What is the pediatric burn fluid bolus for a 4-year-old?

• A. 125 mL NS/LR
• B. 250 mL NS/LR
• C. 500 mL NS/LR
• D. 100 mL NS/LR

Answer: (A)

In pediatric burns, the first priority is restoring circulating volume with an isotonic crystalloid to counteract burn shock and poor perfusion. For a child around four years old, many EMS and pediatric protocols use a modest initial fluid bolus to quickly improve signs of hypoperfusion without risking fluid overload.

That 125 mL bolus of normal saline or lactated Ringer’s is chosen because it provides enough volume to help perfusion in a small child who may have limited cardiac reserve, while avoiding the risk of giving too much fluid at once. Larger fixed boluses, like 250 mL or more, can overwhelm a young child’s circulatory system, and a very small bolus like 100 mL may not be sufficient to improve perfusion if shock is present. The goal is to stabilize circulation promptly and then follow up with the appropriate weight-based, ongoing resuscitation plan in the ED.

Use isotonic fluids (NS or LR), monitor vitals and urine output, and prepare for full burn resuscitation calculations in the hospital.