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Rule of Nines (paediatric)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The Rule of Nines in inaccurate in children due to the relative disproportion of body parts:

  • hips and legs are smaller
  • head, neck and shoulders are larger

Hence, a paediatric version is available in chart form that estimates burn area as it changes with age. Alternatively, an estimate can be made from the following for a child up to the age of one year:

  • head and neck total for front and back: 18%
  • thorax and abdomen front: 18%
  • thorax and abdomen back: 18%
  • each upper limb total for front and back: 9%
  • each lower limb total for front and back: 14%

Over the age of one year, the relative percentage of body surface area changes:

  • the head decreases by 1% per year
  • the lower limbs each increase by 0.5% per year

Hence, by the age of ten years the relative proportions assume the values for adult surface area:

  • perineum becomes 1%
  • each lower limb becomes a total of 18% for front and back
  • head and neck become 9% total for front and back

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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