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,
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.
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 childs 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 Childrens 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. Létiologie des brûlures est décrite. Un seul cas a été soumis à lattention du Département des Services Humains. Un programme de sensibilisation a été activé.
|This paper was received on 6 June 2001.
Address correspondence to: Dr. D.A. Berlin, Department of Surgery, Albert Einstein Medical Center, Philadelphia PA, USA.