Review of methods to determine hand surface area of children less than six years old: a case study

Hanna Perone, Kyra Rattler, Alesia C. Ferguson, Kristina D. Mena, Helena M. Solo-Gabriele

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Various methods exist to determine the surface area of hands. The consistency of these methods is essential given that risk assessments utilize hand surface area (HSA) to quantify exposure to environmental contaminants. HSA is also utilized in the clinical setting to estimate size of burns, and to determine specific treatments and medication dosages. A reliable method of surface area measurement is important to guide these decisions, especially in children who are vulnerable to environmental contaminants and medication side effects. Despite this, fewer HSA-determining studies have been performed for children compared to adults. In this study, 122 children completed hand tracings, and the tracings were digitized using an ImageJ program to determine HSA. Six previously published methods of determining HSA were utilized based on the child’s height, weight, and length and width of hand. Children were analyzed by age group including 0–2, 3–4, and 5–6 years. The HSA measurements determined by five of the six methods were statistically different from HSA determined using direct hand tracings/Image J methodology (p < 0.001). The single remaining study that did not differ significantly from the hand tracing method provided a uniform hand to total body surface area (TBSA) ratio for children of all ages. Based on these results, we propose a novel age-group-specific ratio utilizing the HSA results from hand tracings and TBSA calculations. The percentages of TBSA that reflect HSA for children aged 0–2, 3–4 and 5–6 years were 0.91%, 0.90% and 0.87%, respectively. These percentages should be considered for use in risk assessments and the clinical setting to guide treatment and prognosis.

Original languageEnglish (US)
Pages (from-to)209-219
Number of pages11
JournalEnvironmental Geochemistry and Health
Issue number1
StatePublished - Jan 2021


  • Dermal exposure estimation
  • Hand surface area (HSA)
  • Hand tracing methodology
  • Lesion and burn area determination

ASJC Scopus subject areas

  • Environmental Engineering
  • Environmental Chemistry
  • Water Science and Technology
  • Environmental Science(all)
  • Geochemistry and Petrology


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