Prevention

About 75 percent of all burn injuries in children are preventable. Most common are scalding injuries that take place in the home, both in the bathroom from too-hot tub water and in the kitchen. An average of nine children aged 14 and under die from scald burn-related injuries each year; children aged four and under account for nearly all of these deaths. And yet more than 75 percent of all scald burn-related injuries among children aged two and under could be prevented through behavioral and environmental modifications.

Water heater safety To reduce the risk of injury to children from hot water scalds, which are the most common type of burn injuries in children, the hot water heater should be turned down to no more than 120°F, which should provide plenty of hot water for normal household activities. At 130°F, a serious burn can occur in 30 seconds. At 140°F, only five seconds are required. The time may be reduced by 50 percent or more for children under age five.

Gas water heaters can be adjusted easily, but electric water heaters need to be disconnected from the electricity and have the cover plates removed in order to adjust the thermostat. After the thermostat is turned down, the temperature should be checked 24 hours later by running the hot water to make sure the temperature is low enough to be safe.

Many communities have established local ordinances or building codes which require the installation of anti-scald plumbing devices in all new construction. Such legislation has been effective in reducing the number of scald burn deaths and injuries associated with hot tap water.

Bathroom Hot tap water accounts for nearly one-fourth of all scald burns among children and is associated with more deaths and hospitalizations than other hot liquid burns. Tap-water burns most often occur in the bathroom and tend to be more severe and cover a larger portion of the body than other scald burns.

The water in a child's bath should never be warmer than 100°F. Parents should run cold water into the tub first, adding hot water later to reach a safe temperature. This will prevent a scald burn if the child should fall into the tub while it is being filled. Before placing a child into the bathtub, parents should check the temperature of the water by moving a hand through the water for a few seconds. if the water feels hot, it is too hot for the child. The child should be faced away from the faucets at the other end of the tub. Most hot tap water scalds happen in the bathroom, so even with the water turned down, parents should never leave a small child unsupervised in the tub.

Pressure balancing, thermostatically controlled shower and tub valves that reduce the water temperature to 115°F or less can help prevent scalding injuries. These valves can be attached to the bathtub fixtures, installed in the wall at the bathtub, or connected at the water heater. Temperature-controlling valves vary in cost and installation requirements and can be purchased at some hardware stores or through plumbers.

Kitchen safety The second most common place for burn and scald injuries is the kitchen. There are a number of safety measures parents should take to protect their children:

• Saucepan handles should be turned toward the back of the stove.

• Hot drinks should be kept away from the edge of the table; a drink heated to 140°F can cause a burn in five seconds and at 160°F, a burn will occur in one second.

• Back burners should be used whenever possible.

• Tablecloths should be avoided if toddlers are in the home. If a child tries to pull himself up by the tablecloth, a heavy object or hot liquid on the table could fall on the child.

• All hot items should be kept near the center of the table to prevent a young child from reaching them.

• While someone is cooking, young children should be kept in a high chair or playpen, at a safe distance from hot surfaces, hot liquids, and other kitchen hazards.

• Deep fat (oil) cookers/fryers should be used with caution when young children are present. The fat or oil may reach temperatures over 400°F, hot enough to instantly cause a very serious burn.

• Ground fault circuit interrupter receptacles should be placed near sinks and other wet areas.

• Appliance cords should be kept away from the edge of counters and unplugged when not in use. A dangling cord is dangerous because it can get caught in a cabinet door or be pulled on by a curious child.

• Snack foods should be stored away from the stove area so children will not be tempted to reach across a hot burner.

• Parents should establish a "safe area" in the kitchen where a child can be placed away from risk but under continuous supervision. Parents should establish a "no zone" directly in front of the stove marked with yellow tape or a piece of bright carpet and teach children to avoid this area.

Microwave safety The vast majority (95 percent) of microwave burns among children are scald burns. Microwave burns are typically caused by spilling hot liquids or food, and injuries are primarily associated with the trunk or the face. Children should be careful when removing a wrapper or cover from a hot item, since hot steam escaping from the container as the covering is lifted can cause a burn. When liquids are heated in the microwave, the containers may feel only warm rather than hot. cooking some foods in the microwave is more likely to result in scald burns unless very specific precautions are taken. children should check the microwave oven manual for specific instructions for cooking eggs, squash, potatoes, and eggplant.

In addition, food can heat unevenly in a microwave oven, which can cause serious mouth burns. For example, the jelly in a jelly-filled pastry may be scalding while the pastry itself is only warm. Frozen foods may be cold or only warm in one spot and scalding in another. children should use caution and follow directions when popping popcorn in the microwave, since the vapor produced in the bag may exceed 180°F.

When heating foods for a young child, parents should check the temperature by sampling the food before allowing the child to eat it. Heating baby formula or milk in bottles with disposable plastic liners may be risky, because the liner may burst. Using a baby bottle warmer is a safer way to heat baby bottles. Parents should not hold a child while removing items from the microwave. children should be kept at a safe distance from the microwave oven.

As a general rule, only those who have read and understand the directions should use the microwave oven. This means that children under age seven may be at risk, unless they are closely supervised. Even children over seven must be properly supervised and taught microwave safety. A child's height is important to consider when allowing microwave use. children should be tall enough that their faces are not directly in front of the microwave heating chamber when the door is open.

Smoke alarms Smoke alarms are extremely effective at preventing fire-related death and injury; the chances of dying in a residential fire are cut in half if a smoke alarm is present. In fact, smoke alarms and sprinkler systems combined could reduce fire-related deaths by 82 percent and injuries by 46 percent. For this reason, many states have laws requiring smoke alarms in new and existing dwellings.

Smoke alarms should be installed in the home on every level and in every sleeping area. They should be tested monthly, and batteries should be replaced at least once a year (or at the beginning and end of daylight savings time). The alarms themselves should be replaced every 10 years. Ten-year lithium alarms are also available and do not require an annual battery change.

Flammable sleepwear To prevent burn injuries, the U.S. Consumer Product Safety Commission (CPSC) recommends that parents make sure their children's sleepwear is either flame-resistant or snug-fitting. Loose-fitting T-shirts and other clothing made of cotton or cotton blends should not be used for children's sleep-wear, since these garments can catch fire easily, burn rapidly, and are associated with nearly 300 emergency-room-treated burn injuries to children each year.

children are most at risk for burn injuries from playing with fire (matches, lighters, candles, or burners on stoves) just before bedtime and just after getting up in the morning. For this reason, cPSc requires hangtags and permanent labels on snug-fitting children's sleepwear made of cotton or cotton blends to remind consumers that because the garment is not flame-resistant, it must fit snugly for safety. Parents should look for tags that say the garment is flame-resistant or snug-fitting.

Flame-resistant garments are made from inherently flame-resistant fabrics or are treated with flame retardants and do not continue to burn when removed from a small flame. Snug-fitting sleepwear is made of stretchy cotton or cotton blends that fit closely against a child's body. Snug-fitting sleepwear is less likely than loose T-shirts to come into contact with a flame and does not ignite as easily or burn as rapidly because there is little air under the garment to feed a fire.

cPSc sets national safety standards for children's sleepwear flammability to protect children from serious burn injuries if they come in contact with a small flame. Under federal safety rules, garments sold as children's sleepwear for sizes larger than nine months must be either flame-resistant or snug-fitting.

Fireworks More than 40 percent of people injured in fireworks accidents each year are under 14 years of age. In 1999 nearly 3,800 children aged

14 and under were treated in hospital emergency rooms for fireworks-related injuries. Boys are injured three times as often as girls, and boys between five and 14 years of age have the highest fireworks-related injury rate of all. Not surprisingly, those who are actively participating in fireworks-related activities are more often and more severely injured than are bystanders.

Most injuries occur at home during the July Fourth festivities. Fireworks-related injuries most frequently involve hands and fingers (40 percent), the head and face (20 percent), and eyes (18 percent), and more than half of the injuries are burns. in addition, fireworks can cause life-threatening residential fires.

Nearly two-thirds of fireworks-related injuries are caused by backyard, "class C" fireworks such as firecrackers, bottle rockets, Roman candles, fountains, and sparklers that are legal in many states. However, the most severe injuries are typically caused by "class B" fireworks, such as rockets, cherry bombs, and M-80s, which are federally banned from public sale. in spite of federal regulations and varying state prohibitions, class B and C fireworks are often accessible by the public. it is not uncommon to find fireworks distributors near state borders, where residents of states with strict fireworks regulations can take advantage of another state's more lenient laws.

Among class C fireworks, bottle rockets can fly into the face and cause eye injuries; sparklers can ignite clothing (sparklers burn at more than

1,000°F); and firecrackers can injure hands or face if they explode at close range. Children aged four and under are at the highest risk for sparkler-related injuries.

injuries may occur if the child is too close to fireworks when they explode; for example, when a child bends over to look more closely at a firework that has been ignited, or when a misguided bottle rocket hits a nearby person.

One study estimates that children are 11 times more likely to be injured by fireworks if they are unsupervised. Younger children often lack the physical coordination to handle fireworks safely, and they are often excited and curious around fireworks, which can increase their chances of being injured. Homemade fireworks can lead to dangerous explosions.

Cigarette lighters Disposable and novelty cigarette lighters were required to be made child-resistant in a 1994 mandatory safety standard by the CpsC. since this standard has been in effect, the number of child-play lighter fires has dropped 42 percent, and the number of deaths and injuries associated with these fires has declined 31 percent and 26 percent, respectively.

Burns United Support Group A support group for burn survivors and their families that provides support services and information on burn care and prevention. The group conducts educational programs and children's services and operates a speaker's bureau.

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