Annals of Burns and Fire Disasters - vol. X - n. 1 - March 1997

BURN CAMPAIGNS IN BELGIUM FOR CHILDREN UNDER THE AGE OF FIVE YEARS

Hendrickx A., Boeckx W.

Burn Care Unit, University Hospital, St. Pieter Leuven, Belgium


SUMMARY. Of Belgium's population of about 10,000,000, some 120,000 (1.2%) are the victims of burn injury every year. Ten thousand (0. 1 %) need to be hospitalized, in either a general hospital or a burns centre. Approximately 800 of these patients are treated in one of the six specialized burn units in Belgium. Annually about 150 patients die owing to the consequences of their burns. Since the early 1980s, the number of burn cases has not substantially changed. By the year 2000 we expect an important increase in burn prevention measures (e.g. smoke detectors) as well as a growing awareness among the target-public (e.g. through media campaigns), as a result of which, hopefully, there will be a drop in the number of burn injuries. Studies show that in Belgium 70% of all burn-related accidents occur in the home and that pre-school children (23 yr) form an extremely vulnerable group. There is a need for general awareness of the dangers involved, with education of the public underlining the importance of parental supervision: for example, keeping children out of the kitchen would prevent a significant number of accidents. It is important to organize ongoing information campaigns, as those who have recently become parents may not be aware of the dangers facing their children. Safety training is an absolute necessity and accordingly there are several organizations and centres in Belgium that specialize in burn prevention. This paper also describes a number of practical precautions and a video campaign.

Introduction

Belgium has a population of about 10,000,000. Every year some 120,000 persons (1.2%) are the victims of burn injury, of whom about 10,000 need to be hospitalized in either a general hospital or a burns centre. Approximately 800 of these patients are treated in one of the six specialized burn units in Belgium. Annually about 150 patients die as a result of their burns. There has been no substantial change in the number of burn cases since the early 1980s. Ideally, the effectiveness of a successful prevention campaign would be reflected in a decrease in mortality and morbidity rates.
Unfortunately, it is extremely difficult to gain access to data on burn, fire, and injury frequency as most statistics are kept in city or state files, while international data, especially from developing countries, are for the most part unavailable.
By the year 2000 we expect an important increase in the use of burn prevention measures, for example smoke detectors; we also hope for growing awareness among the target-public, by means of massive media campaigns. All this hopefully will lead to a drop in the number of burn injuries.
Physical safety is obviously one of the most important values of life. Protection of the human body against disaster and disruption of its integrity is essential. Physical injuries are a major cause of death, especially among infants and youngsters.
Burn wounds not only damage the body but also have profound individual, social, and economic consequences that are not always fully appreciated by the authorities and the community.
Accidents in and around the house are a daily reality. However, although they present a real health problem for the community, only some very general figures are available.
When the different locations of all accidents are analysed, those in the home prove to be very frequent (Table I). Accidents in the domestic environment (58.7%) are twice as frequent as road accidents (29.7%) and five times as frequent as accidents at work (11. 6%).
Besides trauma caused by falling, poisoning, or drowning, burn injuries are important in the category of home accidents (Table II).

Location Number Percentage
Home 161,164 58.7
Street 81,487 29.7
Work 31,823 11.6
Total 274,474 100.0
Location Number Percentage
Home 1145 67.2
Work/School 408 23.9
Street 64 3.8
Other 87 5.1

Total

1704 100.0

Table I - Distribution of all types of injuries in Belgium by location of accident (1994)

Table II - Distribution of burn injuries by general location of accident

As can be seen, nearly 70% of all burn injuries occur in the home, confirming the consideration that the risk of burn injury is highest in the domestic environment. It is important to notice that in all age categories accidents in the home are the most frequent. This is especially true among children up to the age of 15 yr, particularly in the 0 to 4 yr old age group, as we shall see when we consider the distribution of burn accidents according to age.
Table III shows that more than 50% of domestic burn injuries occur in the kitchen. Many injuries are also sustained in the garden, bathroom, and garage.

Place Percentage
Kitchen 55.0
Bathroom 10.0
Garage 8.0
Garden 15.5
Living-room 3.5
Bedroom 7.0
Other 1.0
Total 100.0

Table III - Distribution of domestic burn injuries by exact location of accident

By monthly distribution, the highest percentage (11.0%) of burn victims is found in May, followed by December (Table IV). The explanation for the high frequencies may be due to the fact that in May, i.e. at the beginning of the summer period, barbecue parties become popular and inexperienced people are easy victims, while in December the increase is mainly due to the widespread practice of making cheese fondues and to the use of fireworks at parties.

Month Percentage Number
January 7.3 82
February 6.4 72
March 6.1 68
April 8.4 94
May 11.0 123
June 7.8 87
July 9.8 110
August 9.1 102
September 6.3 71
October 9.5 107
November 8.4 94
December 10.0 112
Total 100.0 1122

Table IV- Distribution of burn accidents by month of occurrence

Table V shows that children, especially very young children, are particularly exposed to the risk of burn injuries. It is frightening to see that over 10% of all patients are found in the 0-4 yr age group. The rate of burn injuries in males is twice as high as among femalesl even though in the total population males are less numerous than women. If we examine the age groups we find that two groups dominate:

  • children under the age of 5 yr (this group is massively present in burn units if we consider their proportion in the Belgian population)

  • young adults aged between 21 and 30 yr

Age (yr) Number Percentage
0-4 401 10.4
5-10 402 9.4
11-20 576 14.2
21-30 901 22.2
31-40 702 17.3
41-50 425 10.4
51-60 293 7.3
>60 289 7.6
Unknown 50 1.2
Total 4038 100.0

Table V - Distribution of burn accidents by age

Prevention efforts for schools

We distribute brochures with numerous prevention recommendations and we present slides and videos. For little children (3-5 yr) we use a puppet theatre and try to teach entertainingly. We show slides suitable for young children, representing comic characters in a variety of dangerous situations.
We teach children to light matches safely, i.e. away from the body. It is not a good idea to forbid them to use matches - it is better to teach them how to do so properly.
We teach not only schoolchildren but also members of associations, etc.

Dangers in the kitchen

Analysis of the immediate causes of burn injuries indicates that the great majority of patients are burned by hot liquids. In our experience, hot water is the primary cause, being responsible for 46% of cases, followed by hot oil, hot coffee, tea, and soup.
Of these burns caused by hot liquids, 35% of cases occur in girls aged under five years. Also in the male population scald burns are very frequent in boys aged less than five years (44%). This is because at this age children are still crawling and are in the habit of pulling things off tables (especially in the kitchen).
More than 50% of domestic burn injuries occur in the kitchen. A good safeguard is to prevent children from entering the kitchen by putting a small fence across the doorway. It is especially dangerous when parents start cooking or boiling food. The pan must always be placed on the cooking-range with the handle pointing inwards, and preferably the hot plates at the back should be used.
Oven fronts become very hot on the outside and it is therefore recommended that eye-level ovens should be fitted.
Deep-frying pans must always be kept away from children; they must never be put on the ground after use.
Coffee-makers present no danger when the coffee filter is fixed in the machine. However, if it is separate, they turn over very easily. A redesign of coffee filters led to a decrease in the number of coffee scalding injuries in Denmark and the Netherlands.
A tablecloth on a table is tempting for a child to pull at, and if there are hot fluids on the table there is considerable risk of severe scald burns.
Never use too many plugs in the same power-unit, and don't use more than one extension cord. Beware of power points.
When children are eating or drinking something hot, they should sit at table. Don't let them walk around!

Dangers in the bathroom

Water can be a nice toy for a baby - but not when it is hotter than 37 OC. The best burn prevention measure is never to leave a child alone in the bathroom - even when the phone rings! In many households the hot water temperature is around 60-65 'C, enough to produce a full-thickness burn in as little as 2 to 5 seconds of exposure.
Reducing the hot water temperature to 55 'C or less decreases the risk of burn injury, since at 55 "C it takes at least 30 seconds of exposure for a full-skin thickness burn to occur. It is important to have a thermostat in the waterheater so that the temperature can be regulated.
Don't use electric equipment when the bath is full of water, as this increases the potential risk of electrocution.
When you take a bath, first fill it with cold water and then hot. This is less dangerous and has the added advantage of not steaming up the bathroom mirror.
Teach your children the difference between cold blue) and hot (= red).

Conclusion

There is a need for general awareness of burn risk. This can be achieved through education of the public with special emphasis on the importance of careful parental supervision of children.
Safety training is an absolute necessity and several Belgian associations and centres have specialized in burn prevention:

  • National Foundation for Assistance to the Severely Burned

  • Belgian Association for Burn Injuries - all six burns centres in Belgium are members

  • Youth and Health Insurance Company (co-organization for our European Burn camp)

  • Burn Units (six in Belgium)

It is important to promote ongoing information campaigns as those who have recently become parents may not be aware of the dangers to which their children are exposed.

 

RESUME. La Belgique a une population de 10 millions de personnes, dont 120.000 (1,2%) subissent annuellement des brûlures. De ces patients 10.000 (0, 1 %) sont hospitalisés dans une polyclinique ou un centre de brûlés; 800 de ces patients sont traités dans un des six centres spécialisés qui existent en Belgique. Tous les ans environ 150 patients meurent à cause de leurs brûlures. Depuis les premières années quatre-vingts le numéro annuel des cas de brûlures reste presque inchangé. D'ici à 2000 nous prévoyons une grosse augmentation des mesures pour la prevention des brûlures (par exemple, les détecteurs de fumée) et aussi une sensibilisation croissante de la population cible (par exemple, à travers des campagnes des média). Il faut espérer que nous verrons une réduction de la fréquence des brûlures. De tous les accidents qui provoquent des brûlures, 70% se produisent dans la maison. Les enfants d'âge préscolaire (2-5 ans) constituent un groupe très vulnérable en Belgique. Il faut augmenter la conscience collective du problème à travers l'éducation de la population afin de souligner l'importance de la surveillance des parents, qui doivent le plus possible éviter que les enfants entrent dans la cuisine, pour prévenir les accidents qui s'y produisent en numéro significatif. Il est très important d'organiser des campagnes permanentes d'information parce que les nouveaux parents peuvent ignorer les dangers auxquels leurs enfants sont exposés. La formation à la sécurité est une nécessité absolue et par conséquent il y a en Belgique plusieurs organisations et centres spécialisés dans la prévention des brûlures. Les Auteurs décrivent quelques précautions pratiques et une vidéo-campagne.


BIBLIOGRAPHY

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This paper was presented at the
Ninth Meeting of the Mediterranean Club
for Burns and Fire Disasters in
Tunis in May 1996.

Address correspondence to: Ms Sandra Hendrickx
Burn Care Unit, University Hospital
Gasthuisberg, 3000 Leuven, Belgium
Tel.: +3216.348721, Fax: +3216.348723




 

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