Tap water scald burns in children

Water Burns accounted for 7% to 17% of all pediatric burns requiring inpatient treatment.
Burns are usually severe and disabling.
Young children and preschool children are the most common victims.
In 45% of the injuries, tap water was opened by an unattended victim or companion;
In 28%, the reason was abuse.
Among the families tested, 80 of the families were unsafe with a bath water temperature of 54 °c (130°F)
Or larger, exposing occupants to the risk of a full-thickness burn exposed to hot water for 30 seconds.
By limiting the water temperature of the home to less than 52 °c (125°F).
New water heaters can be preset at this temperature, and families can be taught to reduce the temperature of existing equipment.
Materials and methods the emergency room monitors the computer database of the National Electronic Injury Monitoring System (NEISS)
The US Consumer Product Safety Commission deals with product-related injuries.
100 hospitals in the United States were surveyed.
The system searched for all burns in 18 tap water related product categories, as well as all other burns in children under 14 in 1975.
Data on age, gender, severity and national incidence were obtained.
Summary of hospital chart review of all burns admitted to Children\'s Orthopaedic Hospital and Medical Center (COHMC)
From 1963 to 1976, to the regional burn unit at the Harborview Medical Center (HMC)
1975 and 1976 were reviewed.
The charts of all patients who suffered from tap water injuries were examined in detail. (
Burns include all burns caused by contact with the thermal fluid;
\"Other Burns\" include all burns caused by liquid other than hot water that flows directly from the tap. )
In order to obtain random samples of other scalds for comparison, records of all scalded patients hospitalized at COHMC and HMC were examined in detail, with chart numbers ending at 3 or 7;
This resulted in 67 out of a total of 318 cases.
The household tap water survey evaluated 57 Seattle households in a household water temperature survey.
Of the 62 families in a rowto-
A door-to-door survey of a white middle-class community was conducted, with 31 families attending the survey and agreeing to be investigated.
26 of the 30 families selected from the Women, Infants and Children program are a pediatric clinic primarily for low-income services, and black families agree to participate in family surveys conducted by clinic outreach personnel.
Neither sample was randomly taken.
An adult from the family was interviewed to identify awareness of the risk of scalding with tap water and past preventive methods.
Check the water temperature in the bathtub using the Reotemp double-layer metal thermometer (
Reotemp instruments, Van Nuys, California)
Two minutes after opening the water or when the water temperature is stable, whichever comes first.
The water heater was checked to determine if it was adjustable.
During the pediatric rounds at COHMC, the pediatrician SURVEYA questionnaire was distributed to the participants, usually attended by approximately 100 primary care and hospital pediatricians.
They were asked what the temperature setting of the water heater should be in order to prevent injury.
32 participants, including 13 pediatricians, responded.
Other responses came from staff at the pediatric hospital, medical students and nurses.
Statistical methods, based on the classification of Hollingshead, determine the economic categories of inpatient and household samples from major family occupations (
A. B. unpublished data, 1956).
No education data.
The significance was determined by 2 × 2x2 test (χ21)and 2 × κ (χ2k−1)
Joint table, student two-sample t test, Wilcoxon rank sum (T1)
Correlation with the rank of Spelman with a normal approximation (rs)
In the right place
The value represented is mean ± 2 SDs with a probability greater than 0.
05 is not significant (NS).
Results according to the report of 89 tap water burns in 1975, NEISS concluded that there were 2473 tap water burns in the national emergency room that year; 543 (22. 0%)
Children under the age of 15 are involved.
Tap water scalds reported to NEISS are more extensive than other scalds and are more likely to lead to hospital admissions (
L g Desbordes, personal communications)(table 1).
25% of scalding with tap water involves a physical surface area of 32% or more and requires in-hospital treatment.
There is no final outcome data such as mortality for this sample.
All types of Burns are most common among young children and preschool children;
Other burns are more common among older children.
Of all the tap water burns, eight or eight were done before the age of 5, but only 60% were other Burns (fig 1).
View this table: on 1975, NEISS outpatients with 0 to 14 years old were burned. View inline View pop-up table 1 download new tabDownload powerpoint figure 1 age distribution of outpatients with tap water burns other scalpers reported to NEISS on 1975.
The average medical record review in hospital is 3.
6 patients with tap water burns,
From 1963 to 1976, other burns are hospitalized in COHMC each year.
During this time, the incidence of both Burns was constant.
2 More
During 1975 and 1976, 5 patients with scalding with tap water and 23 other scalding patients were hospitalized annually at HMC.
Due to the large and diverse geographical area of these institutions, the incidence of Burns that require emergency room care alone cannot be determined.
The age distribution of tap water and other hospitalized patients with burns is similar (fig 2)
The average age of the two groups was 19 months.
Gender, race and economic class are also similar.
Download figureOpen in new tabDownload powerpoint figure 2 age distribution of hospitalized pediatric orthopedic hospitals and medical centers for tap water burns and other burns from 1963 to 1976 (calculated by percentage and cumulative percentage) medical centers for the period 1975 and 1976.
Tap water burns are often more extensive than other burns, involving about twice the average body surface area; 12.
The tap water burns 5%, but only 1.
5% of other Burns involve a physical surface area of 40% or more.
This difference is reflected in the death rate of 12.
5% of the victims of tap water burns were 0.
3% of the other scalp.
When scalding tap water, the body part of the scalding is usually the presenting part.
If a child is placed in a hot tub, the hips, legs and hands are usually involved.
If the injury occurs under running water, scale the hips, feet, or shoulders proportionally.
\"Inventory\" and \"splash\" damage are common.
Scars usually involve the part of the body\'s clothing, while the foot is a common part of joint contraction.
In all burns, graft, fat scars, and joint contracture contractions are common (table 2).
View this table: View the inline View pop-up table 2 6 cases were diagnosed with the severity of Burns in the hospital of pediatric orthopedics and Harborview Medical Center, and 10 cases were strongly suspected.
In the analysis, these 10 cases were classified as abuse (table 3).
Abuse occurs twice as often in boys as in boys, and is more likely to be injured when an adult is in the same room as the victim, and when the victim is taken to medical treatment by someone other than the waiter.
When the medical treatment is delayed for more than two hours, the injury is more likely to be abusive (table 3).
Abuse has nothing to do with the degree of injury.
See this table: see inline View pop-up table 3 physicians of abusive patients in hospital often comment on major family disturbances such as long-term neglect, parents in prison, or ongoing divorce.
These cases are grouped in a non-
A specific category known as \"stress.
Since these comments are not sought by the pre-selected criteria, recognition depends on the efforts of the management caregiver to seek and record these events.
Many stressful families may not have been identified.
In the lower economic class, stress, injury and abuse are more frequent (table 4).
View this table: View inline View pop-up table 4 stress and abuse in hospitalized burn patients compared to occupational grade 45% of tap water burns the victim or the companion who opens the water, in 78% of the other burns, children can cause injuries.
In a scalding of tap water that an adult turns on water, 60% of it is abusive.
Tap water burns often occur in the bathtub or shower (74%)or sink (22%).
Coffee, tea and other foods account for 97% of other cattle.
All 11-month-old boys are the third child of the Korean war bride.
At 32 weeks of pregnancy, after his natural delivery in the toilet bowl, he was hospitalized for 40 days due to the condition of acute respiratory distress syndrome.
His mother attempted suicide several times after his birth.
When his mother put him in a portable plastic tub and only turned on the hot water, the boy\'s burn happened.
His father returned home after five hours of injury and took him to medical care.
The child had 35% degrees of second and third burns in the lower body.
Fracture of skull was also found.
Two transplants are required, resulting in shrinking joints and fat scars on the legs.
He was hospitalized for 73 days and was discharged from hospital under the care of his father\'s parents.
Case 26 a 23-month-old white girl left unattended in the bathtub and turned on the hot water.
Her father was not in the Army and her mother was receiving welfare assistance.
It is said that the hygiene conditions at home are very poor.
The child\'s legs below the thigh were burned 35% degrees.
She has been in hospital for 23 days.
Case 25 a 28-month-old girl soiled her diaper, her father was an unemployed logging worker with welfare assistance, and she rinsed her ass under a faucet in the bathroom sink
Although he thought he turned on the hot and cold tap, only the hot tap was running.
The child\'s hips, genitals and left thighs were burned 12% in grade 1 and 2.
She has been in hospital for 19 days.
No problems left.
The 11-month-old white boy playing in the bathtub fell and grabbed the hot water handle.
His parents \"found him in seconds\" and sustained 30% degrees and two degrees of burns on the back, sides, hips and lower left thigh.
He has been in hospital for 11 days.
No remaining problems occurred.
Case 14 mother (a nurse)
Among a 17-month-old white boy, the water heater temperature in their home increased because the water heater was \"too inefficient.
While the baby was sitting next to the kitchen sink, his mother heated his bottle under running water, he fell into the sink and suffered first and second Burns of 14% degrees on his neck and shoulders
He has been in hospital for six days.
No problems left.
Case 47 the 5-year-old siblings of a 17-month-old white boy put the toddler in the bathtub and became a \"mother\'s helper \".
The 5-year-old opened the hot water.
Toddlers have burns of 20% degrees and 5% degrees on their forearm, entire left and left lower legs.
He was hospitalized for 26 days.
A transplant and surgical treatment of scar contracture contraction is required.
The average household bath water temperature of 57 households was 61 ± 14 ℃ (142 ± 26°F)
Range from 32 to 76 °C (90 to 168°F)(fig 3).
The bath water temperature of the interviewed family exceeds 54 degrees Celsius (130°F)
, This will expose occupants to the risk of exposure to a full thickness burn of 30 seconds.
3 Water temperature is not relevant to the economic class, neighborhood sampling, previous efforts to adjust the water temperature, acquaintances of victims of previous tap water burns, children under the age of 5 at home, or hope scalding with tap water is a common problem.
There is no significant difference in the water temperature of households with electric water heaters or gas water heaters.
Similarly, the water temperature is not relevant to those families who are satisfied or dissatisfied with the quantity or temperature of hot water.
Figure 3 average water temperature of the home Bath (±2 SD)
Drawn on the duration curve exposed to hot water, this requires a full thickness burn of the adult skin at different water temperatures.
Adapted from Mortiz, Diana.
3 families generally do not know that tap water may be in danger or that the water temperature can cause burns.
When asked about the temperature required for one minute and one second exposure to hot water to cause burns, 22 out of 57 answered 59 ± 33 °c (138 ± 59°F)
29 people answered 66 ± 45 °c (151 ± 81°F)
38 to 100 °C (100 to 212°F), respectively.
The correct answer is 53 °C (127°F)and 70°C (158°F).
Of the 51 households that control the water heater, 3 consider the water heater to be adjustable, but only 23 try to adjust the water heater.
All checked heaters are adjustable.
The heater temperature adjusted by the local power company service team is usually 60 to 66 °C (140 to 150°F)
Heater with a maximum temperature of 76 °c (168°F)
They already checked.
12 of the 32 participants (37. 5%)
In the pediatric rounds, they replied that they would recommend a home water temperature higher than 54 °c (130°F);
Answers range from 41 °C to 74 °C (105 to 165°F).
In the context of more frequent food burns and flame burns, tap water burns seem to be a rare and insignificant problem.
But tap water accounted for 14. 3%1 and 16.
9% hospitalized patients with burns in the past Study 2.
Water caused 7.
4% of 1975 hospitalized patients and 14 of the NEISS scalding samples.
At present, 9% of the hospitalized scalding population.
If inpatient treatment is required, the mortality and incidence of tap water burns are higher than other burns.
Since 1971, a total of 44 patients have been admitted to the brook army hospital, with a mortality rate of 34%.
4 When curiosity, imitation or abuse causes the child to enter the hot water he cannot escape, tap water and other burns are most common among toddlers and preschool children.
The two oldest members in the inpatient tap water series (
1 case of severe cerebral palsy (9 years old) and 1 case of 12 years old (accompanied by incurable disease and anemia)
It is a typical pattern of scalding of tap water in adults, in which case the nerve, motor or mental disability is prone to injury.
It is noted that scalding with tap water is a pattern of child abuse.
The observation was confirmed by 28% of the abuse rates in the current study.
Since the water temperature does not change with the economic class, in the lower economic class, the frequency of injuries is higher, and there must be other reasons.
The victim or companion opened the water in 45% of the tap water damage.
Either the water temperature must be low enough to rule out the injury, or the person who takes care of the child must be constantly vigilant to prevent such injury.
In the case of an adult opening water, 60% of the damage is abusive.
For the rest of the time, adults are careless when checking the water temperature;
Either he put the victim in the water or the victim fell or jumped in.
Education can\'t prevent human error or anger responsible for both injury patterns, but lowering the tap water temperature will.
Most injuries occurred in the bathtub or shower.
The Consumer Product Safety Board and the pipeline industry have put forward a voluntary standard to limit the temperature of the story to 49 °c (120°F)
New bathtub and shower.
9 in this new device, this standard Brigadier effectively eliminates the damage, but 26% of the damage in the sink or portable bathtub will continue to exist and the existing pipes will not be affected.
The water temperature control of the whole house can prevent these injuries.
The water temperature is 49 to 52 °c (120 to 125°F)
It is a reasonable compromise between the demand for hot water and the safety of the family. At 49°C (120°F)
It takes 10 minutes at 52 °c (125°F)
It takes two minutes to cause full-thickness burns on adult skin.
The child\'s skin burns in less time.
The home washing machine works well at this temperature and it is too painful to wash the dishes in hot water with your hands.
Although the inlet temperature is 60 °C (140°F)
Home dishwasher, commercial dishwasher detergent (Cascade)
Will be fully dissolved and disinfected at a temperature of 54 °c (130°F)(
Benedict XVI and e a Banan, personal communication).
At present, the gas water heater is preset to 60 °c (140°F)11 (
Adult Skin full thickness burns for 6 seconds)
Electric heaters at 3 and 66 °c (150°F)11 (
Burn for two seconds with full thickness).
3 The recommended water temperature of Seattle Electric Power Company is 60 ~ 66 °c (140 to 150°F)
Their service team set the temperature in this range.
If the manufacturer is at 52 °C (125°F)
And provide a clear warning label on the risk of high temperature, should reduce the incidence of Burns.
Since the Federal Energy Administration estimates the average life of the water heater to be 10 years, it will take about 11 years to complete the water temperature conversion.
At the same time, private health care providers, the fire department, power companies and the news media can provide information about existing risks and suggest lowering the water temperature.
The current level of knowledge of tap water injuries by pediatric health providers does not seem sufficient to provide meaningful safety advice.
Those who can provide safety advice need to be aware of the risk of hot water.
Because of the energy saving of 4% per month C (10°F)
Temperature from 66 °C (150°F)
, There is an additional incentive to reduce the water temperature.
Families interviewed generally do not know the risk of scalding tap water.
Most families are interested when the problem is explained, and some ask to help reduce the temperature of the water heater.
The gas heater usually has a thermostat at the bottom outside the tank;
The low setting corresponds to 49 °C (120°F).
The electric water heater has two panels screwed in front of the top and bottom of the tank, or one panel spans the height of the tank.
Under these panels, there are two thermostats.
Both should be set at 52 °C (125°F)or “low”.
Some families who use small water heaters or use a lot of hot water may feel that the hot water is often used up, making the temperature rise.
In the current sample, satisfaction with the temperature and the amount of hot water has nothing to do with the actual water temperature.
Perhaps those who do raise the temperature will have a greater understanding of the risks and a greater vigilance.
Thanks to Dr. Abraham Bergman and Dr. Edgar Marcusse for their comments;
National Injury Information Center, Bureau of Epidemiology, Consumer Product Safety Commission;
Go to the burn center at the Harborview Medical Center in Seattle.
We thank Cheryl Herndon for her illustrations and Barbara Robinson for typing with Cecilia Amado.
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This article first appeared in Pediatrics (1977; 62:1–7)
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