Burn care in children: Special considerations

The majority of children (52 per cent) admitted each year to our institution are under 2 1/2 years of age and progressively fewer admissions are required as children become older. The majority of admitted patients had relatively small burns with perhaps 75 per cent of the inpatients having a superficial scald burn involving less than 10 per cent of the total body surface area. Burns were usually caused by hot liquid spills at home during a toddler's misdirected explorations. Scald burns accounted for about one half of all hospital admissions; flame burns were present in about 15 per cent of the children admitted. Flame burns tended to be more severe and frequently were associated with inhalation injury. Contact burns were most frequently observed in the toddler age group (12 to 36 months) and these represented 13 per cent of Burn Unit admissions. These burns usually involved a very small portion of the body surface area but frequently involved the hands or feet and were not uncommonly associated with a suspicious history of origin that suggested the potential for abuse. During the past 2 years, we have noted a sharp increase in contact burns related to the use of wood stoves and kerosene heaters. These injuries have increased more than 60 per cent during the last 2 years and are particularly prone to occur in toddlers. The majority of these children have palmar burns that were sustained during exploration. Other types of burns that are less frequently observed are electrical injuries. Interestingly, high-voltage electrical injuries are quite uncommon, and the most frequent type of electrical burn observed is the electrical injury to the commissure of the mouth as a result of biting on an electrical cord. This continues to represent approximately 3 per cent of annual admissions. There continues to be a significant number of patients with wringer injuries (10 per year) admitted to the Burn Unit despite the fact that production of wringer washers has ceased.