## Lund and Browder Chart for Pediatric BSA Estimation The **Lund and Browder chart** is the gold standard for estimating BSA in burn injuries in children, as it accounts for age-related variations in body proportions. ### Age-Based BSA Percentages for One Lower Limb (Total and Anterior Surface) | Age Group | Total Lower Limb (each) | Anterior Lower Limb (each) | Head | |---|---|---|---| | 0–1 year | 21% | ~10.5% | 19% | | 1–4 years | 21% | ~10.5% | 17% | | **5–9 years** | **18%** | **9%** | 13% | | 10–14 years | 19.5% | ~9.75% | 11% | | 15+ years (adult) | 18% | 9% | 9% | **Key Point:** In the Lund and Browder chart, the **total BSA of one lower limb in a 5-year-old is 18%**, divided equally between anterior and posterior surfaces. Therefore, the **anterior surface of one lower limb = 9%** in a 5-year-old child. **High-Yield:** The head percentage **decreases with age** (19% at birth → 9% in adults), while lower limb percentage adjusts accordingly. At age 5, the lower limb total is 18%, giving an anterior contribution of **9%** — identical to the adult Rule of Nines value for the anterior lower limb, but arrived at through age-specific Lund and Browder proportions. **Clinical Pearl:** For accurate fluid resuscitation in pediatric burns, the Lund and Browder chart is **mandatory** because the Rule of Nines underestimates head involvement and may misestimate limb involvement in young children, leading to inaccurate resuscitation volumes. **Common Confusion:** The value 10.5% applies to children aged 0–4 years (where the total lower limb is ~21%), not to 5-year-olds. At age 5, the total lower limb drops to 18%, making the anterior surface **9%**. [cite: Lund CC, Browder NC. The estimation of areas of burns. Surg Gynecol Obstet. 1944;79:352–358; Parikh's Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology, 7th ed., Ch. 15]
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