Burns and scalds - children

Children are naturally curious and love to explore. They don’t understand that hot water and hot drinks can burn them, and a child’s sensitive skin burns far more easily than an adult’s. Burns and scalds are a major cause of serious injury in children, from newborns through to age 14.

Children under four years old – especially those aged one to two – are most at risk, because they are increasingly mobile but still very curious. A severe scald can cause a serious injury, a long hospital stay, painful skin grafts and years of treatment, and may leave permanent scarring. A severe scald over a large area of skin can be fatal.

What causes burns and scalds#

Scalds are burns caused by hot liquids or steam, and any hot substance can scald a child. Treat all hot things as if they are as dangerous as fire. Everyday items in and around the home cause most burn and scald injuries, including:

• hot drinks such as tea and coffee
• hot water from saucepans, kettles, jugs, urns and thermoses
• hot food and saucepans of hot liquid
• hot tap water, showers and bath water
• fat and hot cooking oil
• steam and vapour
• coal ashes
• lighters and matches
• friction burns (for example, from treadmills)
• vehicle exhausts

When injuries are most likely#

Injuries often happen when families are rushed, under pressure, distracted, tired or unwell, or when there is a lot going on at once. Children are also most at risk when routine is disrupted – away from home, visiting friends or family, or on holiday.

The hours between about 4 pm and 7 pm are a busy time, and it is easy to become distracted. A simple routine can reduce the risk. For example:

• Give a toddler their main meal at lunch time and serve something light that doesn’t need cooking in the early evening.
• Set bath time for quieter parts of the day when there are fewer distractions. (Occasionally a wipe-down can replace a bath.)
• Prepare the evening meal earlier in the day, when you are less likely to be interrupted.

Preventing burns and scalds in the bathroom#

The bathroom is one of the most hazardous rooms in the house for a baby or child. As well as scalds and burns, there are risks of falls, poisoning and drowning. Most hot tap water scalds happen in the bathroom. To reduce the risk:

• Use a bath thermometer so the bath water is always a safe temperature. The recommended bathing temperature for young children is between 37°C (98.6°F) and 38°C (100.4°F).
• Run cold water first and turn it off last so the tap spout is left to cool.
• Use non-slip suction bath mats to help prevent falls, and soft bath spout covers to reduce injury.
• Keep the bathroom door closed when not in use. You may wish to fit a lock or restraint on the outside of the door, out of reach of children but accessible to adults in an emergency.
• Always stay within arm’s reach of children in the bath. If you have to answer the door or phone, take the child with you.

Turn your hot water down#

The hotter the water, the faster it burns. Cooler water takes longer to cause injury, which gives more time to react. As a guide, water at about 60°C (140°F) can cause a full-thickness (third-degree) burn in roughly one second, water at about 55°C (131°F) in about ten seconds, and water at about 50°C (122°F) in about five minutes.

The delivery temperature of domestic hot water is often around 70°C (158°F). A much safer maximum is 50°C (122°F). To control the temperature, talk to a licensed plumber about options such as:

• tempering valves, fitted to the water pipeline, which mix hot and cold water to a set temperature (commonly adjustable between about 35°C and 50°C)
• hot water shutdown devices, fitted to the tap, which cut off the flow once the water reaches a pre-set temperature

Many regions now require new hot water systems to limit bathroom tap water to no more than 50°C at the basin, bath and shower in new homes and renovations. Facilities used by children and older people, such as early childhood centres, schools and care homes, may use an even lower limit (around 45°C), so cold water still needs to be mixed in.

Preventing burns and scalds in the kitchen#

• Always supervise children in the kitchen and never leave cooking unattended.
• Keep hot drinks, pot handles and cords out of reach. Put your baby down somewhere safe before you drink something hot.
• Use the back hotplates first, and turn saucepan handles inwards, towards the back of the stove.
• Install stove and oven guards.
• Use non-slip place mats instead of tablecloths, and keep hot drinks away from the edge of the table or bench. Where possible, use a cup with a lid.
• Make it a habit from birth to keep hot drinks out of a child’s reach – you never know when a baby will suddenly be able to reach or a crawler will start to toddle.
• Never carry hot drinks while children are playing underfoot or while holding a child.
• Use a cordless kettle, or keep cords well away from the edge, and empty unused water out after boiling.
• Give toddlers their own special mug so they don’t drink from an adult cup that may be too hot.
• Carry plates to the pot, not the pot to the plates. Serve cold drinks when children are present and take a hot drink break while they sleep.
• When you are very busy, a playpen, highchair or child safety gate can keep a toddler out of harm’s way for a short time.
• Extend the same care when you are away from home, visiting friends and relatives or attending playgroups.

First aid for burns and scalds#

Immediate first aid reduces the severity of a burn. First, stop the burning process while keeping yourself safe.

• If clothing is on fire: stop, drop to the floor, cover the face with the hands, and roll to put the flames out. You can also smother the flames with a woollen blanket. If the person cannot do this themselves (such as a baby or young child), help them.
• If the burn is electrical: turn off the current at the switch. Do not touch the person while they are still in contact with the current.
• If the burn is chemical: remove the burning agent and wash the area with cool running water for 20 minutes. Do not let the chemical touch your own skin. Seek advice about what to do if a chemical burn affects someone’s eyes.

Then treat the burn:

• Remove any clothing or jewellery near the burn, unless it is stuck to the skin.
• Apply cool running water to the burn for 20 minutes (not ice or iced water).
• Keep the child warm by placing a blanket over the unburnt areas.
• Cover the burn with a clean dressing, a clean sheet, a clean non-fluffy towel, or cling film.
• If the burn is severe or covers a large area, keep the child warm and calm and call your local emergency number for an ambulance.

Burns to the face, hands, feet, genitals or bottom, or any burn larger than a small coin, need urgent medical attention.

What not to do#

• Never use butter, oils or ointments on a burn – they trap heat and can make the injury worse.
• Never use ice or iced water, which can deepen the injury and dangerously lower a child’s body temperature.

Learning first aid#

Consider taking a first aid course. Many hospitals, ambulance services and first aid organisations run courses for the public, which are especially useful for parents, grandparents, nannies and childcare providers. You can search for a first aid training provider in your area.

Key points#

• Young children don’t understand that hot water and hot drinks can burn them, and their skin burns far more easily than an adult’s.
• Burns and scalds are a major cause of serious injury in children from newborn to 14 years, with those aged one to two most at risk.
• A severe scald can cause serious injury, a long hospital stay, skin grafts, years of treatment and permanent scarring, and a large scald can be fatal.
• Keep hot drinks and pot handles out of reach, supervise children in the kitchen and bathroom, and turn domestic hot water down to a safer temperature.
• For any burn, cool it with running water (never ice), cover it, and seek urgent care for severe or large burns or burns to sensitive areas.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).