Recent advances in surgical techniques, control of infection and nutritional support have dramatically increased the survival rates of burned children. The characteristics of severely burned pediatric patients dictate that management be different from that required for adults in the intensive care unit. The formulas for fluid replacement should be based on body surface rather than weight in children and adjusted for degree of stress and age, with appropriate monitoring and treatment of hypothermia, pain and associated psychological disorders. Early assessment and treatment of airway obstruction and gas and smoke inhalation syndromes with high FiO2 is necessary; prophylactic endotracheal intubation may be required.