3MD + THE HONEST COMPANY: 4th of July Safety

TOP TIPS FOR AN INJURY-FREE 4TH OF JULY

TOP TIPS FOR AN INJURY-FREE 4TH OF JULY

Nothing feels like summer more than the 4th of July. Barbeques and fireworks make for some of the best family memories. But while this may be one of the most anticipated days of the summer, we, as emergency physicians, brace ourselves for the unfortunate accidents and injuries that inevitably come along with it. 

Read more about how to make sure you and your loved ones have a safe and injury-free holiday on the Honestly Blog. Full article at https://blog.honest.com/top-tips-injury-free-4th-july/.

TIP TUESDAY: Baby powder & diaper rash

TIP TUESDAY: Keeping baby’s bottom dry when they have a diaper rash is a must. However, talc-based baby powder (talcum) is bad for baby’s lungs. Instead, gently wash with mild soap & water 💦, allow them to air-dry 💨, then apply a barrier cream (like Z-guard in babySTAT) to keep the rash from getting worse. #z-guard #babySTAT #nobabypowder #diaperrash

LAUNDRY PODS: the candy-like poison

With advances in modern technology, who doesn’t love clever inventions that make our household chores a little easier? Laundry pods are one such item. No more measuring out messy laundry detergent…just pop one pod into the machine, and you’re good to go!

But imagine this: you’re putting your third load of laundry into the wash and it is not yet noon. Your toddler comes to give you a hand. You step away, for only a moment to answer the door, and suddenly, you hear a shriek and sputtering cry. You run back to find him with a broken laundry pod in his hand, blue ooze running down his face. What do you do? Are these laundry pods poisonous?

Laundry detergent pods have an attractive candy-like appearance which is rather deceptive. These colorful little packets look tempting to eat in the eyes of young children but are, in fact, harmful. From 2012 to 2013, U.S. poison control centers reported over 17,000 exposures to laundry detergent pods, the vast majority occurring in children under 5 years of age. Of these, 7.5% suffered major injuries, including several deaths. In 2016, this number is now on the rise as laundry pods become more popular and increasingly used.

As each pod contains enough detergent for a whole load of laundry, the solvents and chemicals they contain are highly concentrated. With even just one partially ingested pod, a child can suffer a multitude of injuries, including:

  • Minor Injuries
    • Chemical burns to the eyes, nose and mouth
    • Nausea and vomiting
    • Rash
  • Major Injuries
    • Severe burns to the throat and/or vocal cords
    • Difficulty breathing
    • Seizures
    • Confusion
    • Coma
    • Death

It is also important to note that there are both immediate and delayed effects.  Therefore, even if your child does not exhibit any immediate symptoms, all parents should call the poison control center for any ingestion.

If your child has any major reactions such as difficulty breathing, seizure or other alarming signs, drop everything and call 911. For minor injuries, wash out your child’s face/eyes with tap water, then call the poison control center 1-800-222-1222 for further advice. We encourage you to have this number handy, even programmed into your phone, so that it is easily accessible during that moment of panic.

As parents, we understand the challenge of keeping everything in your home childproof. Accidental overdoses, however, remain one of the leading preventable injuries in young children. Keeping laundry detergent pods stored away in a high place, fully sealed, and inaccessible from your little ones is the best way to prevent these pretty poisons from being ingested.

References:

  1. Valdez A, Casavant M, et al. Pediatric exposure to laundry detergent pods. Pediatrics. 2014 Dec;134(6):1127-356.
  2. http://www.aapcc.org/alerts/laundry-detergent-packets/

 

NEWBORN BELLY BUTTON CARE

Before leaving the hospital, you remembered to bring the car seat and ask your doctor about diapering and feeding your new bundle of joy. But one topic that is often overlooked is your newborn’s belly button: what is that shriveled up remnant and what am I supposed to do with it? The umbilical cord, which provided blood flow between your baby and the placenta in utero, gets clamped and cut at birth. This little stump slowly shrivels and dries, eventually falling off to create the umbilicus (a.k.a. navel or belly button).

Keeping the umbilical stump clean and dry is imperative in preventing complications and promoting healing.

Top 5 tips in caring for the umbilical stump:

  1. Do not soak baby - give sponge baths only to minimize water exposure to the stump.
  2. Do not use rubbing alcohol, ointments, betadine, etc, as the stump requires no actual wound care.
  3. Keep the top of diaper folded down away from the stump to prevent urine from reaching the area. Many newborn diapers have a notch built in for this purpose.
  4. Dress baby in loose fitting clothing (e.g. our favorite babySTAT™ Kimono shirt).
  5. Never attempt to pull off the stump.

For decades, doctors recommended daily use of alcohol swabs to keep the umbilical stump clean. However, there is little evidence proving the benefits of using alcohol, and now the American Academy of Pediatrics (AAP) advises against it. It is now recommended simply to keep the area clean and dry, using care tips such as those listed above.

Most umbilical stumps will naturally fall off on their own in the first few weeks of life, but some can last up to two months of age. If it remains longer, you should see your pediatrician. It is possible to see a tiny drop of blood from the area, which is common and normal. Active bleeding, however, is a concern and should be seen emergently.

One of the rare complications that can occur is an infection of the stump known as omphalitis. Omphalitis is a severe infection that can progress rapidly and warrants immediate attention.

RED FLAGS for an umbilical stump infection include:

  • Redness or dark skin color changes around/at the base of the stump
  • Foul-smelling drainage
  • Fever
  • Pain or crying when the stump or surrounding areas are touched
  • Lethargic or ill-appearing baby

If any of these signs or symptoms are present, head to the nearest emergency department.

 There will be plenty to think about during the first few weeks of life, and the umbilicus is just one of them. Remember to keep it simple with umbilical care - clean and dry. Just as the umbilical stump phase is fleeting, so is having a newborn. Enjoy the wonderful chaos!

 

References:

1.      Imdad A, Bautista R, et al. Umbilical cord antiseptics for preventing sepsis and death among newborns. Cochrane Database Syst Rev. 2013 May 31;5:CD008635.

2.      Palazzi D, Brandt M. et al. Care of the umbilicus and management of umbilical disorders. Uptodate.  updated: Dec 02, 2015.

3.      McConnell T, Lee C, et al. Trends in Umbilical Cord Care: Scientific Evidence for Practice. Newborn & Infant Nursing Reviews

4.      https://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/Pages/Umbilical-Cord-Care.aspx Umbilical Cord Care. Caring for Your Baby and Young Child: Birth to Age 5. American Academy of Pediatrics, Nov 21, 2015

National Women Physicians Day

In honor of National Women Physicians Day, February 3rd, 2016, 3MD | Three Mommy Doctors is teaming up with Physician Moms Group (PMG) to celebrate women in medicine. As physicians, mothers, and businesswomen, we are grateful to pioneers like Dr. Elizabeth Blackwell & PMG for paving the way. To celebrate, 3MD will be giving away two STAT kits to anyone like/sharing this post, or using the hashtag #NWPD or #iamblackwell in support of this day.


NOROVIRUS (AND FRIENDS)

Norovirus

Norovirus, and its nasty “friends," have plagued us this winter! It is not uncommon to have bursts of the “stomach flu” throughout the year. However, this winter, these viral illnesses seem to be hitting harder than usual, as evidenced by an increase in ED visits. Severe outbreaks have even shut down school districts/daycares, creating a legitimate fear amongst parents. Acute gastroenteritis (A.G.E.) is the medical term for diarrheal illnesses usually caused by viruses such as Norovirus, but the reality is that there are many viruses that can cause A.G.E.

Outbreaks of these viruses spread like wildfire because they are so easily spread from person-to-person through direct contact or via fecally-contaminated food or water. All it takes is one infected person, for example, who then prepares food for a large group, and then suddenly, the whole group is sick.

 SYMPTOMS of A.G.E. include:

    ≥3 loose or watery stools in 24 hours

    Vomiting

    Crampy abdominal pain that comes and goes

    +/- Low grade fever

Symptoms typically last anywhere from 2-10 days, usually not exceeding two weeks. Severity will vary even amongst family members exposed to the same virus, depending on previous exposure and built-up immunity to that specific virus. So while mom and dad might have some crampy abdominal pain and mild diarrhea, their little 8 month old might be hit quite hard and suffer significant dehydration.

TREATMENTAcute gastroenteritis is caused by viruses, not bacteria, therefore antibiotics are NOT indicated for this illness. In fact, if treated with antibiotics, symptoms may become even worse. A.G.E. is generally self-limiting, meaning with some good hydration and T.L.C., it will go away on its own.

During the course of illness, most children will have a decreased appetite and they may not want to eat as much as usual. This is distressing for any parent. However, maintaining hydration is the MOST important factor, as level of dehydration directly correlates with the “severity” of illness.

 DIET- Keep their diets simple and age-appropriate.

    Infants: Breastfeeding or bottle-feeding should continue. However, if you find your baby is vomiting after bottle-feeds, it may be useful to reduce the volume of each feed, and increase the frequency instead (for example, if normal feeds are 4 oz. every 3 hours, change this to 2 oz. every 1.5 hours). This ensures that their overall 24 hour consumption is the same, while allowing their sensitive tummies to better tolerate smaller quantities at each feed.

    Babies/children that eat solids: Complex carbohydrates, lean meats, yogurt, fruits, and vegetables are better than foods containing high fats and sugar. Previously the “BRAT diet” (bananas, rice, applesauce, toast) was frequently recommended, however, newer studies suggest this does not provide sufficient nutrients. Foods high in sugars (including fruit juices) can actually increase diarrhea and cause electrolyte disturbances, and should be avoided.

    Probiotics: or other yogurt-containing live culture products, have been shown to replenish good “gut bacteria” and help reduce length of disease.

MEDICATIONS- Avoid the temptation of using anti-diarrheal medications and over-the-counter anti-vomiting medications. These medications can have adverse effects and are currently not recommended for children, unless specifically prescribed by your physician.  

COMPLICATIONS-The complications of A.G.E. are mostly associated with dehydration. At times, your child may need medical evaluation to assess the need for IV fluids and rehydration in a monitored setting.

 RED FLAGS to seek immediate medical attention:

    Decreased urine output (no urine in diaper for over 6-8 hours)

    Lethargy or ill-appearing

    Vomiting that is green (bile), bloody, or doesn’t stop (intractable)

    Refusal to drink any liquids

    No tears when crying

    Rapid, shallow breathing

    Severe abdominal pain

It is important to note that there are other disease processes that can cause vomiting, fever, and diarrhea. Everything from a urinary tract infection to appendicitis and other surgical emergencies can also manifest in this way. If your child looks very ill, has persistently high fevers, severe abdominal pain, prolonged symptoms or other alarming signs not listed above, these are NOT consistent with A.G.E. and you should seek immediate medical attention or consult your physician.

 PREVENTION-

    Wash hands thoroughly after diapering or cleaning up vomit.

    Keep contaminated diaper/trash away from food preparation areas.

    Use diluted bleach-containing products to disinfect contaminated areas (alcohol-based solutions have little effect on Norovirus).

    Frequent hand washing is the MOST important preventative measure for everyone in the family.

    If your kids are sick, keep them home.

As mothers ourselves, we know first-hand the misery and exhaustion of frequent laundry and smelly cleanup that is associated with Norovirus and its friends. Just remember to allow your child to rest, keep them hydrated with lots of fluids, supplement with probiotics, avoid sugars, wash hands frequently, and keep reminding yourself...this too shall pass!

 

Written by 3MD|THREE MOMMY DOCTORS™

DISCLAIMER: The information contained on this website are not intended nor implied to be a substitute for professional medical advice. It is designed to support, not replace, the relationship that exists between a patient/medical treatment facility and his/her physician. For specific medical advice, diagnoses, and treatment, consult your doctor.

 

REFERENCES

1.     Noda M, Fukuda S, Nishio O (2007). "Statistical analysis of attack rate in norovirus foodborne outbreaks". Int J Food Microbiol 122 (1–2): 216–20. PMID 18177970.

2.     Guarino A, Ashkenazi S, Gendrel D, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J Pediatr Gastroenterol Nutr 2014; 59:132.

3.     National Institute for Health and Care Excellence. Diarrhoea and vomiting in children: Diarrhoea and vomiting caused by gastroenteritis: diagnosis, assessment and management in children younger than 5 years. https://www.nice.org.uk/guidance/cg84 (Accessed on July 15, 2015).

 

NOSEBLEEDS

Bloody noses in winter are common. The air is cold and dry, and kids can’t resist the urge to pick their little noses. Did you know that nose-picking (booger-hunting) is the #1 cause of “bloody noses” (a.k.a. epistaxis) in kids? And the index finger is usually the main culprit!

Many parents bring their children to the ER for nosebleeds, with concerns that their child might have a “bleeding disorder” or are now anemic after having lost so much blood. However, bleeding disorders are rare, particularly in children. Patients with bleeding disorders generally have other manifestations of bleeding such as easy bruising, frequently bleeding gums, and blood in their urine or stool.

Most patients do not need blood tests to check for anemia, even after a heavy nose bleed. If your child gets the occasional bloody nose, most can be managed at home, sparing you a trip to the ED.

TO STOP A NOSEBLEED:

  • When bleeding starts, grab some tissue and pinch the upper/middle portion of the nose, where the hard nasal bone turns to softer cartilage.

  • Squeeze firmly and hold constant pressure for 5-10 mins.

    • Do not let go to “check” to see if the bleeding has stopped. If you let go before the full 5-10 minutes, resume holding pressure over again.

PITFALLS:

  • Do not lean their head back, as kids can choke on the blood dripping back into their throat. Keep their head leaned forward to allow them spit out of their mouth as needed.

  • Do not use medicated nasal sprays such as Afrin® in children, as these can have dangerous side effects.

HELPFUL TIPS:

  • Once bleeding has stopped, allow the sensitive nasal passages to rest. Before bedtime, you can consider gently applying a vaseline-based ointment into the entry of the nostril for moisture.

  • The use of a humidifier in the room can also help prevent drying of these sensitive nasal membranes.

RED FLAGS TO GO TO THE ER:

Proceed to the ER, if your child has a massive nosebleed AND:

  • Has suffered an injury to his/her face.

  • Has massive bleeding that doesn’t stop despite constant pressure for 10 minutes.

  • Is taking a medication that is known to thin his/her blood.

  • Has had recent nasal/sinus surgery.

  • You are concerned that your child might have stuck something up their nose (i.e. nasal foreign body). Button batteries are particularly concerning. If you suspect your child placed a button battery up their nose, do NOT wait! This is a true medical emergency and you must go to the ER immediately.

Note: If your child has other signs of frequent bleeding (e.g. bleeding gums, easy bruising, recurrent epistaxis), talk to your pediatrician.             

*This is not a complete list of red flags. The information contained in this blog is not a substitute for professional medical advice, diagnosis, or treatment. If your child looks ill or you are concerned about their health, please seek immediate medical attention. When in doubt, call your child’s doctor, or go to the nearest Emergency Department.

    

WINTER-RELATED EMERGENCIES

With the excitement and hustle and bustle of the holidays, it is easy to get caught up in the spirit of the season. Nobody wants to spend the holidays in the Emergency Department (ED), however, every year, EDs are flooded with winter-related illnesses, injuries, and traumas.

As emergency physicians, we see many cases that could have potentially been AVOIDED. Here are the top five pediatric emergency diagnoses and what you can do to lower the risk of your child ending up in the ED this winter:

1. HEAD INJURIES FROM WINTER SPORTS

Millions of children in the U.S. participate in winter sports each year, including skiing, snowboarding, sledding, ice-skating, and hockey. These sports can be thrilling and fun for all ages, however, high speeds and slippery surfaces can lead to serious injuries. Traumatic brain injury is the leading cause of death and disability in children and young adults. According to the National Pediatric Trauma Registry, almost half of winter sports result in head-related injuries.

Signs and symptoms of a mild brain injury, or concussion, can present immediately at the time of impact, or can be delayed for days, or even up to weeks afterward. Concussion symptoms include:

  • Headache

  • Weakness

  • Numbness

  • Decreased coordination or balance

  • Confusion

  • Slurred speech

  • Nausea or vomiting

Sometimes children complain of “just not feeling themselves.” If your child experiences any of these symptoms, proceed to the nearest ED immediately. And if your child loses consciousness, call 911.

Helmets have been shown to be effective in reducing 50% of head injuries in skiing and snowboarding sports. During a fall or collision, most of the impact energy is absorbed by the helmet, rather than by the head/brain. Helmets save lives!

2. BURNS

The idea of a sunburn in the winter can seem unusual, but snow can reflect up to 85% of the sun’s ultraviolet rays. Be sure to protect your kids’ faces with sunscreen.

Other burn injuries that are more common in winter include thermal burns from campfires and heaters, as well as hot liquids. Fireplaces should have proper screens on them and children should always be supervised around any open flames (including gas burners, incense burners, candles, and fire pits). Children should not be left unattended around campfires, even if the fire has been put out, since the embers, coals, and ashes can stay hot for many hours after the fire has been extinguished. Hot drinks and foods should be kept out of reach of children, and parents should use extra precaution when handling hot drinks/foods such as coffee, instant noodles, and soups.

If any child sustains a burn, run the affected area under room temperature (not cold) water, use a burn dressing if available, and head to the nearest ED.

3. HYPOTHERMIA/FROSTBITE

Children are at an increased risk of frostnip/frostbite because they lose heat from their skin faster than adults, and often do not want to come inside when having fun playing outdoors. The best way to prevent this is to make sure they dress warmly in layers, and to ensure they do not spend too much time in extreme weather.

Frostnip is an early warning sign of frostbite. If your child has red skin that feels numb or tingly, bring your child indoors immediately and remove all wet clothing (wet fabric draws heat from the body). Immerse the chilled body parts in room temperature (not hot) water, until they are able to feel sensation again. 

Frostbite occurs mostly on fingers, toes, ear, noses, and cheeks. The frostbitten area is typically very cold and turns a white or yellowish-gray color. If your child has frostbite, quickly proceed to the nearest ER.

4. TOXIC INGESTIONS

Along with bringing holiday cheer, the season’s shrubbery can also be toxic if eaten. Mistletoe berries, holly berries, the fruit of Jerusalem cherry, the leaves and twigs of boxwood, as well as all parts of yew plants can be poisonous to humans (and pets). Despite a long-standing belief of toxicity, the poinsettia is not a poisonous plant. For any concerns of harmful ingestion, call Poison Control immediately at 1-800-222-1222.

Christmas trees and their adornments can pose another risk for potential ingestion. Christmas tree preservatives are usually not toxic, but check the label nonetheless for special ingredients and warnings. Contrary to popular belief, spray-on snow is non-toxic after it is dried. The propellant contains fluorinated hydrocarbon and methylene chloride, whose main risk is from intentional abuse by “huffing.” Old ornaments may be decorated with harmful lead paints and certain types of tree light wires may contain lead as well. Always wash hands after handling tree lighting and discard of any ornaments for which the presence of lead may be a risk. And lastly, remember that small ornaments can pose as a choking hazard for infants and children.

5. RESPIRATORY AND FOOD-BORNE ILLNESS

As emergency physicians, we see an abundance of high fevers, colds, flus, and other viral illnesses during the winter. Although these cannot be entirely prevented, the transmission rate can be dramatically decreased by practicing good hygiene and hand washing, getting family flu shots, and keeping children home when they are sick. Children should stay home at least 24 hours after the fever is gone without the use of any fever-reducing medication.

Also, when preparing holiday foods, be sure to cook meats thoroughly at a temperature above 160 degrees Fahrenheit. Salmonella bacteria are often present in turkey, even when frozen. Wash hands, knives and cutting boards after working with raw meats to reduce the chances of spreading bacteria to uncooked foods.

REMEMBER:

To help avoid visits to the ED this holiday season, remember to wear helmets and dress appropriately when participating in winter sports. Be sure to apply sunscreen during prolonged sun exposure, use caution when handling hot liquids, and limit time outdoors in extreme weather conditions. Also, holiday decorations can be festive, but keep an eye out on young children to avoid any possible toxic ingestions. Lastly, good hand washing helps decrease infectivity of contagious illnesses and it’s not too late to get a flu shot.

HAPPY HOLIDAYS FROM 3MD!

 

References:

http://www.cdc.gov/headsup/index.html

http://www.brainline.org/content/2008/12/winter-sports-injury-prevention-tips.html

https://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/pages/Winter-Safety-Tips.aspx

http://kidshealth.org/parent/firstaid_safe/outdoor/winter_safety.html#

http://www.calpoison.org/public/winter-holidays.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555592/

http://www.cdc.gov/foodsafety/foodborne-germs.html

 

HALLOWEEN SAFETY AND INJURY PREVENTION

Ghosts and goblins, witches at night, trick-or-treaters in costume - a spooky fright!

Halloween is an exciting celebration for children, who dress up, enjoy parties, and eat yummy treats. However, Halloween-related injuries also make it a busy night in the Emergency Department. The most common of these Halloween injuries include:

  • AUTO vs PEDESTRIAN - Kids are particularly prone to being struck by cars on Halloween night. With excited trick-o-treaters dashing across streets in poor lighting and distracted drivers, Halloween is the perfect setup for catastrophe.

    • Prevent these injuries by:

      • Walking in larger groups, staying within arm’s reach of your little ones.

      • Reminding older kids to go down one side of the street together, then crossing the street collectively to the other side. No zig-zagging!

      • Wearing brightly colored items (e.g. glow sticks, lighted necklaces).

      • Carrying flashlights.

      • If wearing a mask, removing it while crossing the street for better peripheral vision.

  • FOOSH - This is medical acronym for “Fall Onto OutStretched Hand.” It is by far the most common mechanism of injury for fractures (broken bones) in the forearm and wrist. Kids are distracted on Halloween, running in the dark in unfamiliar costumes and carrying their candy totes. Inevitably, many of them trip and fall.

    • Prevent broken arms and other FOOSH injuries by:

      • Hemming costumes so they are not tripping hazards.

      • Removing masks while walking, so as to increase depth perception.

      • Using flashlights while walking.

  • COSTUME CONTACT LENSES - Fake contact lenses are increasingly popular for added dramatic effect, especially for tweens and teens. However, these inexpensive decorative contact lenses can actually be very dangerous for the eye and can even cause blindness. Costume contact lenses, if not properly fitted, can cause scratches and ulcers to the cornea (the outer layer of the eye). They can also cause infection (conjunctivitis) and even adhere to the cornea, requiring surgical removal. These complications may result in permanent damage to the eye. The FDA has gone so far as to place warnings on contact lenses not properly fitted by an eye doctor (either an ophthalmologist or optometrist).

    • Refer to the FDA website for further consumer warnings regarding decorative contact lenses. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm275069.htm

  • CANDY TAMPERING - There are many urban myths of malevolent individuals hiding sharp objects (such as razor blades, needles, or broken glass) in Halloween candy. However, the actual data for this is lacking. More frequently, children and teenagers present to the ED for complications from drug or alcohol ingestion.

    • To avoid accidental ingestion, make sure that all candy is recognizable, wrapped, and not tampered with. Many street drugs can look like candy. It is highly unlikely that neighborhoods would hand out bags of methamphetamine, MDMA (ecstasy), or cannabis (marijuana), however, children can inadvertently or unintentionally access the stash of others. When in doubt, throw it out.  

    • Alcohol intoxication/overdose is particularly common on Halloween night. Kids can present to the ED nearly comatose after even small amounts of alcohol consumption. Discussing alcohol and drugs with teenagers is always important, but especially so on Halloween.

Before heading out to trick-o-treat, make sure you are familiar with your candy-route. If you are trying out a new neighborhood, it is advised to check your local and state website for a list of registered sex offenders and to avoid these homes.

Remember -  stay in groups, cross the street together, wear bright colors, use glow sticks/flashlights, hem costumes, and map your trick-or-treating route. 3MD wishes you all a safe and HAPPY HALLOWEEN!

Written by 3MD | THREE MOMMY DOCTORS

REFERENCES:

1. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm275069.htm

2http://www.halloween-safety.com/halloween_safety_adults.html

PEDIATRIC BURNS - WHAT YOU NEED TO KNOW

IMG_8281.JPG

As we head into this holiday season, we are reminded that with the warm, open hearths and hot seasonal beverages that await us, comes the opportunity to talk to parents and families about pediatric burns and their prevention.

Pediatric burns are the third leading cause of accidental death amongst children. In 2005, an estimated 120,000 children under 15 years of age received care in the emergency department (ED) for a burn. In children under the age of 5, more than half of these burns were due to scald injuries. During a recent shift in the ED, a 3-year-old boy was brought in by his parents after accidentally knocking over a pot of coffee while twirling a baton. He suffered first and second degree burns over 18% of his body, from hot coffee spilling onto his back and leg, and was transferred to a pediatric burn center for further care.

What is considered a burn?

Burns are broken down into the depth of skin and soft tissue involved and by injury pattern:

Burn classification

·      Superficial burns (1st degree) – the skin is pink or red and painful; think sunburn.

·      Partial thickness (2nd degree) – the skin is red, painful and with blister formation OR white, pale and less painful (since the nerve fibers have been destroyed);  think curling iron or kitchen oven.

·      Full thickness (3rd degree) – the skin is white, waxy, leathery without bleeding, and painless; think house fire.

·      4th degree burn – there is destruction of underlying tissue including tendons, nerves, muscle and bones; think electrocution.

Types of burns

·      Thermal - a scald burn resulting from contact with fire, hot objects, or hot fluids. Imagine a toddler pulling down a piping hot cup of cocoa and spilling it on themselves!

·      Electrical- a burn resulting from flow of an electrical current, carrying temperatures as high as 5000°C. Entry and exit points do occur but most burned tissue remains invisible at surface levels. Imagine a newly crawling baby discovering Christmas lights and chewing on the cord!

·      Chemical- injury caused by an alkali (e.g. ammonia, caustic potash, sodium hydroxide) or acid (e.g. hydrochloric, sulphuric). The severity of burn depends on the chemical and type of tissue involved. Imagine a child spraying cinnamon air-freshener into his brother’s eyes.

Why are burns in an infant or child more serious than in an adult?

(1) Body surface area (% BSA) –children have different proportions of surface area as compared to adults (e.g. larger heads) so they can quickly suffer fluid loss.

(2) Location...location...location! All burns in kids need immediate medical evaluation. Burns to the face, hands, feet, genitalia, and areas that cross joints are considered high-risk locations. If not immediately treated, children can suffer poor cosmetic outcomes and growth complications.

What can you do to prevent burns in your child?

There are several things that YOU as a parent can do to protect your child, many of which begin in your own home:

·      Reset your water heater – Hot water scald burns cause more deaths and hospitalizations than any other hot liquid burns. Most home water heaters are set at 140-150 ℉. Water at this temperature will result in a 3rd degree burn within 2 seconds. Reset your water heater to 120 degrees. And as a reminder, never leave a child unattended in the bath tub.

·      Do not leave handles within reach – You would be surprised how far your little one can reach. Many scald burn injuries are the result of a child pulling a pot off the stove or a cup of coffee from the countertop.

·      Hide matches and lighters - Most child play-related home fires begin with matches or lighters in a room where children are left unattended. Keep matches and lighters away from children and when necessary, use child-resistant lighters.

·      Smoke alarms - Children under the age of five are at greatest risk of suffering fire-related injuries and twice as likely to die in a fire. It is critical to ensure that the smoke alarms in your home are working and checked regularly.

Treating burns in your child

If your child does suffer from a burn, appropriate wound care and further evaluation is key. Contrary to popular belief, ice should never be applied to a burn. Instead, the area that is burned should be immediately cooled with room temperature water for 10 to 20 minutes after the injury. This helps to prevent ongoing damage to the skin and soft tissue.

When available, the wound should be covered with a wet, sterile dressing. Otherwise, the burn should remain uncovered - do not apply butter or any other topical ointment until further evaluation by a medical professional. Elevate the burned extremity to minimize swelling and seek medical attention. This is extremely important to avoid infection and minimize any long term complications from wound healing.

Remember, the best approach is prevention. Re-set your water heater, turn pot handles in, never leave your child unattended in the kitchen or bath, and make certain your smoke detectors are working and you change your batteries once a year.

Written by 3MD | THREE MOMMY DOCTORS

References:

  1. National Center for Injury Preventions and Control www.cdc.gov/ncipc/wisqars/ (Accessed on April 12, 2007).

  2. D'Souza AL, Nelson NG, McKenzie LB. Pediatric burn injuries treated in US emergency departments between 1990 and 2006. Pediatrics. 2009;124(5):1424. PMID: 19805456

  3. Drago DA. Kitchen scalds and thermal burns in children five years and younger.Pediatrics. 2005;115(1):10. PMID: 15629975

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