Burns are an especially serious form of injury because they can cause severe injuries, and death.  Recovery from burns is often slow, painful and can result in permanent disabilities and disfigurement.

Deaths
Although fire-related deaths among children are not common, fires and burns are the fifth leading cause of injury‐related death to children in the U.S. Of about 3400 annual fire-related deaths in the U.S., in 2010, 365 were among children age 19 or younger, and 88% (322 deaths) occurred in residential homes. More than two-thirds of these child deaths were caused by inhalation of the smoke and toxic gases produced by fires rather than by flames and burns. The youngest children are at highest risk, 47% of children who died from fires or burns were ages 4 and under. Their death rate is twice that of 5 to 9 year olds, and four times that of those between ages 10-19.  More than half of children ages 5 and under who die from home fires are asleep at the time of the fire; often they are too young to react appropriately to save themselves. Remember, It only takes two minutes for a fire to fill a home with black smoke or engulf it in flames.

Injuries
Among young children aged 4 and younger, scald burns, caused by hot liquids or steam, are the most common type of burn‐related injury. Hot tap water scald burns cause more deaths and hospitalizations than any other hot liquid burns. Scald burns to small children between the ages of 6 months and 2 years, are likely to be caused by hot foods or liquids spilled in the kitchen or other areas where food is prepared and served. The bathroom is a high-risk area for tap water burns and these burns tend to be especially dangerous because they can be more severe and cover a larger portion of the body than other scald burns. Burns caused by direct contact with fire are more common among older children.

Burn Causes
The majority of fires that kill or injure children are residential, most commonly due to carelessness. The leading cause of home fires and related injuries is home-cooking equipment. However, most fire-related deaths are from residential fires ignited by smoking materials such as cigarettes. Water heaters that furnish tap water that is excessively hot and unsupervised children are common risk factors contributing to burns. The most common causes of product-related thermal burn injuries among children ages 14 and under are hair curlers, curling irons, room heaters, ovens and ranges, irons, gasoline, and fireworks. Burns also result from chemicals, electricity, and other sources of heat. Children, even those who are very young, start many fires when playing with matches and lighters. In 2008, approximately 53,000 fires reported to U.S. fire departments were started by children.

Protecting Children from Fire and Burns
Children in homes without working smoke alarms are at greater risk of fire-related death and injury in the event of a fire. More than 95% of U.S. homes have a smoke alarm, but a survey showed that they are poorly maintained.  Only three-quarters of all homes had at least one working smoke alarm. Smoke alarms and sprinkler systems combined can reduce fire-related deaths by 82 percent and injuries by 46 percent. Automatic sprinkler systems reduce the chance of dying in a residential fire by approximately 73 percent.
The first line of defense for safeguarding children is adult fire safety. The Journal of the American Medical Association advises:

• Do not smoke. If you do smoke, never smoke in bed. Avoid smoking while consuming alcoholic beverages.
• Never throw a lighted cigarette or a match anywhere. Dispose of those hazards in proper ashtrays.
• Be very cautious around any type of open flames.
• Supervise children carefully.
• Follow electrical safety rules. Never put electrical appliances or cords in or near water.
• Do not touch downed power lines.

Here are some more precautions adults can take to prevent fires:

• Store matches, lighters and flammable liquids in a locked cabinet or drawer. Teach children that matches and lighters aren't toys.
• Keep burning candles out of reach, and extinguish candles before leaving the room.                
• Keep space heaters at least three feet (about one meter) away from bedding, drapes, furniture and other flammable materials.
• Keep children away from space heaters. Never leave a space heater on when you go to sleep or place a space heater near someone who's sleeping.
• Keep fireplaces clean. An annual cleaning and inspection can help prevent a chimney fire.
• Install and maintain smoke and carbon monoxide alarms on every level of your home and outside sleeping areas. Home smoke and carbon monoxide alarms are often required by law.     
• Keep fire extinguishers handy throughout your home.
• Teach children to leave a burning building by crawling under the smoke, and to stop, drop and roll if clothes catch fire.
•  Develop and practice a fire evacuation plan

The Mayo Clinic has burn safety advice for children. They note that it is difficult for young children to learn that some things — such as stoves, radiators and flickering flames — can be painfully hot. And if children play with fire can threaten the entire family. Burns are most likely to occur in a home.  Here are some burn-safety precautions from the Mayo Clinic that can be taken in a home:    

• Reduce water temperature. Set the thermostat on your hot water heater to below 120 F (48.9 C). Consider installing anti-scald devices on bathtub faucets and showerheads. Always test the water temperature before your child gets in the tub.
• Avoid hot spills. Don't cook, drink or carry hot beverages or soup while holding a child. Keep hot foods and liquids away from table and counter edges. Don't use tablecloths or placemats, which young children can pull down. When you're using the stove, use back burners and turn the handles of your pots and pans inward. Avoid leaving food cooking on the stove unattended.
• Establish 'no' zones. Block access to the stove and fireplace, and make space heaters and hot water heaters inaccessible.
• Unplug irons. Store items designed to get hot, such as clothes irons, unplugged and out of reach.
• Test food temperature. Food or liquids warmed in a microwave may heat unevenly. Never warm a baby's bottle in the microwave.
• Choose a cool-water humidifier or vaporizer. If you use a hot-steam vaporizer, keep it out of reach.
• Address outlets and electrical cords. Place plastic plugs in electrical outlets. Inserting a fork, key or other metal object into an outlet could result in an electrical burn. Keep electrical cords and wires out of the way so children don't chew on them. Replace damaged, brittle or frayed electrical cords.

Also, check product labels to make sure mattresses and pajamas meet federal flammability standards, and
avoid loose fitting garments made of 100 percent cotton, such as oversized T-shirts.

Burn-safety Outdoors
These burn-safety measures can protect children from outdoor hazards:

• Watch grills and fire pits. Don't allow children to play near these potential hazards.
• Check car seats. Before placing your child in a car seat, check for hot straps or buckles. If you park in direct sunlight, cover the car seat with a towel or blanket.
• Forgo backyard fireworks. Leave fireworks to trained professionals.

The following information about how to evaluate the seriousness of burns is from a patient page provided by The Journal of the American Medical Association:
Burns are classified based on how much of the skin’s thickness is involved. First-degree (or superficial) burns involve only the top layer of the skin and are the least serious burn injuries. Second-degree (or partial-thickness) burns injure deeper into the skin and cause blistering. Third-degree (or full-thickness) burns involve all the layers of the skin, including the nerves that supply the skin, and are extremely serious injuries. Fourth-degree burns extend into the muscle below the skin.

Burn Treatment
Treating burns depends on the severity of the burn, the type of burn, and the amount of body tissue involved. Persons who have large surface areas of their body burned have a poorer prognosis (chance of surviving and doing well after an injury). Burn treatments include fluids (given intravenously for serious burns), pain management, surgical debridement (removal of dead tissue) for third-degree or fourth-degree burns, intensive care (often in a specialized burn treatment intensive
care unit), and skin grafting. For persons who have serious burn injuries, physical therapy is often used in addition to other treatments to aid recovery and prevent complications such as contracture (where the burned skin and body tissue become very difficult to move).

First degree-burns that cover more than a small surface area and second-degree burns should be evaluated and treated by a medical professional. Large burns and third and fourth degree burns constitute a medical emergency and must receive prompt and appropriate medical care.

Links and Resources
Information and portions of text used in this essay have been derived from the following sources:
http://www.safekids.org/

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web‐based Injury Statistics Query and Reporting System (WISQARS). National Center for Injury Prevention and Control Website. Unintentional fire/burn fatalities and injuries, children ages 19 and under. Available from: http://www.cdc.gov/injury/wisqars/index.html.

National Fire Protection Association. Smoke Alarms. Available from: http://www.nfpa.org/categoryList.asp?categoryID=278&URL=Safety%20Information/For%20consumers/Fire%20&%20safety%20equipment/S moke%20alarms.

Ahrens M. Home structure fires. Quincy (MA): National Fire Protection Association; 2012. 4 FEMA. Home Fires. Available from: http://www.ready.gov/fires.

Simon PA, Baron RC. Age as a risk factor for burn injury requiring hospitalization during early childhood. Arch Ped Adolesc Med. 1994; 148: 394‐97.

Morrow SE, Smith DL, Cairns BA, et al. Etiology and outcome of pediatric burns. J Pediatr Surg. 1996; 31(3): 329‐33.

American Burn Association. National burn repository 2011 report: dataset version 7.0. American Burn Association Website. Available at: http://www.ameriburn.org/2011NBRAnnualReport.pdf.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Protect the ones you love: child injuries are preventable. Centers for Disease Control and Prevention Website. Available from: http://www.cdc.gov/safechild/Burns/index.html.

Feldman KW, Schaller RT, Feldman JA, McMillon M. Tap water scald burns in children. Pediatrics. 1978; 62(1): 1‐7.

Baptiste MS, Feck G. Preventing tap water burns. Am J Public Health. 1980; 70(7): 727‐729.

American Burn Association. Scald injury prevention educator’s guide. American Burn Association Website. Available from: http://www.ameriburn.org/Preven/ScaldInjuryEducator'sGuide.pdf.

Safe Kids Worldwide, Public Policy Department, 2005.

AntiScald, Inc. Available from: http://antiscald.com/.

Torpy, JM, Lynm, C, Glass, RM, Burn Injuries JAMA Patient Page, p. 1828 JAMA, October 28, 2009—Vol 302, No. 16, www.jama.com
 
American College of Emergency Physicians, www.acep.org

American Burn Association, www.ameriburn.org

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