Be On The Safe Side: Prevent Burn and Scald Injuries

According to the American Burn Association, approximately 600,000 burn injuries are treated in hospital emergency departments each year. Close to half of these burn injuries and one-third of admissions to burn centers are categorized as scald injuries. An estimated 60 percent of scald injuries happen to young children aged 4 or younger. With the high number of children affected by scald burns, it is important for caregivers to develop strategies that decrease the risk of burns and maintain a safe and healthy environment for children.

(Scald Injury Prevention. (April 25, 2017). Retrieved from http://ameriburn.org/scaldinjury/)

A scald injury occurs when contact with hot liquid or steam damages one or more layers of skin. Young children are especially at risk for burns and scald injuries because of their limited understanding of danger and inability to react quickly to hot contact. Additionally, children's thin skin results in deeper burns at lower temperatures than adults. Most burn injuries happen at home, with tap water scalds in the bathroom or other bathing areas, and in the kitchen while cooking or serving food.

Scalds also occur in child care facilities. In North Carolina child care providers must comply with Sanitation Rules regarding food storage and preparation. Do you know North Carolina's sanitation requirements regarding food storage and protection?

Child care facilities must follow Sanitation Rule 15A NCAC 18A .2806(i)(2), which states:

• The internal temperature of potentially hazardous foods requiring hot storage shall be 140 degrees Fahrenheit (60 degrees Celsius) or more, except during necessary periods of preparing and service.
• Potentially hazardous food to be transported hot shall be held at a temperature of 140 degrees Fahrenheit (60 degrees Celsius) or more.

The exception in this rule allows providers to take necessary steps to serve children properly cooked food in a timely manner at a safe temperature to prevent injury. There is not a specific temperature that is safe for all foods and liquids to be served to children to prevent scald burns. Some foods such as mashed potatoes, grits, and oatmeal hold heat and may be more likely to cause burns during food service. Steps should be taken so food is served to children at a safe temperature but also to prevent injury if it is spilled.

The American Burn Association identified factors that increase the severity of a scald injury. These factors include the length of time and type of contact with hot substances, temperature of the substance, type of substance, the amount of body area scalded, and location of the scald.

As explained by KidsHealth, burns are categorized as first, second, or third-degree, depending on how badly the skin is damaged. The chart below shows water temperature and how quickly a third-degree burn can occur at that temperature. A third-degree burn, the most serious type of burn, occurs when all three layers of the skin are burned, and can cause damage to bones and muscles.

There are several ways to help protect children from scalds:

Do:

• Keep hot food, hot liquid, and bottle warming equipment out of reach of children by moving the food and equipment away from the edges of counters.
• Create a "NO KID ZONE" if you cook or serve lunch in a space with children present. Place colored tape on the floor to create a visual boundary to remind children of the "no kid zone" that exists while cooking, preparing, or serving food. Provide adequate supervision for the age and developmental abilities of children in your care.
• If you plate food in a space with children present, consider having an additional caregiver in the space to interact with the children while one caregiver handles and plates hot food.
• Use appropriate bottle warming equipment. Child Care Rule 10A NCAC 09 .1706(p), for family child care homes, states that microwaves shall not be used to thaw or warm breast milk, baby food, formula or other bottled beverages. Bottle warming equipment and power cords must be inaccessible to children when in use. For centers, Sanitation Rule 15A NCAC 18A .2804(d) states that microwaves will not be used to thaw or warm breast milk, baby food, formula or other bottled beverages. Centers must use bottle warming equipment with shorter power cords.
• Temperature of formula or breastmilk in a warmed bottle can be tested by putting a couple of drops on the inside of your wrist. Formula should be barely warm, not hot.
• Remember microwaves can heat unevenly and create hot spots in food and liquids. Stir food after plating to cool the food and avoid hot spots. Spread food on the plate to help with cooling. Sanitation Rule 15A NCAC 18A .2807(f) states that potentially hazardous foods requiring cooking and being cooked in a microwave oven shall be rotated during cooking to compensate for uneven heat distribution and shall be heated an additional 25°F to compensate for shorter cooking times.
• To help reduce burn hazards, plate food and keep away from children until there are no signs food is too hot to serve. Look for steam and listen for sounds such as sizzling to indicate that food may be too hot.
• To help reduce burn hazards, determine if food is too hot for children to safely carry food from food service line to eating area.
• Post first aid posters in food preparation and food service areas. NC Child Care Rule 10A NCAC 09 .0802 (g) and .1719 (a)(14) require a First Aid information sheet be posted in a place for quick reference by staff members. Request a First Aid information poster free of charge from the NC Child Care Health and Safety Resource Center at 1-800-367-2229.

Do Not:

• Do not place anything hot within a child's reach.
• Do not drink hot beverages or soup with a child sitting on your lap. Best practice is to not allow hot beverages in child care spaces.
• Do not carry hot liquids or hot dishes near children.
• Do not warm baby bottles in a microwave oven. Microwave heated liquids may heat unevenly, resulting in hot spots of breast milk or formula that can scald a baby's mouth.
• Do not allow children to carry hot food or liquids.

Additional Resources:

KidsHealth for Parents: Information on Burns

American Burn Association: Scald Injury Prevention Presentation

American Burn Association: Scald Injury Prevention Educator's Guide

Safe Kids Worldwide: Burns and Scalds Prevention Tips

Safe Kids Worldwide: Burns and Fire Safety Fact Sheet

Nationwide Children's Hospital: Burn Prevention: Infant and Toddler

Burn Foundation: Safety Facts on Scald Burns

National Scald Prevention Campaign