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ORIGINAL ARTICLE
Year : 2017  |  Volume : 25  |  Issue : 1  |  Page : 72-75

Burn injury in infants and toddlers: Risk factors, circumstances, and prevention


Department of Plastic surgery, Guru Gobind Singh Medical College, Faridkot, Punjab, India

Date of Web Publication13-Dec-2017

Correspondence Address:
Dr Sonal T Lal
H.no 21, Medical Campus Sadiq Road Faridkot Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijb.ijb_14_17

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  Abstract 

Aim: To study the risk factors and circumstances of burn injury in infants and toddlers.
Materials and Methods: A retrospective study was conducted on children visiting the plastic surgery department with acute burns or postburn deformities in the year 2016. The children who sustained burns up to an age of 3 years were included. An analysis of data for their age, sex, type of burn injury, involved body part, seasonal variation, place of occurrence, time of the day, presence of guardians at the time of injury, and socioeconomic status was performed.
Results: A total of 44 children were included in the study. Thirty-one were males and 13 were females. The majority of children (77.3%) belonged to the toddler age group (1–3 years). Scald was the most common burn injury (54.5%). The majority of burns (68.2%) were sustained in winters. Burns were most frequent in domestic settings (90.9%). 64.1% were kitchen accidents. Hands were the most commonly affected anatomical site (54%). Ninety percent of the burnt children belonged to low socioeconomic strata.
Conclusion: Pediatric burns were seen more commonly among toddlers. Scalds were the most common form of burns. Male gender, domestic environment, winter season, and low socioeconomic strata were found to have an increased frequency of burns. Hands were the most commonly affected site. Focused burn prevention strategies consistent with local circumstances should be implemented for the prevention and better management of pediatric burn injuries.

Keywords: Infants, pediatric burn injuries, scald, toddlers


How to cite this article:
Lal ST, Bhatti DJ. Burn injury in infants and toddlers: Risk factors, circumstances, and prevention. Indian J Burns 2017;25:72-5

How to cite this URL:
Lal ST, Bhatti DJ. Burn injury in infants and toddlers: Risk factors, circumstances, and prevention. Indian J Burns [serial online] 2017 [cited 2018 May 23];25:72-5. Available from: http://www.ijburns.com/text.asp?2017/25/1/72/220651


  Introduction Top


Burn injury in children is a major health problem around the world. Pediatric burn injury constitutes about one-fourth of the total burn accidents in India.[1] Postburn disfigurement and disabilities in children are considerable to an extent of denial of social acceptance and inability to lead a productive life. Burn injuries in children are the results of behavior that can be closely related to developmental stages.[2] Children sustain burn injuries in varieties of ways in many domestic settings. A child under 3 years is too young to recognize the hazards in the vicinity and be responsible for sustaining the burn injuries, so an identification of the risk factors leading to injuries is important. An understanding of the associated risk factors and the circumstances of injury enables better assessment and ultimately prevention of burn injuries.


  Materials and methods Top


Forty-four children, up to 3 years of age, with a history of sustaining burns, with acute burn injury, or with some form of postburn disfigurement and deformity visited the plastic surgery department in the year 2016 for surgical correction. A record of detailed history of the circumstances leading to the burn injury of children was noted. Children were divided into two groups based on their ages: 0 to ≤1 year (infants) and 1–3 years (toddlers). Injuries were classified as scalds, contact, flame, and electrical burns. The data were analyzed for gender, socioeconomic strata, involvement of the body part, place, and time of occurrence, seasonal variation, and presence of parent/guardian nearby at the time of incident.


  Results Top


In the study, out of 44 children, 31 were males and 13 were females (M:F, 2.38:1) [Figure 1]. Male predominance was in both the age groups. The age group ranged from 1 day to 3 years. The majority of children (77.3%) belonged to the toddler age group and 22.7% were infants. The most common cause of burns was scalds, accounting for 54.5% followed by flame burns (22.7%), contact burns (11.4%), and electrical burns (11.4%) [Figure 2]. Most of the burn injuries were seen in winter season (68.2%). Scalds were the most frequent cause of burn in winters. Burn incidents occurred more frequently in morning between 7 AM and 10 AM and evening between 4 PM and 8 PM [Table 1]. 90.9% of the burn injuries occurred in domestic settings, out of which 64.1% were kitchen accidents [Figure 3]. 87.5% of the domestic accidents occurred at the home of the burnt child and the remaining 12.5% occurred at others home usually in the neighborhood. Forty-four children with burns had the involvement of 68 distinct anatomical sites of injury. Hand burn injury was the most common (54%) [Figure 4]. A guardian was directly supervising the child in 56.8% of the cases. Out of this, a parent (usually mother) was present in 52% of the cases. Most of the families (90%) belonged to low socioeconomic strata.
Figure 1: Gender distribution

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Figure 2: Type of burns

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Table 1: Distribution of burns by causes, seasons, time, and place of burns

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Figure 3: Place of burn injury

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Figure 4: Distribution as per anatomical site

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  Discussion Top


Burns are the frequent cause of injury among children. Pediatrics burn injury can lead to severe physical, social, and psychological impairment. Burn injury results in longer hospitalization and a substantial cost of treatment. Pediatric burn injury can be more severe in comparison to the adults, because the skin is thinner. Even trivial burns in children can lead to dense scarring and contractures.

The data were collected for 44 children with any form of burn injury or postburn deformities, who had sustained burns up to the age of 3 years. Ten were infants and 34 were toddlers. Injuries in children can be a result of their exploratory behavior. Toddlers are seen to have the highest rate of injury, because they are becoming mobile and actively searching their environment and readily encounter hazards in the home.[2] This age group has been reported to be most vulnerable to burns in other studies also.[3],[4],[5],[6] When motor skill development outpaces cognitive development, disaster may result.[7],[8] In the study, there were 31 males and 13 females (M:F, 2.38:1). Male predominance was present in both the age groups. Male predominance is also reported in other studies.[9],[10],[11]

Burn injury sustained can be thermal contact burn from hot object, hot liquid (scalds) and fire, electrical burns, chemical burns, and friction burns. In the study, thermal burns were the most common (88.6%), out of which, scalds (54.5%) were the most common, followed by flame burns (22.7%) and contact burn (11.4%). Most of the pediatrics burn injuries are due to hot liquid.[12],[13] Scalds were caused by hot water, hot tea, or milk. Young children sustain burn injuries usually due to their curious behavior and unsteady moves. Children sustained thermal burns at home by touching and overturning vessels containing hot liquid, pulling handles or tubing in kitchen, or exposure to water being heated for bathing in the house courtyard. After scalds, flame burns were common. In most of the cases, kitchens were small and cooking occurred at ground level (64%). Flame burns were caused by the flame of the gas stoves kept on the floor, bed sheet catching fire due to mosquito coil kept under the bed, and falling in the fire made on roadside during winters. Electric contact burns (ECB) were sustained by five children (11.4%). ECB was seen mostly in toddlers, perhaps associated with their inquisitive behavior.

Different studies have reported variable frequency of the involvement of different anatomical sites.[14],[15] Hands have been reported to be frequently injured by burns.[7],[16] In this study also, hands were the most common site involved (54%). It was also noted that the involvement of hands was most common irrespective of the type of burns. This may be associated with the exploring behavior of children by touching the objects in their vicinity. The majority of burns (68.2%) occurred during winter season. Other studies too have shown increased incidence during winter season.[9],[10],[11] These increased burn injury occurring in colder season may be explained by the need of more heating in the form of hot beverages, hot water for bathing, and open camp fire. Children easily tend to sustain burn by hot liquid, touching hot object, or by falling in fire.

Approximately 90% of the burns are caused by household accidents.[1] We also noted that the majority (90.9%) of burns occur at home. In relation to home environment, most of the burns occur in the kitchen involving food preparation and meal times.[7],[17] In our study also, the majority of burns (64.1%) occurred in kitchen. Most of the thermal burns were sustained between 7 AM and 10 AM and between 4 PM and 8 PM, which correlate with the time of cooking food or preparation of hot beverages in the kitchen. In this study, 56.8% of the children were accompanied by a guardian during the time of injury. Out of this, in 52%, a parent was present and in the remaining, grandparents or other house members were present. Injury may occur while under supervision of one or both the parents.[17] Most of the families (90%) belonged to low socioeconomic strata. The average family size was six. One family had 15 members. The majority of fathers (82%) were manual laborers followed by farmers and factory workers. Most of the mothers (75%) were housewives and the rest were either manual laborers or factory workers.Usually the pediatric burns are nonfatal but the calamitous consequences of injury are possible for child as physical disabilities and psychological disturbances, as well as for the family in the form of significant investment in time and finances.[17] The fact that most of the pediatric burns occur at home provides opportunities for its prevention.[18] To prevent kitchen accidents, which is the most common in pediatric burns, the parent should be advised to keep the children away from the kitchen during food preparation. The avoidance of ground level cooking, securing the hanging electric cords or table cloth which can be easily grasped and pulled, and turning the pot handles away from edges of the shelves should be performed.[8],[19] For prevention of electric burn to children, measures such as covering the electric outlet with plastic covers and fixation of any loose electric wiring should be performed. Most of the pediatric burn injuries are preventable. The onus of prevention lies totally with the parents/guardians. More than carelessness, these accidents occur due to the lack of the awareness of the elders. The mere presence of the parent/guardian does not prevent burn, because injury may occur even during the supervision of the elders. The parent should be offered education about the prevention of pediatric burn. Campaigning should be conducted to identify the population at risk and methods should be devised to educate these people. Spreading awareness through social and print media such as television, radio, press, and posters is required. Education about the prevention of burn injury should be given at school so that the elder siblings can take care of the younger ones. Effective pediatric burn prevention programs should be established to acknowledge the parent/guardian and child education and awareness about hazard reduction.


  Conclusion Top


Burns are a major cause of morbidity and mortality in children. Burn injury usually results from a child’s exploratory and curious behavior and inability to understand the hazards. Most of these injuries occur at home and are preventable. Simple preventive measures can help to eliminate pediatric burn injuries. The most effective way is public education.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Sharma RK, Parashar A. Special considerations in burn patients. IJPS 2010;43:43-50.  Back to cited text no. 1
    
2.
Toon MH, Maybauer DM, Arceneaux LL, Fraser JF, Meyer W, Runge A et al. Children with burn injuries – Assessment of trauma, neglect, violence and abuse. J Inj Violence Res 2011;3:98-110.  Back to cited text no. 2
    
3.
Ramakrishnan KM, Sankar J, Venkatraman J. Profile of pediatric burns Indian experience in a tertiary care burn unit. Burns 2005;31:351-3.  Back to cited text no. 3
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4.
Van Niekerk A, Rode H, Laflamme L. Incidence and patterns of childhood burn injuries in the Western Cape, South Africa. Burns 2004;30:341-7.  Back to cited text no. 4
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Goldman S, Aharonson-Daniel L, Peleg K, Israel Trauma Group (ITG). Childhood burns in Israel: A 7-year epidemiological review. Burns 2006;32:467-72.  Back to cited text no. 5
    
6.
Den Hertog PC, Blankendaal F, ten Hag SM. Burn injuries in the Netherlands. Acid Anal Prev 2000;32:355-64.  Back to cited text no. 6
    
7.
Drago DA. Kitchen scalds and thermal burns in children five years and younger. Pediatrics 2005;115:10-6.  Back to cited text no. 7
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8.
Libber SM, Stayton DJ. Childhood burns reconsidered: The child, the family, and the burn injury. J Trauma 1984;24:245-52.  Back to cited text no. 8
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9.
Mukerji G, Chamania S, Patidar GP, Gupta S. Epidemiology of paediatric burns in Indore, India. Burns 2001;27:33-8.  Back to cited text no. 9
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Gupta M, Gupta OK, Goil P. Paediatric burns in Jaipur, India: An epidemiological study. Burns 1992;18:63-7.  Back to cited text no. 10
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Ying SY, Ho WS. An analysis of 550 hospitalized pediatric burn patients in Hong Kong. J Burn Care Rehabil 2001;22:228-31.  Back to cited text no. 11
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Palmieri TL, Alderson TS, Ison D, O’Mara MS, Sharma R, Bubba A et al. Pediatrics soup scald burn injury: Etiology and prevention. J Burn Care Res 2008;29:114-8.  Back to cited text no. 12
    
13.
Agran PF, Anderson C, Winn D, Trent R, Walton-Haynes L, Thayer S. Rates of pediatric injuries by 3-month intervals for children 0 to 3 years of age. Pediatrics 2003;111:683-92.  Back to cited text no. 13
    
14.
Chen WD, Yin SL. [Etiology of 375 paediatric burns]. Guangzbou Yi Yao 2002;33:44-6.  Back to cited text no. 14
    
15.
Xie J, Zhang XL, Zhang LB, Shen XY, Li HW, Wang N. [Epidemiological investigation on hospitalized paediatric burns in Ma Gang Hospital between 1998 and 2002]. Ji Bing Kong Zbi Za Zbi 2005;9:181-2.  Back to cited text no. 15
    
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Iqbal T, Saaiq M. The burnt child: An epidemiological profile and outcome. J Coll Physicians Surg Pak 2011;21:691-4.  Back to cited text no. 16
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Natterer J, de Buys Roessingh A, Reinberg O, Hohlfeld J. Targeting burn preventions in the paediatric population: A prospective study of children’s burns in the Lausanne area. Swiss Med Wkly 2009;139:535-9.  Back to cited text no. 17
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18.
Benjamin D, Herndon DN. Special considerations of age: The pediatric burned patient. In: Herndon DN, editor. Total Burn Care. 2nd ed. London: W.B. Saunders; 2002. p. 427-38.  Back to cited text no. 18
    
19.
D’Souza AL, Nelson NG, McKenzie LB. Pediatric burn injuries treated in US emergency departments between 1990 and 2006. Pediatrics 2009;124:1424-30.  Back to cited text no. 19
    


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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
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