Background and Objectives : Extensive burns are devastating injuries, especially in children, associating high risk of morbidity and mortality in the absence of immediate and appropriate treatment. Negative-pressure wound therapy (NPWT) has emerged as a versatile tool for the local treatment of burn wounds. This study aims to present our approach in using NPWT for extensive burns in children, emphasizing the indications and outcomes of these very challenging cases, and proposing an algorithm for NPWT use for extensive burn patients, even in low-resource settings. Materials and Methods : We retrospectively analyzed pediatric burn patients admitted between January 2020 and December 2024, selecting the cases with at least 20% TBSA burn and the application of NPWT during treatment, recording indications and parameters of use, treatment period, and results. Results : We identified 12 patients with a burn surface ranging from 20% to 80% TBSA, caused by high-voltage electrical current (6 cases), flame (4 cases), and scalds (2 cases). NWPT was used for 3-25% TBSA for obtaining granulation tissue in very deep burn wounds with bone and tendon exposure, for reducing edema and enhancing spontaneous re-epithelialization in intermediate circumferential burns, and for preparing the wound bed for re-grafting after local infection and graft failure. There were no complications related with the NPWT use and no fatalities. Conclusions : NPWT represents a reliable option for several clinical situations in local burn treatment, for temporary closure of burn areas, graft fixation, burn wound preparation, local infection control, or enhancing re-epithelialization. The proposed algorithm offers a comprehensive overview of indications of NPWT for burn local management and may guide clinical decisions, easing the identification of the best situation and moment to use the device. Our study contributes to the body of knowledge that enforces the evidence of the safe and effective use of NPWT for burn management in the pediatric population.