Big Kids' Burn Culprits

With winter weather upon us, what better way to cope with falling temps than having a hot cup of cocoa in front of a warm, inviting fire? This may be a serene scene to many, but for those who deal with medical emergencies involving burns, it's cause for concern. Hot liquids and fireplaces can pose serious safety issues for children.

"Approximately 440,000 children receive medical attention annually in the United States for burn-related injuries," says Jenny Ziembicki, medical director of the UPMC Mercy Burn Center in Pittsburgh. Thermal injuries -- those resulting from heat -- are the most common type of childhood burn. "This includes flame, scald and contact injuries," Ziembicki says.

Younger children are especially vulnerable. In a study of 1,215 kids treated for burns across the United Kingdom during a two-year period -- published online last February in the Archives of Diseases in Childhood -- 72 percent of the victims were under age 5; the majority were only a year old. Researchers attributed this to the increased mobility and curiosity of infants exploring their environment. More than 700 of the children were treated for scald injuries -- more than half of which were caused by hot drinks. Tea was the most common culprit, and all of the burns occurred at home.

Though this study was conducted in Europe, these types of injuries are prevalent in the United States, too. "We see up to 100 children per year under the age of 12 in our burn center," says Jay Collins, who oversees the trauma and burn programs at Sentara Norfolk General Hospital in Virginia and is a professor of surgery at Eastern Virginia Medical School. "The majority are burns due to scalds as a result of hot liquids being spilled in the kitchen."

Besides hot drinks such as coffee or tea, a major burn source in the kitchen is instant soup. These often come in Styrofoam cups and require little more than hot or boiling water, which can be an accident waiting to happen.

"[It's a] common food eaten by many young children," Collins says. "Once heated, the child will attempt to carry the cup to the table. However, the cup may be too hot and the child drops or spills the item, resulting in a scald burn."

Instant noodle soups are especially dangerous. Not only are the cups they come in prone to tipping over, but the noodles themselves, which conduct heat, can stick to skin. "They may cause significant burns over the lower trunk and legs that may require grafting," Ziembicki says.

A 2007 study published in the Journal of Burn Care & Research found that the average hospital stay for noodle soup burn victims was significantly longer than it was for those with other soup burns. While the boiling temperature of broth-only and noodle soup is essentially the same, the cooling curve of noodle soup is much slower, making it much more harmful.

Parents should always supervise children in the kitchen, especially when using a microwave or when the oven or burners are on. "Pots should be on the back burner with the handles out of reach," Collins says. "Do not serve steaming hot foods to children."

In addition to kitchen accidents, bathroom injuries from hot water happen frequently. Caretakers should submerge their hands in the bath water for at least five seconds to test it. "If it's too hot, do not place your child in the tub," Collins warns. "If available, use a bath thermometer." Aim for 100 degrees Fahrenheit, according to the Mayo Clinic.

Other bathroom hazards include hair straighteners and curling irons. Some flat irons can reach a high of 450 degrees Fahrenheit. Contact burns usually occur when "a toddler-aged child reaches up for the [heated device]," Ziembicki says. "These [burns] may be quite deep in nature."

Though contact burns are less common than scalds, they often occur from touching hot objects such as space heaters, oven doors, barbecue pits and fireplace covers, which become a considerable hazard this time of year.

A 2012 survey revealed that more than 10 million homes have a gas fireplace with a glass front and more than half of residents in those households don't realize the glass can become very hot when the fireplace is in use and will continue to stay hot long after the flames have gone out. When children teeter into the glass or touch it when exploring, contact burns can result.

Gas fireplaces should have a sturdy screen in front to prevent kids from touching the hot glass, Collins says. A mandatory safety standard now requires all certified gas fireplaces manufactured after Jan. 1, 2015 to have a safety screen or protective barrier installed.

The fireplace industry also recommends installing a switch lock to prevent children from turning on the fireplace; keeping the remote control out of reach; and remembering that the cool-down period can last as long as an hour or more.

If a child does get burned, immediately "remove the source of the burn and wrap the burn in a clean, dry cloth," says Collins.

"Anti-inflammatory medications, like ibuprofen, aren't just for fevers and pain; they actually reduce the amount of inflammation, which is important for burns," explains Amy Baxter, an Atlanta-based emergency pediatrician specializing in pain management. "Much of the damage of burns is the body's inflammatory immune response," she says, "and even [the] actual heat, making burns both feel worse and be worse."

If the burn is small, Baxter recommends immediately putting the burned extremity in cold water. "It doesn't just feel good, but research shows that the persistent immersion and cooling of burns decreases the likelihood of a burn becoming a full-thickness burn that needs grafting. For places like the chest that can't be immersed, cool washcloths are good."

After addressing the pain and immersing as much as possible, Baxter says most small burns should be covered with an antibiotic ointment and bandaged in sterile, non-stick gauze. Blisters should be left unbroken as long as possible.

"Small burns, where the skin is largely intact, may be cared for at home by cleansing daily with a mild soap and then applying a lubricant such as Aquaphor," Ziembicki says.

But don't even think about reaching for ice, says Baxter, which can actually damage skin. Just keep skin cool. Butter and oils should also be avoided, since they can concentrate the heat and lead to infection.

Seek medical attention right away, says Baxter, if a burn is larger than the size of a palm; located on the face or genitals; covering a joint; or is white or charred inside. Also get help if the pain can't be controlled with cool water and ibuprofen.

To avoid burns, "Everyone should ensure they have a functioning smoke detector in the house," and that the water heater is set to 120 degrees Fahrenheit, Ziembicki says. Hot items should also never be within a child's reach. After all, fire and burn injuries are a leading cause of injury-related death among children in the U.S., according to the Centers for Disease Control and Prevention. The best antidote, whenever possible, is to keep burns from happening in the first place.