TY - JOUR
AU1 - BIBR, D.J. Dewar,
AU2 - Magson, C.L.
AU3 - MRCP, J. F. Fraser,
AU4 - FRACS, L. Crighton,
AU5 - Surg), R.M. Kimble, FRACS (Paed
AB - Abstract Our objective was to compile data on the mechanism and severity of injuries associated with hot beverage burns in children. We identified 152 children over a 3-year period who attended a tertiary level burns center, representing 18% of all children treated. Their median age was 17.5 months and median body surface area burned was 4% (range, 0.25% to 32%). Significantly, 52% of children required admission, 18% received a split skin graft, and 26% required long-term scar management. In 70% of all cases, the mechanism of injury was the child pulling the hot beverage over himself or herself. In 80% of incidents, a primary care giver witnessed the injury. These findings indicate that scalding from hot beverages carries significant morbidity and is an important pediatric public health issue. It is clear that further research towards effective education programs for primary caregivers is warranted. It has been more than 20 years since the first study of hot beverage scalds was published in the Medical Journal of Australia.1 Since then, there have been many small studies looking at the epidemiology of scalds.2,–5 There have, however, been no specific studies looking uniquely at hot beverage burns in children. The aim of this study was to define the mechanisms by and the settings in which hot beverage burns occur in children and the resulting morbidity. METHODS Data were collected retrospectively from the Stuart Pegg Paediatric Burns Centre (SPPBC) at the Royal Children's Hospital Brisbane from the records of all children presenting to the Centre with hot beverage scalds from July 1, 1999, to June 31, 2002. The SP-PBC serves as the only tertiary pediatric burns center in Queensland. The SPPBC treats over 300 children per year, providing both inpatient and outpatient care for children from Queensland, Northern New South Wales, the Northern Territory, and the regional Pacific. On attendance at the SPPBC, a detailed patient proforma is prospectively completed for all patients. For this study specific data were collected from the detailed patient proforma regarding age and sex of the child, time of injury, place of injury, causal beverage, mechanism of injury, presence of witness, characteristics of the burn, and level of treatment required. RESULTS One hundred and fifty-two children were treated at the SPPBC for hot beverage scalds over the study period, corresponding to 18% of all the burns treated in the unit during this time. The median age of the children was 17.5 months (range, 3 months to 11.5 years), 68% of the children were younger than 2 years of age (Figure 1), and 62% were boys. Figure 1. View largeDownload slide Distribution of scalds by age. Figure 1. View largeDownload slide Distribution of scalds by age. The incidence peak was in the morning between 6 AM and 9 AM. There were other smaller peaks occurring at 11 AM and 6 PM. There was no correlation between the month of the year and the incidence of burns. In 120 cases, an environmental location was documented. The most common location reported was the patients own home (71%), followed by relative's home (6%), caravan (6%), friend's home (3%), campsite (3%), preschool/school (3%), restaurant (3%), hotel (2%), car (2%), aircraft (2%), and church (1%) When an injury occurred in a house, the specific room was documented. The most commonly reported room was the kitchen (84%), followed by: lounge/dining room (14%), bathroom (1%), and bedroom (1%). The most common beverage involved was tea (45%), followed by coffee (25%), hot milk drinks (3%), and soup (1%). The beverage was predominantly in a cup or mug (74%). Boiled water, either in the kettle or in a mug, was responsible for burning a further 26% of the patients. The most common mechanism of injury was that of the child “reaching up” to the hot beverage container and pulling it down over themselves (70%). This was followed by splash burns from the child knocking a hot beverage container over (19%). A small proportion of the burns were caused by another person spilling the beverage on the child (8%). Tripping, pulling the tablecloth, and other mechanisms accounted for the remaining four cases. In 80% of cases, there was a parent/adult witness. The burns covered a median body surface area of 4% (range, 0.25–32%). The majority of the burns involved the anterior torso (65%) and upper limbs (51%). Other areas affected were head and neck (39%), lower limbs (26%), and posterior torso (11%) (Table 1). Fifty-two percent of the children required admission, with a median stay of 4 days (range, 0.5–45 days). One child required intensive care therapy for 2 days. Twenty-seven patients (18%) required one or more split-skin grafts including 19 grafts to the anterior torso, 11 to the upper limbs, 7 to the lower limbs, 3 to the posterior torso, and 2 to the head and neck (Table 2). Three patients required secondary surgery to release scar contractures. Thirty-nine patients (26%) required the long-term use of a pressure garment for scar management. There was no evidence of nonaccidental injury in any of the cases. Table 1. Burn distribution View Large Table 1. Burn distribution View Large Table 2. Area graft View Large Table 2. Area graft View Large DISCUSSION This study reveals that the child most likely to sustain injury from hot beverage scalding is male and less than 2 years of age. Other studies support this finding, highlighting the vulnerability of this age group to accidental injury because they are a stage of limited cognitive and motor development and require a greater amount of direct parental supervision.1,6 This study shows that it is the usual, everyday hot drinks consumed by parents across Australia that are causing the scalds, namely tea and coffee. Other studies support this study's findings of tea, followed by coffee, then boiled water as being the most common source of scald injury from hot beverages.1,–3 It is of no surprise that this study found incidence of injury peaks between 7 AM and 9 AM, again at 11 AM, and between 6 PM and 8 PM. This almost certainly corresponds to the times when adults are most commonly preparing hot drinks. The kitchen is revealed in this study as the most likely place for a child to be scalded by hot beverages. As have been the findings of previous research, our data show that children are most commonly scalded in their own home.6 A literature search revealed little information regarding the exact mechanism of injury. One study postulated the mechanism as being caused by coffee and tea cups having handles and being light enough for toddlers to slide or tip over.3 Another study suggested the child pulling the tablecloth and spilling the cup onto themselves was the main cause.2 Our data were very clear in identifying the main mechanism of injury as the child “reaching up” to the hot beverage and pulling it over themselves. This study identified the frequency of distribution of burn distribution as anterior torso (65%), upper limbs (51%), head and neck (39%), lower limbs (26%), and posterior torso (11%). These findings are consistent with the spillage pattern sustained by a child “reaching up” to a hot beverage and pulling it over themselves. The high admission (52%) and grafting rate (18%) and long-term scar management (26%) also has not previously been documented. This is an important finding because it emphasizes the severity of this type of burn and its potential to impact on life-long physical function.4,5 The regions grafted indicate that a child's clothing potentially prolongs the exposure of the child to the thermal injury and consequently produces a deeper burn. This finding emphasizes the need for education of immediate first aid for these burns, that is, to remove all clothing and then immerse the child in water or run cold water tap water on the injury for 20 minutes. In our study, in 80% of cases an adult witnessed the child being scalded. This refutes the proposal of a previous study that increasing parental supervision of children is likely to reduce the incidence of scald injuries.2 It is clear that a more sophisticated approach is required if these injuries are to be prevented. Harstad et al7 from Norway showed a 53% decrease in the incidence of all childhood burns was achievable over a 7-year period with a mixture of active and passive interventions. Active interventions focused on establishing community groups; using all media; educating parents on safe activity around children, including first aid; and free texts on influencing behavior and outcomes. Passive interventions were established by changes in government legislation to increase child safety in the home and engineering changes to household appliances to reduce their temperatures. The Harstad study used the Haddons Matrix to identify preinjury, injury, and postinjury events, and then used a multidisciplinary approach involving the media, lay organizations (Red Cross), the public, health and private sectors (Injury Prevention Group) to implement a community-based intervention program.7 We similarly used a Haddons Matrix (Table 3) to analyze the key findings to propose feasible prevention options within Australia. Our Haddons Matrix targeted three modifiable risk factors. First, the supervised male child, identifying the toddler's clothing as benefiting from being more spill and splash resistant to liquids, minimizing the severity of injury (Table 2). Second, the parent/adult supervisors need to be targeted with a specific public education media campaign aimed at promoting the simple message to place hot beverages at all times out of a child's reach, minimizing the consumption of hot beverages when raising a toddler, using cups designed to minimized spills that have a firm lid or wide heavy base and reinforce appropriate first aid of immediately removing a child's clothing. Last, the home kitchen environment would benefit from installation of child-safe measures, such as toddler-proof gates to the kitchen. Table 3. Prevention strategies using a Haddons matrix View Large Table 3. Prevention strategies using a Haddons matrix View Large CONCLUSION Hot beverage scalds most commonly involve supervised toddlers who reach up and pull the beverage over themselves. This injury can cause significant morbidity, and the majority could be prevented if caregivers were educated never to leave their hot beverages within the reach of children. It is clear that research into effective primary prevention programs targeting hot beverage burns in children is required. REFERENCES 1. Gonski LA Prevention of tea and coffee scalds. Med J Aust  1979; 3: 484. 2. Lyngdorf P Epidemiology of scalds in small children. Burns  1986; 12: 250– 3. Google Scholar CrossRef Search ADS   3. Ray JG Burns in young children: a study of the mechanism of burns in children aged 5 years and under in-The Hamilton, Ontario Burn Unit. Burns  1995; 21: 463– 6. Google Scholar CrossRef Search ADS PubMed  4. Smith MA, Munster AM, Spence RJ Burns of the hand and upper limb: a review. Burns  1998; 24: 493– 505. Google Scholar CrossRef Search ADS PubMed  5. Abdullach A, Blakeney P, Hunt R, et al.   Visible scars and self-esteem in pediatric patients with burns. J Burn Care Rehabil  1994; 15: 164– 8. Google Scholar CrossRef Search ADS PubMed  6. Van Rijn OJ, Bouter LM, Meertens RM The aetiology of burns in developed countries: review of the literature. Burns  1989; 15: 217– 21. Google Scholar CrossRef Search ADS PubMed  7. Ytterstab B, Sogarrd AJ The Harstad Injury Prevention Study: prevention of burns in small children by a community-based intervention. Burns  1995; 21: 259– 66. Google Scholar CrossRef Search ADS PubMed  Copyright © 2004 by the American Burn Association
TI - Hot Beverage Scalds in Australian Children
JF - Journal of Burn Care & Research
DO - 10.1097/01.BCR.0000124821.22553.24
DA - 2004-05-01
UR - https://www.deepdyve.com/lp/oxford-university-press/hot-beverage-scalds-in-australian-children-RKac0eYxhh
SP - 224
EP - 227
VL - 25
IS - 3
DP - DeepDyve
ER -