Our clinical impression is that delayed referrals require more analgesia than children referred to our service acutely. Previous work demonstrated poor uptake of analgesia protocols at district hospitals with probable inadequate background and procedural analgesia, which may account for this. The purpose of this study was to compare analgesia requirements for dressing changes of paediatric patients referred to us acutely versus those children with delayed referral (i.e. more than 21 days post injury). Our hypothesis is that paediatric patients with delayed referral require higher doses of ketamine when taking length of stay and total body surface area (TBSA) of the burn into account.