‘Better prevent burns in children than treat them’

Burns is the fifth most common cause of non-fatal childhood injuries in children. Unfortunately, children are particularly vulnerable to it. In this report by SADE OGUNTOLA, experts say that a considerable number of burn injuries in children are preventable in the home.

 

Two months ago, three children aged between nine months and nine years lost their lives due to burns sustained after extremely hot porridge poured on them in Bauchi State.

The children and the porridge were being transported in the same tricycle, popularly known as Keke, when the incident happened. The porridge was being transported in a jumbo-size plastic flask.

When the tricycle plunged into a pothole, it upturned, emptying its contents on the children’s heads, shoulders and chests.

Within that month, a gas explosion that occurred in Ajegunle area of Lagos, Southwest, Nigeria, left two children burnt to death and 23 others severely burnt. The gas cylinder store had exploded as a result of gas leakage.

Burns in children impose enormous economic burdens on families and society. Burn injuries are most prevalent in children under three years. Toddlers are naturally curious.

As soon as they are mobile, they are curious about their surroundings and they want to play with new objects. Yet this natural learning process means they come in contact with objects that can cause burns.

Playing with fire or touching hot objects can result in burns, causing intense pain and often long-term consequences. So also is playing near cooking stoves or burning bush or filling up lighted kerosene lamps and cooking stoves, resulting in explosions near a baby.

A burn is an injury to the skin or other organic tissue primarily caused by heat or due to radiation, radioactivity, electricity, friction or contact with chemicals.

There are many different causes of burns in children, including sunburn, hot water or other hot liquids, and those due to fire, electrical contact or chemicals.

All of these can cause permanent injury and ill-health, including prolonged hospitalisation, disfigurement and disability, often with resulting stigma and rejection.

In general, most burn injuries are minor and do not necessitate hospital admission.  Minority of burn injuries are serious and meet the criteria for transfer to a burn centre. Conversely, burn injuries tend to be classified based on the total body surface area involved and the depth of injury.

World Health Organisation (WHO) says that burns are a global public health problem, accounting for an estimated 180,000 deaths annually. The majority of these occur in low and middle-income countries and almost two-thirds occur in the WHO African and South-East Asia regions.

Unfortunately, a high incidence of burn-related injuries in the paediatric age group is reported in many hospitals, including University College Hospital (UCH), Ibadan and has become a cause for concern because many of them were preventable.

Over a five-year period (January 2011–December 2015) at the Plastic Surgery Unit of the Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, 47 children sustained burn injuries to the hand.

Researchers in the 2018 edition of the Nigerian Journal of Plastic Surgery said most of the children suffered scald injury followed by contact burns.

Dipping hands into hot water were the most common cause of injury. Holding hot charcoal was the most common type of contact burns. The hands only were affected in 37 of the children. The burns mostly occurred at home.

Reports have shown that the hand, neck, shoulders and chests (upper extremity) are involved in up to 50 per cent of children who sustained burns.

In 2014, a survey in the journal, Burns, said 289 children representing 45.3 per cent of the total number of burn patients were managed over a 10-year period from January 2001 to December 2010 at UCH, Ibadan.

Dr Rotimi Aderibigbe, a burns expert, speaking during the 2019 World Burns day celebration at the Nigerian Burns Injury Society, Oyo State, said bad cultural practices accounted for many of these burn cases in children.

He said carrying a kettle of hot water to mix water in the bathroom for a hot bath; allowing underage to cook; children playing in the kitchen, wrong methods of lighting gas cookers and improper storage of combustible liquids had left many children with burns.

“Children playing games on the phone often do not want to stop. They have it plugged into the electricity mains but there is a possibility of the plugged phone they are playing with exploding,” he added.

Dr Aderibigbe said although the scald and burns from hot water is the commonest, they are also exposed to flame burns that is from a gas explosion and electrical shock.

He declared that this unintended injury in children may not only affect their skin, but even internal organs of the body, including the respiratory tract and bones, depending on the cause of such a burn.

“If there is a gas leakage, it stays in the air and follows into the airway, causing inhalation injury. It can burn the airway and the other internal organs. An electrical burn is even more severe. Although it may be just a small area of skin that was burnt, the damage inside the body might be wider and deeper; bones, muscles and the internal organs may be severely affected.”

Dr Aderibigbe stated that the burns and scarring in children have short and long term implications. “Once the skin is burnt or scarred, you cannot have it smooth anymore. Imagine how much psychological problem such a child would be faced with during growth and later on in life.

“This is aside from other complications like the skin gumming together and limiting movement in areas like the elbow. A scar around the breast as a girl-child grows may prevent the development of breast, so that could affect breastfeeding later.”

Even a small surface area burnt in the hand may adversely affect hand function. It could also have a huge impact on the overall quality of life and significantly influence successful integration into society.

Dr Aderibigbe declared that the treatment of burns demands many hours of wound care from nursing staff and possibly one or multiple surgical procedures. Also, hospitalisation costs associated with burn care are extremely high.

Unfortunately, burn injury truncates schooling in child and adolescent burn patients. A review of paediatric burn survivors at the UCH, Ibadan, indicated that on the average a child with burn could be hospitalised for treatment for 30 days.

Also, such a child, it is said might return to school after discharge from the hospital after 8.4 weeks. But, burns on the chest or trunk are, however, associated with an earlier time to return to school.

This was a cross-sectional study of child and adolescent patients aged one to 19 years that were burn survivors at the hospital.  This 2019 study published in the journal, Burns, involved Michael A.I, Ademola S.A, Olawoye O.A, Iyun A.O, Arowojolu O and Oluwatosin O.M.

In addition, there are a number of specific recommendations for individuals, communities and public health officials to reduce burn risk.

*Keep hot drinks and pot handles out of reach of children.

* Never leave children alone in the bathroom or kitchen.

*If a child is burned, apply immediate first aid by placing the burn under cool running water for a minimum of 20 minutes and take immediately to the hospital.

* Do not use butter, oils, ointments or ice to treat burns as these can further damage the skin.

*Promote safer cook stoves and less hazardous fuels, and educate regarding loose clothing.

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