2- Accidents in and around the home: Part 2: Burns

 

 There are so many different ways a child can be injured and harmed in and around the house.  Working in a paediatric emergency department, medical and surgical wards, I have seen the outcomes of a

few of these potentially preventable accidents.  Nothing replaces the role of supervision by a responsible adult- but there are other things we can do to make the home a safer place for our children.  Not all accidents can be completely avoided, but common sense and foresight goes a long way in prevention.  More than 2000 children die every day across the world as a result of an unintentional or accidental injury and 10s of millions of children are taken to hospital with injuries that often result in lifelong disabilities (UNICEF, WHO, cited in CP, 2009, p.24)..  Don’t let it happen to you and your child!

 

It is important to teach our children about danger and how to stay safe.  We must teach this from an early age, but do not depend on the fact that because you have taught your child not to do something that might harm them, that they will stay safe.  Young children have tunnel vision, cannot comprehend the big picture of a situation, and even though they may understand the word “no” or “stop”, may not obey or fully comprehend the entire concept of why.  Even when you teach a child about a particular danger, they may not understand the concept that it may hurt or kill them.  Don’t rely on your child to keep him/herself safe: continue to supervise and remove potential dangers as well.

 

Burns- each year, burns are responsible for nearly 400 admissions to hospital in South Australia alone. (kidsafe fire and burns fact sheet).  Burns are devastating, painful, require intensive treatment and leave scarring for life.  The formation of scars is not only an aesthetic issue, but can also cause growth and development complications (physiotherapy may be required). Scars impact on the ability to mobilize and scar tissue does not have the same elasticity during periods of rapid growth during early childhood as healthy skin does. Not to mention the learning delays from long terms hospital admissions for extensive treatments, the psychological impacts and the risks of infection.

 

Friction- The surgical/burns ward has seen quite a few cases of treadmill friction burns.  Mum/dad is on the treadmill and child crawls up and puts their hand on the moving belt….ouch.  Try to work out with the kids in view, or when they are not around and reinforce the treadmill area as a no go zone, remove the safety key for electric treadmills and unplug it when not in use, cover with a sheet to prevent children from playing on it.  

 

Flame- I saw a nasty burn come through the PED from a girl who’s nighty had caught alight from being next to a stove top.  Stove guards, non flammable clothing and supervision may have prevented this. I also cared for a boy in intensive care unit who had fallen into a camp fire.  This is one of the most common injuries in the Aboriginal communities. Unfortunately it took 3 days for the child’s parents to seek medical attention, so treatment was a battle.  Avoid young children in the kitchen when cooking.  Keep lighters and matches out of reach and out of sight.  Make sure there are functioning smoke detectors in the home.

 

Radiant/contact- In hot weather the road can get very hot.  I have seen asphalt burns to feet, and hands when the child falls.  Always make children wear appropriate footwear and clothing.  Heater burns are common.  Guards should be used and if possible- choose a heater that is safe for children and not hot to touch. One burn I saw was of a child in a walker: the parents were attending to another child who was refusing to take medication (another issue altogether), and while the parents were distracted the younger child moved the walker over to the combustion heater and tipped the walker and burnt her hands.  Irons are unsafe because not only are they hot, but they have a cord attached which young children and babies will pull on, often pulling the iron onto their head with resulting head injuries as well as burns.

 

scalds-  So many scenarios here.  2 min noodles cooking on the stove, child pulled it down over him, coffee spilled, hot baths etc etc.  Prevention: supervision, don’t drink hot drinks with a child in your lap, don’t leave hot drinks within reach, turn the saucepan handles to the back of the stove, use the rear burners on the stove (not the front burners if possible), use stove guards, don’t let kids make jelly with boiling water, don’t leave kids in the bath unattended (it only takes a split second for them to turn on the hot water tap and get burnt), lower you water temperature settings, avoid using tablecloths,  keep kettle cords out of reach,.  One study set out to prove that burns from immersion into hot baths were child abuse, but in actual fact, it was found that both the parents and the researchers underestimated the developmental ability of an unsupervised child (actually supervised without the child’s knowledge) to climb into a bath without assistance.

Kidsafe scalds factsheet

At 65 degrees celcius, hot water can severely scald a child in less than half a second!

 

Chemical burns- acid or alkaline substances. 

Acids cause damage by a process of coagulation necrosis and are self limiting- ie. The chemical damages the skin in direct contact with the chemical but does not continue to burn through once contact has ceased.. 

Common sources of acid poisoning/burns include:

-toilet bowl or drain cleaners

-tyre or metal cleaners

-engraving solution

-battery fluid

Alkalis cause a liquefication necrosis and potentially much more dangerous than acid burns.  These burns can penetrate deep into the skin and continue to cause damage long after the initial exposure.

Common sources of alkali burns include:

-drain/oven cleaners

-cleaner and detergents that are ammonia based

-household bleach or pool chlorination

-cement, mortar, plaster

-denture cleaners

-toilet cleaners

 

 

Burns larger than a 20cent piece should get medical attention.  Children with burns to the hands, face, joints, genitals or feet, because of associated complications will most likely be admitted to hospital for treatment, depending on the hospital’s individual protocols.

 

ACTION: IF YOUR CHILD DOES GET BURNT:  Stay calm. Immediately cool the burn under running water for at least 20 minutes.  Call an ambulance if the burn is on the face or neck, or a large burn, or if it’s a chemical burn.  Remove affected clothing if you can.  Don’t use ice- ice can cause further damage to the skin cells.  Don’t remove clothing that has melted to the skin.  Don’t apply ointments, butter or oil- these can increase the conduction of heat and increase the risk of infection.  Cover the burn with a non stick sterile dressing or cling wrap to reduce the chance of infection, maintain warmth and moisture and decrease pain (air exposure to burns and broken skin increases the pain).  Seek medical attention. 

  Burnt skin is no longer effective at doing its job- which is protection, moisture retention and electrolyte (body salts) retention, amongst other jobs- so when a large section of skin is burnt there is a risk of shock and death through dehydration, electrolyte imbalances and infection.  DO NOT immerse large area burns into water.  Once the initial 20 minute burn cooling is complete (try to cool ONLY the burn, not the entire body) the aim is to maintain warmth in the body, so wrap the child in a warm blanket.  Large area burns lose a lot of body heat and can result in shock.

kidsafe burns factsheet.

 

 

N.b- facial burns are extremely dangerous.  In the event that a facial burn or inhalation burn may have occurred, call an ambulance immediately.  The airway can swell causing breathing problems and death. Take notice of any difficulty breathing, wheezing and/ or cyanosis. Perform CPR if necessary.

 

First degree burns/ superficial burns (epidermal layer):

Cause: are mainly caused by sunburns, brief scalding, brief contact with hot surfaces.

Appearance: Red, but turns white (blanches) when pressure is applied, and skin continues to have good capillary circulation.

Pain: painful and sensitive to touch.

 

Second degree/partial thickness burns (dermal layer):

Cause: scalds and flash flame

Appearance: blistered, moist, swollen, oozing, pink or red, blanches with pressure and capillary circulation continues.

Pain: extremely painful.

 

Third degree/ full thickness burns (subcutaneous layer):

Cause: fire, contact burns

Appearance: tough, leathery, marbled, varies in colour: white, brown, black, tan or red, no capillary circulation, does not blanch with pressure.

Pain: varies from severe to no pain sensation at all.

 

Some burns cannot be graded until after the first  48 hours once the initial inflammatory response has settled.  There will be times in the emergency department when a burn seems to be minor, but is actually quite deep (or vise versa).  The burn will need to be reassessed regularly because of this.

 

WHAT YOU CAN DO:

**LEARN FIRST AID and CPR.  St John’s offers a “Care for Kids” first aid course.

**Take this home safety questionnaire NOW:

**Kid-safe fact sheets can be found in the foyer of the WCH, possibly also at other major children’s hospitals. And online.

**Assess your home from a child’s perspective- what can you see, what can you reach, what looks interesting, what would encourage your curiosity, what is potentially UNSAFE?

**make sure smoke detectors are functioning and have fire safety equipment near the kitchen.

**keep important phone numbers (like poisons hotline) on speed dial or written near your phone.

**keep a stocked first aid kit in your home and car.

**read more about safety and first aid- most of this information you need to know before an accident happens.  See these links:

 

Kidsafe

http://www.indiaparenting.com/raisingchild/data/raisingchild027.shtml

http://www.hkfsd.gov.hk/home/eng/source/safety/Children_home_accident.html

child and youth health

Child and Youth Health home safety

Child and Youth heath toddler safety

CYH burns info: http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=305&id=1500

CPR current recommendations:

 

 

Conclusion:  Adequate prevention strategies and supervision could potentially prevent over half of childhood accidents.  Look around your house from a child’s perspective, room by room, and predict any potential dangers.  Do this regularly- children grow fast and their development progresses rapidly- one day you are considering when the first roll will be, before you know it, your child is dragging chairs to reach things in high places.  You need to constantly assess your home and be one step ahead of your child- don’t wait until your child can access a danger before you do something about it!!

 

references

CP (author not stated)- 2009, ‘Study: Over Two Thousand Kids Die of injuries Each Day’, Contemporary Pediatrics, vol 26, no1, p.24

http://emedicine.medscape.com/article/926537-overview

 

 

Kidsafe website

 

CYH website.