So Kids Don’t Get Burned

Only three days ago, it happened again.

As far as investigators can tell, after a Buena Park woman refueled a lawn mower in the backyard, she put the gas can in the garage to keep it away from her toddlers.

She intended to cap the can and put it away later but forgot, investigators say. The can spent the night with an open spout 12 feet from a water heater, investigators say.

The next day her toddlers went into the garage to play. The open door probably blew the ground-hugging gasoline fumes toward the water-heater burner, investigators say, and the fumes then did what gasoline is designed to do--explode. Now the woman’s 2- and 3-year-olds have second- and third-degree burns over their feet and legs.

Hospital burn wards see lots of child burns. In Anaheim alone since 1995, half of all burn injuries have been to children. It’s not just because adults are sometimes careless, firefighters say. It’s also because ordinary life has become so complicated.

Throwing dirt on a fire puts it out, right? So at the beach, a well-meaning adult went one better and buried the barbecue coals in the sand. Next morning when a toddler walked over the spot, she got deep second- and third-degree burns on her feet and hands that required skin grafts.

The reason? Barbecue briquettes must be doused to extinguish them, say firefighters. Bury them and they keep burning, creating an oven that generates intense heat for many hours, even days, afterward. Bury them on a beach and you have created a well-concealed booby trap.

A mother bottle-feeding her infant heated the milk in the microwave oven, then did what she was supposed to do; she felt its temperature. Just right. But when she gave it to her baby, he suffered severe burns in his mouth and throat.

The reason? Microwave ovens do not heat evenly. A baby bottle heated this way can be pleasantly warm at the walls of the bottle but incredibly hot in the center.

The child can be burned when the hot center reaches the nipple, or the superheated milk can create high pressure inside the bottle, blowing off the nipple and spraying hot milk on the baby’s face.

Children themselves are burn hazards. Their natural curiosities lead them into danger that their parents often do not foresee.

One mother went into the kitchen to cook, but as she turned with a pan of hot soup in her hands, she fell over her child, who had quietly maneuvered behind her in his new walker to see what Mom was doing. The child suffered severe burns.

“It’s my position that all burns are preventable,” says Bruce M. Achauer, a plastic surgeon and director of UC Irvine’s Burn Center.

“Obviously no one wants their child to be burned; it’s just a lack of knowledge and awareness. It just takes a second; children can move so quickly.

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Burn prevention campaigns have reduced the number of burn injuries by more than 40% over the last decade, but there still were 1.55 million in the United States and Canada last year, 6,000 of them leading to death. Young children get more than their share--more than 35% of all burn injuries and deaths nationwide.

In Anaheim, from 1993 through 1995, 83 fires were started by children playing with matches or cigarette lighters. One was set by an 11-month-old girl who had found a lighter in her parents’ car. The fire killed her and her 5-year-old brother.

Last year, the city’s Fire Department obtained a grant for in-school fire safety programs in 44 local elementary schools from kindergarten through third grade. Titled “Learn Not to Burn,” the program teaches children about the dangers of such adult items as gasoline, barbecues, cigarette lighters and matches.

But most preschoolers are not burned in playing-with-matches fires.

For them, the most common burns are from hot foods and liquids in the kitchen and at the dining table. They are unaware of the consequences of tugging on a tablecloth or grabbing a pot handle.

The bathroom is also high on their burn-danger list. Hot-water scalds are common when small children are left briefly in the tub while water is running. The child or a sibling may turn the hot- or cold-water valve, sending the water temperature soaring.

Most often the parent or baby sitter has gone to answer the telephone, Achauer says. A telephone answering machine can wind up being an important anti-burn device, he says.

So can a kitchen thermometer. Use it to check the temperature of your household hot water.

“We’ve been trying for years to convince people to set their water heaters no higher than 120 degrees,” Achauer says. “Even 100 degrees is plenty hot enough for anything you’re going to do. If your hot water is 140 or 145 degrees, however, it will burn a child in one second.”

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Their thinner skins make young children slightly more prone to burns, but they react no differently than do adults.

For both, the skin is the largest of their vital organs, assigned the task of shielding the others from the dangers of the outside world. Skin sweats to cool the body, grows hair to insulate the brain, secretes oil to keep itself pliable and acts as a barrier to bacteria and toxic substances that would create havoc inside our bodies.

A breech in this barrier, however, can be a catastrophe, depending on how big it is. Lose 100% of your skin to burns and you have a 100% chance of dying. Lose 90% and you have a 90% chance of dying.

But lose 85% and “we figure that nowadays we have a good shot at salvaging someone,” Achauer says. That’s a vast improvement over the pre-World War II days when little was known about treating burn injuries.

“Everyone died three or four days later from burn shock,” he says. “It’s loss of fluids. The capillaries [tiny blood vessels] in the skin leak outside and inside the body, and the body just swells up.

“They didn’t know how much fluid to give them. Basically, you just lost all the fluid from your blood vessels, your heart didn’t have any blood to pump and your kidneys couldn’t work.”

Nowadays, fluids are carefully monitored and restored, so “no one dies of burn shock anymore, really,” Achauer says.

Victims also used to quickly die of starvation.

“You have to use an enormous amount of energy to heal a burn wound, but when you’re burned, you don’t feel like eating,” he says. “We didn’t figure this out for a long while. Now we’ve learned that if someone loses 10% of their body weight with a burn injury, they are just not going to make it. They just run out of gas. They don’t have enough energy for the breathing and the healing and to fight infection.

“So we start feeding people through a tube to their stomachs the day they’re burned. That way we don’t get behind.”

Infection was the third big threat and still is. Burned-away skin is an open doorway into the usually sterile interior of the body, and intruding bacteria “would do horrible things. You’d go into shock or your kidneys would stop working. Most anything could happen,” Achauer says.

Infection is still the rule, not the exception, in burn injuries, but modern antibiotics have greatly improved a burn victim’s ability to resist. Odds of recovery nowadays are good, Achauer says.

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Skin is the only human organ for which finding a transplant donor is seldom a problem. Because you don’t need one.

Whatever skin remains can be used as a farm, producing crop after crop of new skin that can be shaved off and grafted where needed.

“We just take part of the skin. We leave most of it behind,” Achauer says. “You put it on an area that doesn’t have skin and oxygen diffuses through the wound. In a few hours blood vessels grow into that skin graft and it lives. It does this very routinely.”

The new skin does everything the old skin did, except it cannot sweat or grow hair.

Usually replacing the skin is all that is necessary; burns seldom go deeper into the fat or muscle.

But electrical burns do go deep, and they are not uncommon among children.

Sometimes the child inserts something metal into an electrical socket or jack and the current deeply burns wherever it enters and exits the skin.

Sometimes the child puts the end of a plugged-in extension cord into his or her mouth, where the saliva shorts the circuit and creates a 2,000-degree spark. “It literally melts the corner of the mouth,” Achauer says.

Electrical burns are a special case, he says. Because they can go deep past the skin, every one, no matter how small, should be checked by a doctor.

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First aid, however, can be just as important in burn treatment, Achauer says. Actions taken during the first few seconds after a burn can do much to reduce the injury.

If the burn occurred through clothing, remove the clothing. The only exception is if the clothing is fused to the skin.

But removing the heat source of the burn does not immediately stop the burning process, he says. It continues for a few seconds. Cooling the burn immediately can make the difference between a second- and a third-degree burn.

“We’re talking about the first minute. Putting ice on it is OK, but it might take you a while to find some ice,” Achauer says.

“Time is everything. Whatever you can get on the burn the fastest is the best. Water out of a faucet or a garden hose, jumping into a swimming pool, getting into a shower, pouring a cold liquid over it, this dissipates the heat and stops the burning right there.”

Icing a burn is all right, “but sometimes people go overboard and cool the whole body. By the time they arrive at the emergency room, they’re hypothermic with a very low body temperature.”

It’s best not to put ointments or bandages on burns before heading to the hospital or burn center, Achauer says. Doctors will need to examine the burn and will have to remove whatever you applied, often a painful process.

Parents should not panic, he says. “The only hard part of treatment [for the medical workers] is dealing with the emotional involvement of the parents.

“First they start feeling guilty, then after two or three weeks they get angry, mostly at the caregivers; they’re actually mad at themselves. Then they get hyperprotective.

“We know we can get most people through most burns, and we know that children sometimes can survive something adults cannot,” Achauer says. “We can get them back to functioning very well.

“We try to get parents to realize that most children can adapt to almost anything. If people will just treat them normally, the kids do fine.”

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Burn Classifications

First degree: Usually caused by sunburn, scalding or flash flames. Skin is dry and pink with no blisters. Condition is painful. Heals in two to five days with peeling but no scarring. Skin may discolor.

Second degree, superficial: Usually caused by hot liquids or solids, flash flames or chemicals. Skin is pink to cherry red with moist blisters. Condition is very painful. Heals in five to 21 days. No skin grafting required.

Second degree, deep: Same characteristics as second degree, superficial, except burn is deeper. Heals in 21-35 days if not infected. If infected, burn becomes third degree.

Third degree: Usually caused by hot liquids or solids, chemicals, flames or electricity. Skin is dry, leathery or waxy, and color is mixed white, pearly, dark khaki or mahogany. Charred blood vessels visible under skin. Not painful, because skin nerve endings are dead. Large areas may need months of skin grafting. Small areas may heal with grafting within weeks.

Burn Risks for Babies, Children

KITCHEN

Small appliances

Replace long electrical cords with short ones. Keep toward back of counter with cords coiled and away from counter fronts.

Cooking

Turn pot handles inward so children can’t pull them down. Place children in highchairs, cribs or playpens while cooking.

Hot liquids, foods

Never leave unattended; toddler or young child can pull them down. Don’t allow youngsters to handle hot foods or liquids. While drinking or pouring hot liquids, do not hold infants. Seat children at table only after all food has been served and placed out of reach.

Microwave cooking

Microwave ovens heat unevenly. Stir food and check temperature. Never heat baby bottles in a microwave.

Food storage

Never store food above stove; children may climb onto it to reach edibles.

Baby walkers

Keep them out of kitchen.

BATHROOM

Hot water

Set water heater for 120 degrees or less. In bathtub, run cold water first, then hot. Never leave children unattended in bathroom.

Appliances

Avoid using these in the bathroom. If you must use electric grooming appliances, unplug them when your child is unattended.

BEDROOM

Dangling electrical cords

Keep away from crib; children can pull them down.

Vaporizers

Use cool-mist vaporizers out of child’s reach.

Heaters

An infant able to roll should not be left on an adult bed near space heaters. Use only space heaters that shut off if tilted or tipped over. Don’t use space heaters in bathrooms.

GARAGE

Flammable liquids

Store and use out of reach of children. Keep tightly sealed in their containers to prevent spread of fumes. Store and use away from sources of ignition, such as furnaces, water heaters and clothes dryers.

ALL ROOMS

Electrical

Never leave children unsupervised where electrical cords are in use. Children bite cords and suck on cord ends. Put child guards in all unused sockets.

Cigarette lighters and matches

Never leave within reach of children--kids mimic adults and try to light them.

Source: Burn Awareness Coalition; Researched by Steve Emmons / Los Angeles Times

First Aid for Burns

1. Stop where you are, drop and roll to extinguish clothing fire. Remove burned clothing and jewelry unless it sticks to skin. For scalds, removed hot, wet clothes.

2. Immediately pour cool water over burned skin. Continue for three to five minutes (30-40 minutes for chemical burn). Don’t take time looking for ice; seconds count.

3. Apply a clean dry dressing to burn area; cover victim to keep him or her warm.

4. Do not apply ointments, creams, salves--they can hold heat and must be removed later; get victim to hospital.

Source: Burn Awareness Coalition; Researched by Steve Emmons / Los Angeles Times