- Email: [email protected]
Tall toddlers—at increased risk for scalds?
Burns 30 (2004) 581–582
Clinical Report
Tall toddlers—at increased risk for scalds? S.M. Murphy, D. Murray, K. Rooney∗ , D.J.A. Orr Departments of Plastic and Reconstructive Surgery and Occupational Therapy, Our Lady’s Hospital for Sick Children, Crumlin, Dublin 12, Ireland Accepted 3 February 2004
The majority of burns in children result from simple domestic accidents that are preventable, yet account for major morbidity and mortality [1]. A previous study of children younger than 5 years with a burn injury, found that children under 6 months formed only 4% of cases, highlighting the role of development in determining risk as, before the age of 6 months, the infant’s acquisition of motor skills makes him (or her) unlikely to encounter a hot object [2]. A high proportion of children admitted to our unit with scalds sustained by pulling down a hot liquid from a counter top were particularly tall. Between 1 July 2002 and 1 December 2002, the heights of 31 consecutive children who were referred to the unit with burns sustained from pulling down a hot liquid from a kitchen counter were measured. Height was measured with the child lying horizontally with legs straight and their head in contact with a board [4]. All measurements were carried out by one person (SM), and the heights were plotted on growth percentile charts based upon normative data for the Irish population [4]. Thirty-one children with scalds, caused by pulling down hot liquid from a kitchen counter, were referred during this 5 months period. The children ranged from 9 months to 2 years of age with a median age of 15 months. Twenty were male (65%). Eleven were female (35%). Twenty of the children were Irish and 10 were recent immigrants from African and Eastern European countries. Sixteen children (52%) had pulled down a kettle, 14 (45%) a cup of tea or coffee and one child was scalded by a cup of microwaved hot curry sauce. Total body surface area scalded ranged from 2 to 20% with a median TBSA of 4%. Eighteen children were admitted to the burns unit and two required fluid resuscitation for 20% TBSA burns. Six patients required split skin grafts. Thirteen children were treated with dressings only as outpatients. All children were measured and all were above the 90th height percentile for their age. The height range was from ∗
Corresponding author.
0305-4179/$30.00 © 2004 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2004.02.003
81 to 97 cm. Twenty-nine children were above the 97th percentile for their age.
1. Discussion Household building standards place the average kitchen counter top at about 75 cm in height largely for ergonomic reasons. A standing child of 9 months who is above the 90th percentile for height will be atleast 75 cm, allowing some visualisation of the counter top. With the added reach height of a toddler (approx. 15 cm), a child can pull down an object from within his view. This is significantly different to a child at the 50th percentile for their height and age, who would measure 67 cm, a difference of 8 cm, which makes it much more difficult to reach a counter top. It seems logical to suggest that taller toddlers who have not yet acquired a sense of danger, would be at particular risk of pulling hot liquid down on top of themselves while exploring their new environment. This hypothesis appears to be supported by our study with all of the 31 consecutive children who sustained this injury being above the 90th percentile for height. However, the growth charts used in this study date from 1986, and it is likely that (as in other Western European countries [5]) children have increased in size. The children in our study may appear less dramatically tall when measured on updated growth charts. Nevertheless, height does seem to be a significant risk factor. The medical literature contains numerous reports of the aetiology and incidence of paediatric scalds. A public information campaign in Denmark in the early 1990s, advising people to keep electric kettle cords short and not hanging over the edge of the counter or table top, led to a reduction by half in the number of scalds from toppled kettles [3]. Such public information campaigns are important and need to be repeated regularly. The danger from hot liquids on
582
S.M. Murphy et al. / Burns 30 (2004) 581–582
a kitchen counter needs to be emphasised, particularly if toddlers are indeed getting taller. An increase in the height of children over the last decade has been shown to be 1–2 cm in 7-year-olds in a German study [5]. A Croatian study showed there to be between 4–7.5 cm differences in 9-year-old children between 1951 and 1991 [6]. The Irish population has now a wider ethnic community, and this may be reflected when the current growth charts that date from 1986 are updated. Tall toddlers may be at particular risk of scalding from pulling down hot liquids from kitchen counters. This mechanism of injury is preventable by keeping kettle cords short and coiled or using cordless appliances as well as keeping hot objects well back from the edge of the table or counter. Public education campaigns have been shown to be effective in reducing this type of injury [3] and may be even more significant, if toddlers are indeed getting taller.
References [1] Warrington SA, Wright CM. ALSPAC Team. Accidents and resulting injuries in premobile infants: data from the ALSPAC study. Arch Dis Child 2001;85:104–7. [2] 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(6):463–6. [3] Sheller JL, Thuesen B. Scalds in children caused by water from electrical kettles: effect of prevention through information. Burns 1998;24(5):420–4. [4] Hoey HM, Tanner JM, Cox LA. Clinical growth standards for Irish children. Acta Paediatr Scand Suppl 1987;338:1–31. [5] Hesse et al. Alterations in height, weight and body mass index of newborns, children and young adults in eastern Germany. J Paediatr 2003;142(3): 259–62. [6] Prebeg Z, Juresa V, Kujundzic M. Secular growth changes in Zagreb schoolchildren over four decades. Annu Hum Biol 1995;22(2):99– 110.
Clinical Report
Tall toddlers—at increased risk for scalds? S.M. Murphy, D. Murray, K. Rooney∗ , D.J.A. Orr Departments of Plastic and Reconstructive Surgery and Occupational Therapy, Our Lady’s Hospital for Sick Children, Crumlin, Dublin 12, Ireland Accepted 3 February 2004
The majority of burns in children result from simple domestic accidents that are preventable, yet account for major morbidity and mortality [1]. A previous study of children younger than 5 years with a burn injury, found that children under 6 months formed only 4% of cases, highlighting the role of development in determining risk as, before the age of 6 months, the infant’s acquisition of motor skills makes him (or her) unlikely to encounter a hot object [2]. A high proportion of children admitted to our unit with scalds sustained by pulling down a hot liquid from a counter top were particularly tall. Between 1 July 2002 and 1 December 2002, the heights of 31 consecutive children who were referred to the unit with burns sustained from pulling down a hot liquid from a kitchen counter were measured. Height was measured with the child lying horizontally with legs straight and their head in contact with a board [4]. All measurements were carried out by one person (SM), and the heights were plotted on growth percentile charts based upon normative data for the Irish population [4]. Thirty-one children with scalds, caused by pulling down hot liquid from a kitchen counter, were referred during this 5 months period. The children ranged from 9 months to 2 years of age with a median age of 15 months. Twenty were male (65%). Eleven were female (35%). Twenty of the children were Irish and 10 were recent immigrants from African and Eastern European countries. Sixteen children (52%) had pulled down a kettle, 14 (45%) a cup of tea or coffee and one child was scalded by a cup of microwaved hot curry sauce. Total body surface area scalded ranged from 2 to 20% with a median TBSA of 4%. Eighteen children were admitted to the burns unit and two required fluid resuscitation for 20% TBSA burns. Six patients required split skin grafts. Thirteen children were treated with dressings only as outpatients. All children were measured and all were above the 90th height percentile for their age. The height range was from ∗
Corresponding author.
0305-4179/$30.00 © 2004 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2004.02.003
81 to 97 cm. Twenty-nine children were above the 97th percentile for their age.
1. Discussion Household building standards place the average kitchen counter top at about 75 cm in height largely for ergonomic reasons. A standing child of 9 months who is above the 90th percentile for height will be atleast 75 cm, allowing some visualisation of the counter top. With the added reach height of a toddler (approx. 15 cm), a child can pull down an object from within his view. This is significantly different to a child at the 50th percentile for their height and age, who would measure 67 cm, a difference of 8 cm, which makes it much more difficult to reach a counter top. It seems logical to suggest that taller toddlers who have not yet acquired a sense of danger, would be at particular risk of pulling hot liquid down on top of themselves while exploring their new environment. This hypothesis appears to be supported by our study with all of the 31 consecutive children who sustained this injury being above the 90th percentile for height. However, the growth charts used in this study date from 1986, and it is likely that (as in other Western European countries [5]) children have increased in size. The children in our study may appear less dramatically tall when measured on updated growth charts. Nevertheless, height does seem to be a significant risk factor. The medical literature contains numerous reports of the aetiology and incidence of paediatric scalds. A public information campaign in Denmark in the early 1990s, advising people to keep electric kettle cords short and not hanging over the edge of the counter or table top, led to a reduction by half in the number of scalds from toppled kettles [3]. Such public information campaigns are important and need to be repeated regularly. The danger from hot liquids on
582
S.M. Murphy et al. / Burns 30 (2004) 581–582
a kitchen counter needs to be emphasised, particularly if toddlers are indeed getting taller. An increase in the height of children over the last decade has been shown to be 1–2 cm in 7-year-olds in a German study [5]. A Croatian study showed there to be between 4–7.5 cm differences in 9-year-old children between 1951 and 1991 [6]. The Irish population has now a wider ethnic community, and this may be reflected when the current growth charts that date from 1986 are updated. Tall toddlers may be at particular risk of scalding from pulling down hot liquids from kitchen counters. This mechanism of injury is preventable by keeping kettle cords short and coiled or using cordless appliances as well as keeping hot objects well back from the edge of the table or counter. Public education campaigns have been shown to be effective in reducing this type of injury [3] and may be even more significant, if toddlers are indeed getting taller.
References [1] Warrington SA, Wright CM. ALSPAC Team. Accidents and resulting injuries in premobile infants: data from the ALSPAC study. Arch Dis Child 2001;85:104–7. [2] 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(6):463–6. [3] Sheller JL, Thuesen B. Scalds in children caused by water from electrical kettles: effect of prevention through information. Burns 1998;24(5):420–4. [4] Hoey HM, Tanner JM, Cox LA. Clinical growth standards for Irish children. Acta Paediatr Scand Suppl 1987;338:1–31. [5] Hesse et al. Alterations in height, weight and body mass index of newborns, children and young adults in eastern Germany. J Paediatr 2003;142(3): 259–62. [6] Prebeg Z, Juresa V, Kujundzic M. Secular growth changes in Zagreb schoolchildren over four decades. Annu Hum Biol 1995;22(2):99– 110.