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Scald burns in children caused by hot drinks—the importance of the type of cup
Abstract
A prospective study of 36 consecutive scald injuries in children caused by hot beverages is reported. Almost a third of these were deep dermal or full skin thickness and the highest percentage resulted in injury to the upper chest region. The study further investigates the cooling characteristics in four different types of cup. These studies clearly show the potential for significant disfigurement from this type of injury for up to 11 min from the time the drink is poured. The need for greater public awareness in relation to hot drinks is highlighted.
... When this figure is extrapolated to the estimated 800 paediatric scalds requiring admission in the UK alone, this figure reaches £3.2 million, not including outpatient dressing and scar management, and any psychological support that may be required. Fundamentally, the significant morbidity and costs resulting from these injuries highlights the need for effective primary prevention [8][9][10][11][12][13]. ...
... Recent global concern regarding the impact of plastic waste to the environment has resulted in a concerted effort to promote reusable thermoplastic drink containers [14][15][16], with numerous vendors offering discounts and incentives for the use of these cups. Previous literature states that the retention of heat within a liquid is directly related to the volume of liquid, temperature at the time of spill and the presence of a lid and corrugated insulating sleeve [7,[11][12][13][17][18][19][20]. Cup material has been shown to play a minor factor in cooling when comparing disposable paper and polystyrene [18]. ...
... Arrhenius-kinetics mathematical models by Moritz, Abraham and Buettner has been widely used to describe and predict thermal insult effects on skin [21][22][23][24][25][26][27][28]. These models demonstrate complete trans-epidermal necrosis and significant burns to occur at specific temperatures [7,[11][12][13]21,28,29]. ...
Recent global concern regarding the impact of plastic waste on the environment has resulted in efforts to utilise reusable drink containers. Research is lacking regarding temperature dissociation of drinks in reusable thermoplastic cups. This study aimed to compare the cooling time of two common hot drinks sold at a UK retailer, in the three vessels they are sold; ceramic, disposable paper (with and without lid) and reusable thermoplastic cups (with and without lid). All temperatures were collated from 250 ml volumes of black Americano coffee or café latte in the three different containers. The cooling time was measured every sixty seconds using a standardised digital thermocouple thermometer until a threshold liquid temperature of 43 °C was reached. All experiments were performed in triplicate and temperatures converted to a dimensionless logarithmic scale prior to statistical analysis. Cooling time was significantly slower for lidded cups irrespective of material. Unlidded thermoplastic cups significantly slowed cooling times for both black Americano coffee and café latte compared to ceramic and unlidded disposable paper cups. The growing trend in reusable cups does not in itself pose an increased risk of scald injury. However, we consider that the potentially increased ambulatory behaviour associated with using a lidded rather than unlidded cup may increase scald risk. We propose that further consumer guidance should be disseminated regarding the use of any lidded takeaway container to prevent scalds in both adults and children.
... It is estimated that in the U.S. and Europe at least ninety per cent of the adult populations consume caffeine-containing beverages several times each day [1][2][3][4][5]. It is also known that consumers prefer their hot coffee to be in the range of 45-60°C (i.e. as hot as 140°F) [6][7][8][9][10]. If such a drink is spilled on the exposed skin it can cause full-thickness, third degree burns within 5 seconds [6][7][8][9][10]. ...
... It is also known that consumers prefer their hot coffee to be in the range of 45-60°C (i.e. as hot as 140°F) [6][7][8][9][10]. If such a drink is spilled on the exposed skin it can cause full-thickness, third degree burns within 5 seconds [6][7][8][9][10]. These are the kinds of burns that produce permanent damage and scarring for life [8,10]. ...
Arguably, caffeine is the world’s leading drug of choice. It is estimated that in the U.S. and Europe at least ninety per cent of the adult populations consume caffeine-containing beverages several times each day. It is also known that consumers prefer their hot coffee to be in the range of 45-60°C (i.e. as hot as 140°F). If such a drink is spilled on the exposed skin it can cause full-thickness, third degree burns within 5 seconds. These are the kinds of burns that produce permanent damage and scarring for life. The prudence of consuming hot coffee and other hot drinks at such temperatures is questionable, especially when children and adolescents are involved.
... 20 Theoretical models by Moritz, Abraham, and Buettner has been widely used to describe and predict thermal insult effects on skin, [20][21][22][23][24][25][26][27] which suggest that complete trans-epidermal necrosis and significant burns occur at specific temperatures. 20,[27][28][29][30][31][32] 43°C is recognized to be the level at which heat is painful is in adults, and is used as a benchmark threshold for scald injury experiments. [20][21][22][23][24][25][26][33][34][35] How can this scenario be avoided going forward? ...
Hot water immersion (HWI) therapy is an effective and validated treatment for a variety of marine stings. Unsupervised, however, it poses a significant risk of thermal injury. Herein, we describe our experience of iatrogenic thermal injury secondary to marine sting treatment. A five-year retrospective review of all iatrogenic thermal burns secondary to marine stings referred to the State Adult Burn Service was conducted. Nine patients were identified, all sustaining stings to the feet from estuarine cobblerfish, stonefish and stingrays. All patients continued unsupervised HWI at home and sustained thermal injury to their feet. The majority were treated conservatively with dressings and elevation. One patient required surgical debridement.
Whilst heat application is an effective treatment for marine stings, further patient education is required following discharge from point of care. We recommend that first aid treatment guidelines be updated to reflect that patients are not recommended to continue scalding water immersion at home. However, if patients wish to continue HWI, water temperature should be checked manually with a thermometer or with a non-stung limb and limited to 30 minutes immersion, with 30-minute skin recovery time between.
... Extensive research has shown that spills which occur at higher temperatures (ß180°F) are very likely to cause at least middermal burns which are very serious and often necessitate medical intervention (Abraham et al., 2016;Abraham, Plourde, Vallez, Stark, & Diller, 2015;Andrews, Kimble, Kempf, & Cuttle, 2017;Loo, Haider, Py, & Jeffrey, 2018). In addition, some populations (children and elderly for instance) are more at risk for injury because of their thinner skin, inability to move quickly after a spill incident, and smaller body size (Drago, 2005;Lowell, Quinlan, & Gottlieb, 2008;Ramanathan, Ekpenyong, & Stevenson, 1994). ...
Hot beverages are served ubiquitously in the food‐service industry as well as at residences and other venues. Coffee and tea beverages, in particular, are brewed at temperatures that are sufficiently high to cause immediate and serious risk for scald injuries. On the other hand, numerous research studies have been performed to identify the preferred consumption temperatures for hot beverages. The outcome of these mutually reinforcing studies is that the preferred drinking temperatures are significantly below the often‐encountered brewing temperatures (∼200 °F). Consequently, there is great need to distinguish brewing temperatures from serving temperatures. Serving consumers beverages at very high temperatures is not only unnecessary (from a preference standpoint) but also unsafe. An appropriate range for service temperatures is (130 to 160 °F). Often times, hot beverages are served at temperatures near their brewing temperature; far hotter than preferred by consumers. This practice creates unnecessary risk to the consumer. A more rationale recommended range of service temperatures is 130 to 160 °F. This recommendation balances a range of consumer preferences and safety.
... It seems reasonable to promote the service of beverages at temperatures which are both preferred by consumers and safe so that serious mid-dermal burns are unlikely. The cooling results set forth here are corroborated by other mutually reinforcing studies [62][63][64] . It should also be noted that while the above tables correspond to typical adults and children (whose skin thickness is approximately 70% that of an adult), great care must be given to their use [55,65,66] . ...
... Interestingly though, 11% of the scalds from beverages made >5min earlier resulted in deep dermal burns. This supports previous studies that report exposure to hot liquids (>65 C) for just two seconds can result in a significant burn to a child's skin [18,19]. Given that a freshly brewed cup of black tea or coffee remains above 65 C even after 10min' cooling time (5min for hot beverages with milk), the scald injury risk period is considerably longer than many parents and caregivers may realise [20]. ...
Objective:
Hot beverage scalds are a leading cause of burns in young children. The aim of this study was to look at the circumstances surrounding these injuries in terms of setting, mechanism, supervision and first aid to inform a prevention campaign.
Methods:
A cross-sectional study was delivered via iPad to parents and caregivers presenting with a child aged 0-36 months with a hot beverage scald at a major paediatric burns centre.
Results:
Of the 101 children aged 0-36 months that presented with a hot beverage scald over a 12-month period, 54 participants were included. The scald aetiology was as expected with the peak prevalence in children aged 6-24 months, pulling a cup of hot liquid down over themselves. The majority of injuries occurred in the child's home and were witnessed by the caregiver or parent. The supervising adult was often in close proximity when the scald occurred. Less than a third (28%) of participants received recommended first aid treatment at the scene, with an additional 18% receiving this treatment with three hours of the injury-usually at an emergency department.
Conclusions:
While the aetiology of these scalds were as expected, the low use of recommended burn first aid was of concern. Although supervision was present in almost all cases, with the parent/caregiver close-by, this proximity still permitted injury. Attentiveness and continuity of supervision, which can be difficult with competing parental demands, appear to play a more important role role; as do considerations of other safety mechanisms such as hazard reduction through keeping hot drinks out of reach and engineering factors such as improved cup design. By incorporating the findings from this study and other research into a hot beverage scald prevention campaign, we hope to see a change in knowledge and behaviour in parents and caregivers of young children, and ultimately a reduction in the incidence of hot beverage scalds.
... The utility of Tables 2-5 is that they provide the spill temperature for any situation of service temperature and cooling time prior to a spill incident. The results listed in Tables 2-5 are very close matches to previously published work which increases confidence in the results (Mercer 1988;Ramanathan et al., 1994;Warner et al., 2012). ...
Without conscious thought, listeners link events in the world to sounds they hear. We study one surprising example: Adults can judge the temperature of water simply from hearing it being poured. We test development of the ability to hear water temperature, with the goal of informing developmental theories regarding the origins and cognitive bases of nuanced sound source judgments. We first confirmed that adults accurately distinguished the sounds of hot and cold water (pre‐registered Exps. 1, 2; total N = 384), even though many were unaware or uncertain of this ability. By contrast, children showed protracted development of this skill over the course of middle childhood (Exps. 2, 3; total N = 178). In spite of accurately identifying other sounds and hot/cold images, older children (7‐11 years) but not younger children (3‐6 years) reliably distinguished the sounds of hot and cold water. Accuracy increased with age; 11 year old's performance was similar to adults’. Adults also showed individual differences in accuracy that were predicted by their amount of prior relevant experience (Exp. 1). Experience may similarly play a role in children's performance; differences in auditory sensitivity and multimodal integration may also contribute to young children's failures. The ability to hear water temperature develops slowly over childhood, such that nuanced auditory information that is easily and quickly accessible to adults is not available to guide young children's behavior. Adults can make nuanced judgments from sound, including accurately judging the temperature of water from the sound of it being poured. Children showed protracted development of this skill over the course of middle childhood, such that 7–11 year‐olds reliably succeeded while 3–6 year‐olds performed at chance. Developmental changes may be due to experience (adults with greater relevant experience showed higher accuracy) and development of multimodal integration and auditory sensitivity. Young children may not detect subtle auditory information that adults easily perceive. Adults can make nuanced judgments from sound, including accurately judging the temperature of water from the sound of it being poured. Children showed protracted development of this skill over the course of middle childhood, such that 7–11 year‐olds reliably succeeded while 3–6 year‐olds performed at chance. Developmental changes may be due to experience (adults with greater relevant experience showed higher accuracy) and development of multimodal integration and auditory sensitivity. Young children may not detect subtle auditory information that adults easily perceive. This article is protected by copyright. All rights reserved
Non-accidental scalds sustained with sugar solution are potentially devastating and often associated with assaults within prisons where they are commonly known as ‘Napalm’ attacks. However, little is known about the mechanism behind such injuries. Proposed explanations have included a higher initial temperature, increased viscosity compared to water and lower emissivity, although these have yet to be demonstrated in any experimental model. We therefore set out to measure the post-exposure cooling temperature of the dermis after exposure to different concentrations of boiled sugar solution in a dead porcine model.
Dead pork belly tissue was pre-heated to human body temperature (36.3–38.4 °C). Five solutions with different concentrations of sugar (0, 250, 500, 1000 and 2000 g/L) were heated to boiling point using standard commercially available kettles and then poured directly onto the tissue. Intradermal temperatures of the dermis were measured at one-minute intervals for a duration of 10 min.
At one-minute post-exposure, average intradermal porcine temperatures were 46.7 °C, 47.9 °C, 48.9 °C, 50.8 °C and 51.7 °C respectively for increasing concentrations of sugar solution. The rate of cooling was similar in all solutions with an average loss of 1.5 °C per minute. Using a generalised mixed model accounting for concentration and time period, it was identified that increasing sugar concentration resulted in statistically higher temperatures of burn (p = 0.006).
Our report finds that higher concentrations of boiled sugar solution caused a higher initial temperature of burn but did not influence cooling rates. This suggests that ‘Prison Napalm’ attacks will indeed cause more severe burns than those utilising plain water, but not for all the widely believed reasons. We therefore recommend that access to kettles in prison cells should be limited, but where such access is deemed a right, consideration should be given to temperature restricted devices, as is the case in other countries.
Aim:
To identify policies on the consumption of hot drinks by patients and visitors on all perinatal and postnatal wards in the United Kingdom, and to seek the opinions of members of the wider burns MDT as to whether standardised patient education or regulation of hot drinks around newborn babies is required.
Methods:
All maternity units with postnatal wards across the United Kingdom were surveyed to establish availability of hot drinks on site and whether these were permitted on postnatal wards around infants. An online questionnaire was distributed to members of the British Burn Association to ascertain opinions on hot drinks policies.
Results:
Hot takeaway drinks were permitted around newborn infants in 194 of surveyed postnatal wards and were only banned by two units. The online survey received 49 responses from different members of the British Burn Association. Thirty responders (61%) supported a takeaway hot drink ban, while those against the policy would alternatively encourage patient education, dedicated drinking areas and introduction of safety measures.
Conclusions:
Almost every postnatal unit in the UK has access to hot drink retailers on site allowing parents and visitors to bring them into close contact with babies. With varying local regulations, this poses potentially serious consequences during feeding or carrying. We propose a standardised antenatal education be made available, together with standardised designated areas on wards for parents and visitors to consume hot drinks away from infants.
The cooling characteristics of a variety of hot-water receptacles have been tested to provide a guide to the temperatures involved in a scald.
Childhood scalds are a regrettable, but common cause for admission to the McIndoe Burns Centre. A survey of the recent literature confirms that this is not a local but an international problem, and furthermore that the majority of scalds affect children less than 2 years of age. With hindsight, it is possible that a sizeable proportion of these scalds could have been prevented. Taking into account a survey carried out at Waikato, New Zealand, we should like to propose a scheme for public health education; this will be carried out by medical and nursing staff from the unit and will form the basis for a prospective study.
A survey was carried out on all burns admitted to a regional burns centre over a 3-year period. A total of 937 patients were admitted to the Unit, of whom 43 per cent were under 15 years of age and 31 per cent were less than 5 years old. A detailed computer analysis of those patients admitted under the age of 15 years is presented, with special emphasis on scalds in the pre-school child.