Intended for healthcare professionals

Editorials

Preventing scalds to children

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7006.643 (Published 09 September 1995) Cite this as: BMJ 1995;311:643
  1. Alison Kemp,
  2. Jo Sibert
  1. Senior lecturer Professor of community child health Department of Child Health, University of Wales College of Medicine, Llandough Special Children Centre, Llandough Hospital and Community NHS Trust, Penarth CF64 2XX

    Requires environmental modification and work with and by families

    Scalds are among the most distressing injuries that a child can receive. Although they rarely kill, they cause considerable pain, often need prolonged treatment, and often result in lifelong scarring. This scarring and deformity may result in considerable emotional difficulties that can affect the child's whole life. Clearly, prevention is preferable to treatment.

    Eadie and colleagues at the Welsh Centre for Burns and Plastic Surgery have compared the patterns of scalds in 1956,1 1984,2 and 1991.3 Sadly, the numbers of scalds to children at the Welsh centre has not fallen, although the pattern of these injuries has changed. Hot water from teapots caused a fifth of the injuries in 1956 though only very few cases in 1991. Hot liquids from cups, however, now cause almost half the scald injuries, compared with less than one in 10 cases 35 years ago—reflecting current fashions for making hot drinks with instant coffee and tea bags in cups rather than in pots. Scalds from hot water in kettles and baths have also risen.

    Scalds to children are mainly a problem in the under 5s and those living in deprived circumstances.1 None of the three papers mentions abuse as a cause of scalds to children,1 2 3 although we know that this occurs.4 Recognising non-accidental scalds is difficult and has caused controversy in the past.

    Why have we been unsuccessful in reducing these scalds? Prevention of injury needs clear analysis of the epidemiology of the problem and possible preventive strategies. These then need to be piloted and evaluated.5 Modification of the child's environment is more likely to be successful than education.6 We cannot evaluate to what extent safety education has prevented the incidence of childhood scalds rising further. All those working with families need to continue to advise on routines and measures that are likely to reduce scalds in the home. Adopting a safe community programme may be the best approach and has proved successful in Sweden7: it empowers people to recognise hazards and introduce their own safety agenda. Evaluating these programmes is essential.

    The commonest scalds, those from cups, present particular difficulties in prevention. It is difficult to see how an environmental solution such as a specially designed cup would be practicable or acceptable. More encouragingly, environmental modification may prevent scalds from kettles and baths. The usual mechanism of a scald from a kettle is the child pulling the flex that overhangs the work surface. A coiled or short flex should prevent this, and recently European Consumer Standards have limited the length of flexes to no more than 75 cm.

    Most scalds from baths are caused by children falling in the water.4 Reducing the temperature of tap water entering the bath should prevent these scalds. Although standards for gas and electricity recommend 60°C maximum for thermostats, many households have water temperatures above 60°C.8 Even at this temperature a partial thickness burn to a child will result in 10 seconds.9

    Considerable resistance to altering thermostats may exist among consumers. For example, a study in New Zealand evaluated an educational programme to reduce the temperature of water from hot taps in homes.10 It found that the water temperature fell significantly in the study population but in most households the temperature still exceeded 55°C. A more acceptable solution might be the use of thermostatic mixer taps for the bath, set at 43°C. NHS Estates has accepted this,11 although high cost may militate against more widespread introduction of these taps.

    Preventing scalds to children remains a challenge. It needs an approach combining ergonomic design, building regulations, and safety standards together with complementary work with and by families. Let us hope that this approach produces more progress in future than has occurred in the past.

    References

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