Burns in Children: Preventing Burns

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Guest: Ms. Jill Evans - RN, MSN

Host: Dr. Linda Austin – Psychiatrist

Announcer: Welcome to an MUSC Health Podcast.

Dr. Linda Austin: I am Dr. Linda Austin. I am talking with Ms. Jill Evans, who is a nurse and is the Manager of the Pediatric Burn Services at the Medical University of South Carolina. Ms. Evans, one of your areas of great interest, may be passion one could say, is the importance of preventing burns. What’s the most important thing a parent should think about for burn prevention?

Jill Evans: I think the most important thing for parents to know is have an awareness of how children are burn injured and then accordingly kind of go through your house and look at your house through the child’s eyes. The majority of pediatric burn injuries do occur in and around the home. So, these are things that, you know, that the environment is readily accessible to the parent so that they can take some tips and kind of go through their house and make their house safer for the children.

Dr. Linda Austin: So, let’s start with the kitchen which is where family spends a lot of their time. What are some of the things that parents should think about in the kitchen?

Jill Evans: Well, they need to know that the kitchen and the bathroom are the primary areas where small children, children under the age of five, are injured and that is usually funnily enough, people don’t think of it, but hot tap water alone is the number one cause of scald injuries in this country. So, the first thing that you can do in your kitchen and your bathroom to maintain safety is to decrease the setting of your water heaters to 120 degrees Fahrenheit. Now, most hot water heaters, new, are set in the 140 range, so oftentimes if you have a newer hot water heater, you can dial it down to the temperature. Oftentimes in older homes, you do need to actually measure the temperature of the water and then turn the dial down until you can get it to 120.

Dr. Linda Austin: What other things should you think about in the kitchen?

Jill Evans: The other big cause of burn injuries in children besides scald burn injuries in children, besides hot tap water is cooking and kitchen spills in general. So obviously, the kitchen is the place in the room; it is in my house, I am sure, it is in yours where everybody gathers, but it really is not the ideal place for children to play. So, zones of safety should be step up around the stove, around the sink, around any area where you are cooking and that could be the grill on the back porch or on the deck, but those areas should be off limits to children for play and oftentimes that’s as easy as giving the child a job to do or an older child a job to do at the kitchen table so that they are not running behind you while you are cooking and they are not reaching allover to get things by the stove because the spilling of hot liquids off the stove or out of the microwave can be very, very devastating because liquids are so hot and oftentimes, it can be a large amount of liquid that’s instilled, so you can actually have a pretty significant injury.

Dr. Linda Austin: I would imagine that part of the challenges that parents want their children to learn to be resourceful and independent and praise their children when they take responsibility, but if that needs pulling a bowl of hot soup out of the microwave, that could be pretty dangerous thing.

Jill Evans: Right, and I do think that people tend to view the microwave kind of on a level with may be the VCR. I mean, most 3- to 4-year-old children know how to push the play button on the VCR, they may even know how to take the video out or DVD and put another one in, but we need to remember that the microwave is a tool, it’s not a toy and that you often see yourself that you don’t expect the cup or the bowl to be hot and that is. So, there is a lot of variability with microwaves. So, really a child younger than the age of 10 should not be using microwaves and in our experience, we do see children four, five, and six years old that come in that have been cooking in the microwave where that same parent would never allow their children to cook on the stove, particularly a gas stove where there is flame or be getting things in and out of the oven, but we need to remember the that microwave can heat things up just as hot as a conventional oven and so, it really needs to be part of that circle of safety that children are not allowed to play by or operate.

Dr. Linda Austin: What are some other hot spots in the house?

Jill Evans: Well, the kitchen is number one, the bathroom is number two inside the house, and again in the bathroom, it’s generally hot tap water for scald burns and one tip that I learned when I was a young mother and a young nurse, was to ?- and it goes contrary to what most people think, but if you turn on the cold water first and add hot water to the desired temperature, literature says that alone could prevent a good proportion of the tap water injuries along with decreasing your hot water heater setting to 120. So, start with the cold and add the hot. Normally, what everybody does is turn on the hot and add the cold. So, reverse that and then that situation that you don’t expect happen where the child is in the bathroom, you are getting ready to give them a bath and the phone rings or another child calls for you and the child is momentarily left alone in the bathroom, oftentimes that’s when these accidents occur where if the water is not hot -- running hot and it’s running cold instead you are not going to have that potential, it’s going to decrease the potential for the injury. Another big area of burn injury for children in the bathroom is curling irons. Curling irons and clothing irons are contact injuries where the child reaches for the object without realizing that it’s hot and curling irons are used often, they are almost in every home just like clothing irons and oftentimes, the curling iron is turned off, but it’s left on the counter in the bathroom, may be the corners thing down where child can reach it. So, that’s another big hazard, that’s often present in the bathroom for small children.

Dr. Linda Austin: How about fire places?

Jill Evans: Fires places have several areas of danger and those include glass doors. Oftentimes, people think by keeping a glass door on the front of their fireplace and obviously, that’s going to help you prevent flame injuries or prevent a fire happening by a spark in your home, but the fireplace doors get very, very hot their glass and so they hold a lot of heat. So, we get not the majority here in the south that we do in the Northern States. This is a huge problem in the Northern States where fireplaces are run for several months at a time and it’s actually used to help supplement the heat in the home, but we do see the children do have contact burns mainly to their hands or to their face as they fall against the fireplace doors when they are playing in that area. So again, that circle of safety around that area where at all times the child is not allowed to play there not only when a fire is burning similar to outdoors with outdoor burning, a circle of safety should be established in an area where burning is done and that area should be kept safe and off limits to the child all the time not just when they are active.

Dr. Linda Austin: When I was a child, I remember the old ‘smokey the Bear? ads about not playing with matches. You don’t see them so much anymore, but I would imagine that’s still a problem?

Jill Evans: It is still a problem and what we see mostly is in young children. So, children under the age of 5 or 6 really are more at risk for scald and contact burn injuries. The older the child is and then the adult population, the more at risk they are for flame injuries and flame injuries actually have two peaks in age groups and the first peak is in late childhood, early adolescence. So, children from the ages of may be 10 to 14 do tend to experiment with fire, they do tend to, particularly the boys, they do tend to ? may be working on lawn mowers and go-karts and cars with family members and boys of this age in this date often actually participate in rush burning and trash burning or , so a lot of people still burn trash in our state and children as young as 10 and 12 are actually participating and got the actual burning and so what we see are accidental flame injuries where something explodes in the fire or the wind picks up and the fire is gone back on to the child and the clothing catches on fire.

Dr. Linda Austin: How about grills, there must be a source I would imagine?

Jill Evans: Grills we actually see have much more higher concentration of burn injuries in young children who are running around grills; usually, the family is outside, they may be eating outdoors also and the child falls against or reaches for something on the grill and has a contact burn in that way.

Dr. Linda Austin: Finally, what about just a simple presence or absence of smoke detectors?

Jill Evans: Well, they have done studies and they have shown that working smoke detectors, which is the key, working smoke detectors in the home particularly placed outside sleeping areas do decrease the number of deaths from fire. That has been proven again and again in studies and in data collected throughout the whole United States, but the key again is in every fireman’s nightmare is to come into a home and have people severely injured or not alive is there are smoke detectors present, but they are not working and so, the biggest thing that we press forward that is to keep the batteries going in your smoke detectors and to actually change your batteries out with daylight savings time, so twice a year when you change your clocks, you should be changing your batteries in your smoke detector.

Dr. Linda Austin: Ms. Evans, thank you so much for talking with us today.

Jill Evans: Thank you.

Announcer: If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection at (843) 792-1414.

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