According to the American Burn Association (ABA) National Burn Repository 2010 Report, scald burns accounted for 54 percent of all burns in children younger than five years old. More than 90 percent of hot water scalds are due to hot cooking or drinking liquids.1 Fortunately, most pediatric scald burns are not fatal and are minor enough that the victim can avoid admission to the hospital.
For young children especially, the kitchen may be regarded as the most dangerous room in the entire household. Adults often fail to recognize a child’s ability to access hazardous objects in the kitchen and the subsequent likelihood of injury. Ultimately, negligence on the part of the caregiver is the key issue.2
Pediatric scald injuries
The severity of a scald injury depends on the temperature of the liquid and the duration of exposure. Younger children have thinner skin, resulting in deeper injuries compared with adults who are exposed to the same temperature and contact time. Coffee, tea, hot chocolate, and other hot beverages can be served to adults at temperatures of 160–180°F/71–82°C.1 Water at a temperature of 50°C will take approximately 10 minutes to cause a full thickness injury in an adult, while taking only half that time to create an injury of similar depth in a child. The relationship, however, is not linear. Water at a temperature of 58°C will take approximately five seconds to cause a full thickness injury in an adult, but only one second in a child.3
Furthermore, liquid volumes that may appear small, whether they are in a cup or saucepan, can actually affect a large portion of a child’s body. The “rule of nines” is a quick and easy way to estimate total body surface area (TBSA) involvement in an adult, but the rule does not uniformly apply to children. Because children have proportionally larger heads, Lund-Browder charts estimate the extent of burns that allow for the varying proportion of body surface in different ages. While a burn involving the entire head in an adult may be only 9 percent of the TBSA, it would be 19 percent in a one-year-old toddler. This proportional increase in TBSA is exacerbated by the fact that toddlers tend to reach up to pull hot liquid containers down, which make their heads and faces more prone to significant injury.
Causes and effects
To examine the occurrence of pediatric scald injuries in the National Trauma Data Bank® (NTDB®) research dataset for 2013, admissions medical records were searched using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses codes. Specifically searched were records for children age 12 or younger with place of injury codes (E-code) E849.0 (home) and an external cause of injury code E924.0 (burns from hot liquids and vapors, including steam). A total of 3,183 records were found; 3,033 records contained a discharge status, including 2,912 patients discharged to home, 78 to acute care/rehab, and 43 sent to skilled nursing facilities; none died. These patients were 52.8 percent male, on average 5.4 years of age, had an average hospital length of stay of 3.8 days, an average intensive care unit length of stay of 5.1 days, an average injury severity score of 3.0, and were on the ventilator for an average of 9.4 days. Almost 60 percent of all injuries occurred in children five years of age or younger. (See Figures 1 and 2.)
Figure 1. Age of scald injury victims
Figure 2. Hospital discharge status
Children are creative and resourceful; therefore, identifying all the potential hazards that may lead to serious injury is paramount. A study at a major burn center involving scalded children younger than age five found that microwave-related injury was an unaddressed mechanism not found in major prevention resources.4 This type of finding opens an avenue for awareness, education, and possible engineering safeguards. It may also underscore that the mechanisms for scalds and other cooking-related pediatric injuries need further investigation to develop targeted and effective preventive strategies. A kitchen with tantalizing smells may lead to curiosity regarding what’s cookin’; when it comes to preventing injury, though, it is who’s lookin’ that counts.
Throughout the year, we will be highlighting these data through brief reports in the Bulletin. The NTDB Annual Report 2014 is available on the ACS website. In addition, information is available on the website about how to obtain NTDB data for more detailed study. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at firstname.lastname@example.org.
Statistical support for this article has been provided by Chrystal Caden-Price, Data Analyst, and Alice Rollins, NTDB Coordinator.
- American Burn Association. Community Fire and Burn Prevention Program. American Burn Association, Scald Injury Prevention, Educator’s Guide. Available at: http://www.ameriburn.org/Preven/ScaldInjuryEducator%27sGuide.pdf. Accessed January 10, 2015.
- Hunt JL, Arnaldo BD, Purdue GF. Prevention of Burn Injuries. In Herndon DN (Ed). Total Burn Care, 4th Edition. Philadelphia, PA: W.B. Elsevier; 2012:52.
- Moritz AR, Henriques FC. Studies of thermal injury: II. The relative importance of time and surface temperature in the causation of cutaneous burns. Am J Pathol. 1947;23(5):695-720.
- Lowell G, Quinlan K, Gottlieb L. Preventing unintentional scald burns: Moving beyond tap water. Pediatrics. 2008;122(4):799-804.