## Rule of Nines in Children **Key Point:** The Rule of Nines must be **modified for children** because their body proportions differ significantly from adults. The head is proportionally larger in children, and the lower limbs are proportionally smaller. ### Pediatric Rule of Nines Distribution | Body Region | Percentage of TBSA | | --- | --- | | Head and neck | **18%** | | Each upper limb | 9% | | Anterior trunk | 18% | | Posterior trunk | 18% | | Each lower limb | **13.5%** | | Perineum/genitalia | 1% | | **Total** | **100%** | ### Comparison: Adult vs. Child | Region | Adult | Child | | --- | --- | --- | | Head | 9% | **18%** | | Each lower limb | 18% | **13.5%** | | Anterior trunk | 18% | 18% | | Posterior trunk | 18% | 18% | **High-Yield:** In children **under 15 years**, the head represents **18% TBSA** (double the adult percentage). This is a high-yield fact because examiners frequently test the distinction between adult and pediatric Rule of Nines. **Clinical Pearl:** Failure to use the correct pediatric formula can lead to significant underestimation or overestimation of burn severity in children, affecting triage and fluid resuscitation decisions. **Mnemonic:** **"Child's Head is Double"** — Remember that a child's head is 18% (double the adult 9%), while each leg is 13.5% (less than adult 18%). [cite:Parikh Forensic Medicine 3e Ch 8]
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