Annals of Burns and Fire Disasters - vol. XIV - n. 4 - December 2001

IRON BURNS IN CHILDREN UNDER SIX

Berlin D.A.,¹ Hughes W.B.²

¹ Department of Surgery, Albert Einstein Medical Center, Philadelphia PA, USA
² Director Burn Center, Temple University Hospital, Philadelphia

SUMMARY. Contact burns are a very common cause of injury in children. We have reviewed the medical records of 119 children under six years of age seen at Temple Burn Center over a 15-month period. Twenty-seven children (23%) had contact burns from curling or clothes irons. The aetiology of the burns is presented. Only one case was investigated by the Department of Human Services. An awareness programme was also started.

Introduction

Although the majority of burn injuries in children are due to scalds, contact burns are surprisingly common. Curling and clothes irons are readily accessible by toddlers in most households. The aim of this study was to review our experience with iron burns in children under six, identify common denominators, and review preventive measures. The literature was also reviewed to compare our experience with those of other burn centres.

Patients and methods

The medical records of 119 children treated at Temple University Hospital Burn Center over a period of 15 months were reviewed. Data gathered included patient’s age, gender, burn location, and burn aetiology. Patients requiring a skin graft, admission, or referral to the Department of Human Services (DHS) were also noted.

Results

Twenty-seven children (23%) had sustained burns from irons (clothes or curling). Ages ranged from two months to five years old. The majority of patients fell into the 1-2 year old category (5 patients, < one year; 15 patients, 1-2 years; 3 patients, 2-3 years; 4 patients, 3-5 years). The male to female ratio was 16:11. One child was admitted, one child was grafted, and one child was referred to DHS. The percent of total body surface area burned ranged from 1-3% (26 patients) and 8% (1 patient).

Burn locations varied with age group. In the < 1 year group, burns were noted on the arm, foot, hand, face, and chest. In the 1-2 year age group, the majority of burns were noted on the hand (9 patients) (Fig. 1), with the leg second in frequency (5 patients), followed by the arm (1 patient), face (1 patient), and buttock (1 patient). Two children sustained injuries in more than one body area. In the 2-3 year age group, injuries were on the arm (1 patient), hand, and foot (1 patient), and chest, abdomen, chin, and arms (1 patient). This last child “wrestled” with the iron as it was falling from a table. In the last age group (3-5 years) body area was evenly distributed at thigh, arm, legs, and foot with one patient each.

There were various mechanisms of the burn injuries. The majority of injuries occurred from the patients pulling down hot irons from a table or ironing board (nine patients). Eight patients were injured from grabbing an iron. Four patients came into contact with the iron while it was on the floor. In the remaining six patients, two mechanisms were unknown, two patients rolled off a bed onto an iron, and two patients got burned by an iron held by another child.

Discussion

Contact burns secondary to a hot clothes or curling iron form a significant percentage of thermal injuries in children under six. Although the total body surface area burned is minor, the area burned is usually functionally significant (hand, arm, leg).

In reviewing the literature, two articles were found that addressed contact burns in children. In Batchelor et al.’s study,1 12/26 (43%) of their patients had hot iron contact burns in children < 5 years old admitted to the Burn Unit at Stoke Mandeville Hospital (1987-1992). The majority of patients were injured secondary to a clothes iron being left unattended on the floor or a low table. They found that for hand burns the dorsum of the hand was burned more frequently than the palmar surface. In their study, 58% of their patients’ burns were grafted, and no significant associated factors were noted (social class, single parent, race, large family).1

Brown et al.2 from Shriners Burns Institute in Cincinnati reviewed the medical records of 82 patients treated in 1987-1993. They found that the majority were males < 2 years old. In their study, the palmar more than the dorsal surface of the hand (72/28) was involved. Fifteen per cent required full-thickness skin grafts and 10% incurred hypertrophic scarring or contractures. Significant factors were identified to include low income, single child, and single parent. Aggressive physical therapy was initiated in all cases.2

In our facility, all patients are treated with a comprehensive team approach. Our burn team includes physicians and nurse, physical and occupational therapists, a registered dietitian, and a social worker. In this study, only one case (3.7%) was referred to DHS for investigation of abuse. In a study by Brown et al., 7% of their cases were referred to DHS. Banco et al. referred 7.3% of their patients to DHS.3

Toddlers aged 1-2 with both mobility and curiosity are particularly vulnerable to iron burn. As they learn to walk and become more mobile, they knock down irons from tables or they pull their cords, resulting in the iron falling on them.

Education to preven burns must include the dangers of leaving hot irons and children unattended. This can be accomplished by encouraging parents to unplug irons when not in use, and safely store the iron and the cord out of the child’s reach, and also not to leave irons on the floor or low tables. Other authors1 recommend iron manufacturers to attach “keep out of the reach of children” labels to irons, and the development of a thermo-protective box in which to place irons. Brown et al.,2 suggests nine preventive measures, including that parents become more “accident-conscious” and use an ironing board instead of low tables or the floor. The Temple Burn Center along with Temple Children’s Medical Center has developed an awareness programme through the local media to address these issues.

RESUME Les brûlures causées par le contact sont une cause très commune de lésions chez les enfants. Les Auteurs présentent les données médicales de 119 enfants âgés moins de 6 ans traités dans le Temple Burn Centre pendant une période de 15 mois. Vingt-sept enfants (23%) présentaient des brûlures par contact causées par des fers à repasser ou à friser. L’étiologie des brûlures est décrite. Un seul cas a été soumis à l’attention du Département des Services Humains. Un programme de sensibilisation a été activé.

Bibliography

1. Batchelor J.S., Vanjar S., Budny P., Roberts A.H.N.: Domestic iron burns in children: a cause for concern? Burns, 19: 74-5, 1993.
2. Brown R.L., Greenhalgh D.G., Warden G.D.: Iron burns to the hand in the young pediatric patient: A problem in prevention. J. Burn Care Rehabil., 18: 279-82, 1997.
3. Banco L., Lapidus G., Zavoski R., Braddock M.: Pediatric Emergency Care, 10: 98-101, 1994.