Shriners Children’s Dietitians Understand the Unique Nutritional Needs of Children with Burn Injuries

An important aspect of burn care is understanding the specific nutritional needs of a child with a burn injury.

Shriners Children’s Boston dietitians Kathy Prelack, Ph.D., RD, and Jennifer Shiel, MS, RD, are vital members of a patient’s care team. They have the training and expertise to develop individualized treatment plans for children based on the severity of their burn injury.

Burn injuries can result in one of the largest nutritional impacts to the body, particularly for children. Hypermetabolism, or a metabolic rate much higher than normal, occurs immediately after a burn injury. This creates an increased need for calories, protein and micronutrients in order to promote healing. Hypermetabolism can be made worse by surgical procedures, pain and anxiety. The larger the burn size, the greater the impact. Therefore, it is important to start nutrition within 24-48 hours after a burn injury to counteract this hypermetabolic state. This state can last for up to two years after a burn injury, and can result in malnutrition. The clinical nutrition team is therefore involved from the start to determine a nutrition care plan unique to each patient, and participates in daily rounds in order to best facilitate ensuring that patients’ increased nutritional needs are met.

Children in particular are more vulnerable to malnutrition, as they often have fewer nutritional reserves, are still growing, and require nutrition for both growth and healing after a burn injury. Malnutrition has the potential to negatively affect a child’s recovery, including wound healing, infection rates and length of hospital stay.

The Boston nutrition team uses standardized criteria from the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition to determine if a child is suffering from malnutrition. This criteria classifies growth measure indicators such as weight for length/height or body mass index for age and their Z scores. The Z score represents how close or far a patient is from the preferred standards. From there, patients can be determined to be mildly, moderately or severely malnourished based upon how far below they may be from the standard. Once a determination of malnutrition is made, the team develops a comprehensive nutrition plan in order to safely initiate and maximize necessary nutritional support.