJ, et al. Behandlung thermischer Verletzungen im Kindesalter. AWMF S2k-Leitlinie 006/128, Version 3.0, 15.08.2024 (valid to 14.08.2029). (Holliday-Segar maintenance for ALL children with no weight threshold; an added burn requirement of 3-4 mL/kg/%TBSA from 15% TBSA; urine 1-2 mL/kg/h in infants and toddlers and 0.5-1 mL/kg/h at school age; Empfehlung 10, 12/12 consensus, do not initially exceed 10 mL/kg/h; all fluid statements graded expert consensus, evidence level IV.)The authoritative locator is the AWMF register number 006/128 with version 3.0 dated 15.08.2024; the URL is the register's detail page for that number.Source

Reproduction rights

Freely reproducible.Parkland, modified Brooke, and Holliday-Segar are arithmetic formulas built from coefficients (3 mL/kg/%TBSA; 100/50/20 mL/kg/day) and the 8h/16h split — facts, not copyrightable expression. No proprietary scale wording is reproduced (burn-resuscitation.md IP status). The Lund-Browder chart is reproduced as numbers only: the per-segment percentages are facts, while the chart's body diagrams and the JTS worksheet layout are expression and are not copied, and every segment label is this project's own anatomical wording.

Other fluids and resuscitation scores

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.