Hot tea and tiny tots don’t mix: A cross-sectional survey on hot beverage scalds

Effect of a Childhood Burn Prevention Program on Knowledge Level of Caregivers and Burn Risk Factors

BACKGROUND

Prevention activities are very important in paediatric burns. More than 73% of burns occur at home. This study aimed to develop a Childhood Burn Prevention Program for caregivers of children with burns and to evaluate the effectiveness of the program for reducing burn risk factors for children at home as well as increasing the relevant knowledge of caregivers on burn prevention.

METHODS

"Childhood Burn Prevention Program" was developed in the study. Within the scope of the program, caregivers were interviewed twice at home visits. At the first home visit, caregivers were trained in burn prevention and a poster including burn risk factors was put in their homes. In addition, the knowledge levels of caregivers about burns and risk factors in home settings were evaluated in the first and second home visits.

RESULTS

We found the total risk factor for burns in home settings was 28.94 ± 6.24 before the training and 14.68 ± 3.74 after the training (p < 0.05). In addition, the total number of correct answers given by the caregivers to the questions about burns before the training was 8.60 ± 2.62 and 11.71 ± 1.70 after the training (p < 0.05).

CONCLUSION

This Childhood Burn Prevention Program can be used to reduce risk factors for burns at home and to increase the relevant knowledge of caregivers of children.

Aetiology of severe burn incidents in children under 5 years of age in the Netherlands: A prospective cohort study

BACKGROUND

Risk factors and mechanisms of injury may change over time. Since knowledge on aetiology of severe burn incidents in children under 5 years of age in the Netherlands is outdated, this study aimed to identify current risk factors and mechanisms of severe burn injury in children under 5 years of age in the Netherlands to direct future prevention campaigns.

METHODS

Information on personal-, environmental- and behavioural circumstances as well as the mechanism of burn injury was prospectively collected in all burn centres during one year from patient records and structured interviews with parents.

RESULTS

Boys around 18 months of age, who, while in upright position, pulled down a cup of hot tea over themselves, were overrepresented. Children in families with more children, having a migration background, living in urbanised neighborhoods or with a low socioeconomic status (SES) are at increased risk for severe burn injury. Most incidents happened in their own home with the parents in close proximity to the child.

CONCLUSION

Outcomes of this prospective cohort study provide up-to-date and extensive knowledge on the aetiology of severe burn incidents in children under 5 years of age in the Netherlands, and provide directions for prevention policy and campaigns.

Influence of agents and mechanisms of injury on anatomical burn locations in children <5 years old with a scald

OBJECTIVE

To demonstrate how the mechanism and agent of injury can influence the anatomical location of a scald.

DESIGN

Prospective multicentre cross-sectional study.

SETTING

20 hospital sites across England and Wales including emergency departments, minor injury units and regional burns units.

PATIENTS

Children aged 5 years and younger who attended hospital with a scald.

MAIN OUTCOME MEASURES

Primary outcome: a descriptive analysis of the mechanism, agent and anatomical location of accidental scalds. Secondary outcome: a comparison of these factors between children with and without child protection (CP) referral.

RESULTS

Of 1041 cases of accidental scalds, the most common narrative leading to this injury was a cup or mug of hot beverage being pulled down and scalding the head or trunk (132/1041; 32.9% of cases). Accidental scalds in baths/showers were rare (1.4% of cases). Accidental immersion injuries were mainly distributed on hands and feet (76.7%). There were differences in the presentation between children with accidental scalds and the 103 who were referred for CP assessment; children with scalds caused by hot water in baths/showers were more likely to get referred for CP assessment (p<0.0001), as were those with symmetrically distributed (p<0.0001) and unwitnessed (p=0.007) scalds.

CONCLUSIONS

An understanding of the distributions of scalds and its relationship to different mechanisms of injury and causative agents will help clinicians assess scalds in young children, particularly those new to the emergency department who may be unfamiliar with expected scald patterns or with the importance of using appropriate terminology when describing scalds.

Mixed-methods process evaluation of SafeTea: a multimedia campaign to prevent hot drink scalds in young children and promote burn first aid

Objectives

SafeTea is a multifaceted intervention delivered by community practitioners to prevent hot drink scalds to young children and improve parents’ knowledge of appropriate burn first aid. We adapted SafeTea for a national multimedia campaign, and present a mixed-methods process evaluation of the campaign.

Methods

We used social media, a website hosting downloadable materials and media publicity to disseminate key messages to parents/caregivers of young children and professionals working with these families across the UK. The SafeTea campaign was launched on National Burns Awareness Day (NBAD), October 2019, and ran for 3 months. Process evaluation measurements included social media metrics, Google Analytics, and quantitative and qualitative results from a survey of professionals who requested hard copies of the materials via the website.

Results

Findings were summarised under four themes: ‘reach’, ‘engagement’, ‘acceptability’ and ‘impact/behavioural change’. The launch on NBAD generated widespread publicity. The campaign reached a greater number of the target audience than anticipated, with over 400 000 views of the SafeTea educational videos. Parents and professionals engaged with SafeTea and expressed positive opinions of the campaign and materials. SafeTea encouraged parents to consider how to change their behaviours to minimise the risks associated with hot drinks. Reach and engagement steadily declined after the first month due to reduced publicity and social media promotion.

Conclusion

The SafeTea campaign was successful in terms of reach and engagement. The launch on NBAD was essential for generating media interest. Future campaigns could be shorter, with more funding for additional social media content and promotion.

Iatrogenic Thermal Burns Secondary to Marine Sting Treatment

Hot water immersion (HWI) therapy is an effective and validated treatment for a variety of marine stings. Unsupervised, however, it poses a significant risk of thermal injury. Herein, we describe our experience of iatrogenic thermal injury secondary to marine sting treatment. A 5-year retrospective review of all iatrogenic thermal burns secondary to marine stings referred to the State Adult Burn Service was conducted. Nine patients were identified, all sustaining stings to the feet from estuarine cobblerfish, stonefish, and stingrays. All patients continued unsupervised HWI at home and sustained thermal injury to their feet. The majority were treated conservatively with dressings and elevation. One patient required surgical debridement. While heat application is an effective treatment for marine stings, further patient education is required following discharge from point of care. We recommend that first-aid treatment guidelines be updated to reflect that patients are not recommended to continue scalding water immersion at home. However, if patients wish to continue HWI, water temperature should be checked manually with a thermometer or with a nonstung limb and limited to 30 minutes immersion, with 30-minute skin recovery time between.

Establishing scald prevention measures in UK maternity units from takeaway drinks

AIM

To identify policies on the consumption of hot drinks by patients and visitors on all perinatal and postnatal wards in the United Kingdom, and to seek the opinions of members of the wider burns MDT as to whether standardised patient education or regulation of hot drinks around newborn babies is required.

METHODS

All maternity units with postnatal wards across the United Kingdom were surveyed to establish availability of hot drinks on site and whether these were permitted on postnatal wards around infants. An online questionnaire was distributed to members of the British Burn Association to ascertain opinions on hot drinks policies.

RESULTS

Hot takeaway drinks were permitted around newborn infants in 194 of surveyed postnatal wards and were only banned by two units. The online survey received 49 responses from different members of the British Burn Association. Thirty responders (61%) supported a takeaway hot drink ban, while those against the policy would alternatively encourage patient education, dedicated drinking areas and introduction of safety measures.

CONCLUSIONS

Almost every postnatal unit in the UK has access to hot drink retailers on site allowing parents and visitors to bring them into close contact with babies. With varying local regulations, this poses potentially serious consequences during feeding or carrying. We propose a standardised antenatal education be made available, together with standardised designated areas on wards for parents and visitors to consume hot drinks away from infants.

The role of parental acute psychological distress in paediatric burn re-epithelialization

OBJECTIVES

Following a paediatric burn, parents commonly experience high levels of acute psychological distress, which has been shown to increase child psychological distress as well as child procedural distress. The influence of psychological stress and perceived pain on wound healing has been demonstrated in several laboratory and medical populations. This paper investigates the influence of parental acute psychological distress and procedural behaviour on the child's rate of re-epithelialization, after controlling for child procedural distress.

DESIGN

A prospective observational study with longitudinal outcome.

METHODS

Eighty-three parents of children 1-6 years old reported acute psychological distress (post-traumatic stress symptoms [PTSS], guilt, pre-procedural fear, general anxiety/depression symptoms) in relation to their child's burn. A researcher observed parent-child behaviour at the first dressing change, and parents and nurses reported child procedural distress (pre-, peak-, and post-procedural pain and fear). These variables, along with demographic and injury information, were tested for predicting time to re-epithelialization. Date of re-epithelialization was determined by the treating consultant.

RESULTS

Days to re-epithelialization ranged from 3 to 35 days post-injury. A hierarchical multiple regression analysis found wound depth and size significantly accounted for 28% of the variance in time to re-epithelialization. In Block 2, child peak-procedural pain significantly accounted for 6% additional variance. In Block 3, parental PTSS significantly accounted for 5% additional variance.

CONCLUSIONS

Parental PTSS appears to be an important but under-recognized factor that may influence their child's burn re-epithelialization. Further investigation is required to understand the mechanisms contributing to this association. Statement of contribution What is already known on this subject? Psychological stress delays wound healing, and this relationship has been found in paediatric burn populations with procedural pain. Parental psychological stress is often present after a child's burn and is related to the child's procedural coping and distress. What does this study add? Parental post-traumatic stress is related to delayed child burn re-epithelialization. This association is in addition to procedural pain delaying re-epithelialization.

Temperature dissociation of liquids in reusable thermoplastic containers-An eco-friendly scald risk?

Recent global concern regarding the impact of plastic waste on the environment has resulted in efforts to utilise reusable drink containers. Research is lacking regarding temperature dissociation of drinks in reusable thermoplastic cups. This study aimed to compare the cooling time of two common hot drinks sold at a UK retailer, in the three vessels they are sold; ceramic, disposable paper (with and without lid) and reusable thermoplastic cups (with and without lid). All temperatures were collated from 250 ml volumes of black Americano coffee or café latte in the three different containers. The cooling time was measured every sixty seconds using a standardised digital thermocouple thermometer until a threshold liquid temperature of 43 °C was reached. All experiments were performed in triplicate and temperatures converted to a dimensionless logarithmic scale prior to statistical analysis. Cooling time was significantly slower for lidded cups irrespective of material. Unlidded thermoplastic cups significantly slowed cooling times for both black Americano coffee and café latte compared to ceramic and unlidded disposable paper cups. The growing trend in reusable cups does not in itself pose an increased risk of scald injury. However, we consider that the potentially increased ambulatory behaviour associated with using a lidded rather than unlidded cup may increase scald risk. We propose that further consumer guidance should be disseminated regarding the use of any lidded takeaway container to prevent scalds in both adults and children.

Combining Technology and Research to Prevent Scald Injuries (the Cool Runnings Intervention): Randomized Controlled Trial

Background

New technologies, internet accessibility, social media, and increased smartphone ownership provide new opportunities for health researchers to communicate and engage target audiences. An innovative burn prevention intervention was developed using these channels.

Objective

The aim of this study was to evaluate the efficacy of Cool Runnings, an app-based intervention to increase knowledge of childhood burn risk (specifically hot beverage scalds) and correct burn first aid among mothers of young children.

Methods

This was a 2-group, parallel, single-blinded randomized controlled trial (RCT). Participants were women aged 18 years and above, living in Queensland, Australia, with at least 1 child aged 5-12 months at time of enrollment. The primary outcome measures were change in knowledge about risk of burns and correct burn first aid assessed via 2 methods: (1) overall score and (2) categorized as adequate (score=4) versus inadequate (score<4). Efficacy of gamification techniques was also assessed.

Results

In total, 498 participants were recruited via social media and enrolled. At the 6-month follow-up, 244 participants completed the posttest questionnaire. Attrition rates in both groups were similar. Participants who remained in the study did not differ from those lost to follow-up on any characteristics except education level. Although similar at baseline, intervention group participants achieved significantly greater improvement in overall knowledge posttest than control group participants on both primary outcome measures (overall knowledge intervention: mean [SD] of overall knowledge 2.68 [SD 1.00] for intervention vs 2.13 [SD 1.03] for control; 20.7% [25/121] adequate in intervention vs 7.3% [2/123] in control). Consequently, the number needed to treat was 7.46. Logistic regression showed participants exposed to the highest level of disadvantage had 7.3 times higher odds of improved overall knowledge scores than participants in other levels of disadvantage. There were also significant correlations between gamification techniques and knowledge change (P<.001). In addition, odds of knowledge improvement between baseline and 6-month follow-up was higher in participants with low-moderate app activity compared with no app activity (odds ratio [OR] 8.59, 95% CI 2.9-25.02) and much higher in participants with high app activity (OR 18.26, 95% CI 7.1-46.8).

Conclusions

Despite substantial loss to follow-up, this RCT demonstrates the Cool Runnings app was an effective intervention for improving knowledge about risks of hot beverage scalds and burn first aid in mothers of young children. The benefits of combining gamification elements in the intervention were also highlighted. Given the low cost and large reach of smartphone apps to deliver content to and engage with targeted populations, the results from this RCT provide important information on how smartphone apps can be used for widespread injury prevention campaigns and public health campaigns generally.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12616000019404; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369745&showOriginal=true&isReview=true (Archived by WebCite at http://www.webcitation.org/72b1E8gTW)

Knowledge of childhood burn risks and burn first aid: Cool Runnings

AIM

The high incidence of hot beverage scalds among young children has not changed in the past 15 years, but preventive campaigns have been scarce. A novel approach was used to engage mothers of young children in an app-based hot beverage scald prevention campaign 'Cool Runnings'. This paper provides baseline data for this randomised controlled trial (RCT).

METHOD

Queensland-based mothers aged 18+ years with at least one child aged 5-12 months were recruited via social media to Cool Runnings, which is a two-group, parallel, single-blinded RCT.

RESULTS

In total, 498 participants from across Queensland completed the baseline questionnaire. The most common source of burn first aid information was the internet (79%). One-third (33%) correctly identified hot beverage scalds as the leading cause of childhood burns, 43% knew the age group most at risk. While 94% reported they would cool a burn with water, only 10% reported the recommended 20min duration. After adjusting for all relevant variables, there were two independent predictors of adequate burn first aid knowledge: first aid training in the past year (OR=3.32; 95% CI 1.8 to 6.1) and smoking status (OR=0.17; 95% CI 0.04 to 0.7).

CONCLUSION

In this study, mothers of young children were largely unaware how frequently hot beverage scalds occur and the age group most susceptible to them. Inadequate burn first aid knowledge is prevalent across mothers of young children; there is an urgent and compelling need to improve burn first aid knowledge in this group. Given the high incidence of hot beverages scalds in children aged 6-24 months, it is important to target future burn prevention/first aid campaigns at parents of young children.

TRIAL REGISTRATION NUMBER

ACTRN12616000019404; Pre-results.