2TABLE OF CONTENTS Beginnings Slide 3 Objectives Slide 4 Best Practice Guidelines Slide 7Key Message Slide 11Characteristics leading to Injury Slide 15Images Slide 22Prevention & First Aid Slide 26References Slide 34
3“It only takes a second to change a life forever.” BEGINNINGSFrances MacDougallThis tool was developed by Frances MacDougall, a clinical nurse who worked for many years on the Burn Unit at BC Children’s Hospital. After hearing many caregivers say they were not aware of the burn hazards in the home or how seriously their child could be injured, Frances developed an evidence-based educational resource for front line educators.This resource was developed with the support of Dr. Cynthia Verchere, pediatric plastic surgeon and Director for BC Children's Hospital Burn Unit, Safe Kids Canada, the BC Professional Fire Fighters' Burn Fund and Safe Start, the injury prevention program of BC Children's Hospital.Frances would like to extend her appreciation to the BC Injury Research and Prevention Unit, the Division of Plastic Surgery at BC Children's Hospital and to the Vancouver Costal Health Authority for supporting the Impact Evaluation of this program.“It only takes a second to change a life forever.”The black and yellow line – to the left of BEGINNINGS does not appear in the slide show version? Missing animation?
4OBJECTIVES Resource Objectives Structure Key Concepts For this ResourceResource ObjectivesIncrease caregiver awareness about the high risk of burn and scald injuries to children 5 years and under.StructureThis resource is structured on the principles of Evidence-Based Learning and best practices. This learning model proves that strong scientific and medical evidence can effectively promote behaviour change and stimulate parents and caregivers to perform the necessary steps to prevent many of the common burn injuries seen in this young and vulnerable age group.Key ConceptsBurn injury rates are highest during a child’s first year of life.Scald injuries from hot liquids like tea, coffee and hot water are the most common sources of burns in this age group.Although less than 7% of scald burns are caused from hot water, these injuries tend to be more serious than scalds from other sources and require more medical care.Providing constant, close supervision of a child when they are near a burn hazard is the most important strategy parents can employ to keep their child safe.Suggested ProcedureReview the information in this handbook to familiarize yourself with the latest data and statistics and recommendations.Create opportunity for caregivers to view the video in a facilitated session followed by group discussion. The Impact Assessment Study showed that knowledge transfer and behavior change was most successful when delivered in this format.The Caregiver’s Discussion presentation was developed to support post-video discussion. The take-home, Too Hot for Tots! Brochure high lights the video’s key messages and includes a temperature testing card and link to view the video online.
9Education Environment Enforcement To achieve long term change and success, injury prevention programs should include a multi-dimensional approach known as The Three E’s. 9EducationChanging parental knowledge,attitudes and behaviorsEnvironmentEnforcementMinimizing or eliminatinghazards in the homeLegislative changes
11PROGRAM’S KEY MESSAGE What We Want Everyone to Know Early Childhood Injury Prevention ProgramWhat We Want Everyone to KnowPROGRAM’S KEY MESSAGE
12Why Focus on Burns?Why Focus on Burns?Research estimates that 90% of unintentional injuries are preventable by implementing strategies that are known to be effective. 1For injuries that occur in the home, burns are the second leading cause of emergency room visits for children under 5 in British Columbia. 2Infants and 1 year olds suffer a disproportionately high percentage of these serious burns. 3Approximately 130 children in this age group are treated for burn related injuries at B.C Children’s Hospital every year. 470% of Canadian parents do not know that the most common cause of burn injuries to children is scalds from hot liquids, such as tea and hot tap water, rather than from fire. 5Medical care following a scald injury is approximately two times higher than the average for all injuries in the CHIRPP Database. 6Tap water scalds alone cost $5 million annually in direct health care costs. 7 This does not include additional costs such as skin grafting, physical therapy or pressure garments.
13The average annual decline of burn injuries since 1993 was 0.07%. Emergency Department Surveillance of Pediatric Burn Injuries (CHIRPP) databaseThe average annual decline of burn injuries since 1993 was 0.07%.
14Treatment Required Following Burn Injuries CHIRPP Database, B Treatment Required Following Burn Injuries CHIRPP Database, B.C Children’s Hospital,Total number of admissions = 406Advice only = 24Treated and Followed up as needed= 23Treated and follow up required = 310Admitted to hospital = 42Direct admissions to ICU= 6Died = 1
15Characteristics that lead to tragic injuries Early Childhood Injury Prevention ProgramSocial and Cultural ContextCharacteristics that lead to tragic injuries
16The Ecological Theory of Risk Perception Social and Cultural factors that impact parenting behaviour by raising risk perceptionCaregiver CharacteristicsParenting experienceBeliefsParenting styleKnowledgePerceptionChild CharacteristicsDevelopmental AgeActivity LevelCognitive AbilityRisk TakingTemperamentEnvironmental CharacteristicsRisks/Hazards presentHot waterHot surfacesHot liquids
17Actions Taken based on Risk Perception Passive StrategiesOne-time actionsActive StrategiesOn-going actionsLower the temperature of thehot tap waterSecure a barrier aroundthe fireplaceChildproof bathroom andlaundry room doorsUse a mug with a lid*Provide constant closesupervision when aroundburn hazardsKeep appliances andcords out of reachReally like that you’ve add this line below the arrow. Re-worded to make it a little clearer.Risk of injury decreases as use of strategies increases*The Impact Study showed that although this behaviour change (using a mug with a lid) resulted in the best improvement to decreasing burn injuries, surprisingly few caregivers actually made this change. See Discussion Questions in the Caregiver’s Discussion presentation to help caregivers strategize and plan for this behaviour change.
18Caregiver Characteristics Parenting StyleInjuries are more likely to occur when there is no supervision or intermittent parental supervision.The lowest rate of injury occurred when there was constant supervision. 11Parenting ExperienceParents often underestimate or overestimate their child’s abilities and do not adjust those expectations based on the child’s development.12Parenting BeliefsParents may believe that children learn from being injured and that injuries are a natural consequence of play. 13Parents may also believe that teaching their child about burn hazards will keep them safe, but young children do not always remember or follow safety rules. 14“Most of these children were burned with their parents in the same room, who just weren’t able to get there in time.” Dr. Cynthia Verchere, Plastic Surgeon and Medical Director of the Burn Program at BC Children’s Hospital.It only takes seconds for serious burn injuries to occur that’s why parents need to be no more than an arms reach away from their child at all times when they are near a burn hazard.Parenting ExperienceParents told me that they were aware of the burn hazard in the room but thought they would be able to reach it before their child.Parenting BeliefsParents expect their child to remember and follow the rules but young children are impulsive and lack the cognitive skills to understand the consequences of their actions.PerceptionsMother’s were more likely to follow safety precautions and practices when they perceived the risk of injury to beserious.16KnowledgeAs parent’s education level increased, so did their belief that injuries could beprevented.15
19Child Characteristics Developmental AgeThe type of burn injury a child sustains is closely linked to their developmental age.Contact burns from gas fireplaces are more common in children under one year of age.17Activity LevelAround 6 months of age children usually start to crawl. They are then able to reach for, and grab objects of interest such as appliance cords or mugs containing hot liquids.21Cognitive AbilityBurn injuries peak between the first and second year of life19 because children's physical and motor development are growing faster, than their cognitive ability to understand the hazards.20TemperamentSome children are naturally more inquisitive and active which puts them at greaterrisk for injury.18Risk TakingBoys are more likely to be injured than girls.19
20Emergency Department Surveillance of Pediatric Burn Injuries (CHIRPP) database 1990-2008 Public Health Agency of Canada
21Environmental Characteristics Hot LiquidsMore than half of the children treated for scald injuries in the CHIRPP Database were burnt from hot beverages such as tea, coffee and soup. 22Hot WaterChildren who are hospitalized due to hot tap water scalds spend twice as long in hospital as result of their injury, compared to children who are scalded from other sources.23Tap water set at 60°C (140°F) cause a serious burn in less than 1 second, where as hot water that is lowered to the recommended 49°C (120°F) would take 10 minutes to cause the same damage.24Hot SurfacesThe glass of a gas fireplace heats up to 200°C (400°F) in just 6 minutes and takes 45 minutes to cool down to a safe temperature.This is hot enough to cause a third degree burn on contact.25
22Contact burn from fireplace The physical, emotional and social consequences of a burn injury in childhood are multifaceted. These children must undergo lengthy painful treatment and often require skin grafting and reconstructive surgery years later to improve cosmetic appearance and function. Family relations are often strained due to blame and guilt and shame.Hot Liquid ScaldHot Water ScaldContact burn from fireplace22
23Time & Temperature Interaction Associated with Scald Burns 26 Temperature: (°F)Burn Risk Exposure Time (seconds)Possible Exposure in Environment130°30Adults can consider this a reasonable temperature for hot drinks.145°2.5Too hot to drink for most people.150°1.8Dishwasher water temperature before cycle begins.170°0.03When the "rolling" metallic sound is heard in a metal teapot on stove.175°0.01The temperature of water or hot drinks from some home/office counter-top brewing units.180°instantCoffee/hot chocolate temperatures found in some family restaurants.185°
24Emergency Department Surveillance of Pediatric Burn Injuries (CHIRPP) database 1990-2008 7% ElectricalPublic Health Agency of Canada* Please note the statistics are not nationally representative of the entire Canadian population 0-14 yrs old, but rather only of the people 0-14 yrs old captured in CHIRPP hospitals across Canada.
25Emergency Department Surveillance of Pediatric Burn Injuries (CHIRPP) database 1990-2008 Percentage of Hot Water and Beverage Scalds by Circumstance7% Tap waterPublic Health Agency of Canada
26Prevention and First aid strategies Early Childhood Injury Prevention ProgramPrevention and First aid strategies
27Best Practices and Balanced Approach Best approach to injury preventionPassive MethodsActive MethodsLower the temperature of the hot tap water.Secure a barrier around the fireplace.Childproof bathroom and laundry room doors.Provide constant close supervision when around burn hazards.Use a mug with a lid.Keep appliances and cords out of reach.Risk Perception
28The 3B’s Be Aware BE CLOSE BURN PROOF Burn Prevention . Of the burn hazards inthe home and the seriousdanger they present to a childUsing these three strategies in combination is the most effective way to reduce the risk of a burn injuryWhen environments are not burn proofed, the other two strategies need to be heightened – being aware of the hazard and being close..Burn PreventionThe 3B’sBE CLOSEwithin arm’s reachwhen a child is near or around a burn hazardBURNPROOFthe home environment
29What Every Parent Should Know Immediate first aid is essential especially when sustained by a child. The top layer of their skin is thinner there for the damage from the heat sources moves quickly through into the deeper layers where nerves, blood supply, oil gland will be damaged. The depth of damage has a significant impacting on the skins ability to heal on it’s own without surgical intervention.First Aid Treatment for a Burn Injury
30Butter, oil, creams or ice should Stop the Burning!Remove any hot wet clothing unless it is stuck to the skin.At the same time find some cold water or cold liquid to cool the skin. Seconds count!Cool the skin and any clothing that is stuck to the skin for minutes or until the skin feels cool to touch.Continue cooling the skin, even if the skin peels or blisters. Cooling the skin helps reduce the pain and damage caused by the burn.Then cover with a clean clothBecause a child's skin is 4 times thinner it burns faster than an adults. The quicker the skin is cooled the less damage will occur.Butter, oil, creams or ice shouldnever be used on a burn.
31When to get help: If the burn is on the face, hands, feet or groin If blisters developIf the burn is larger than the size of a loonieParents should have someone else drive them to the hospital.Otherwise, call an ambulance!
32Knowledge and Behaviour Behaviour is influenced by more than “what we know” or “what we believe”27Studies have shown that even with this information, there are still a number of barriers that can prevent caregivers from implementing the behaviour changes required to reduce burn injury in the home.Parents are more likely to change their behaviour if they possess the following – be sure to ask:Do they have the necessary skills and resources to modify the child’s environment, i.e. hire a plumber to reduce water temperatures? Explore strategies they can use – how they can “be aware” and “be close” to keep their child safe when in these types of environments.Are there barriers to changing the home environment, such as cultural and family, i.e. grandparents and spouses that are resistant to this learning?Do they believe there is value and benefit in doing so? Many parents believe that it will “never happen to them”. Give a vivid example how quickly and easily this tragedy can happen. The Caregivers Discussion presentation has case studies and questions you can use.
33Through education and advocating for legislative change, we can make a difference and reduce the number of these preventable injuries.
34ReferencesThe Canadian Hospital Injury Reporting and Prevention Program (CHIRPP) collates data obtained from emergency admissions at ten pediatric hospitals and four general hospitals across Canada.The BC Children’s Hospital CHIRPP data contains information obtained from emergency admissions through BC Children’s Hospital.1 Safe KIDS Canada. Safer Homes for children – A guide for Communities 2006:3.2 Safe KIDS Canada. “Injuries Occurring In and Around Private Homes.” (CHIRPP) database, ages birth to four years, ; Table 3:8.3 Public Health Agency of Canada. “Emergency Department Surveillance of Pediatric Burn Injuries” (CHIRPP) database4 BC Children’s Hospital. “Burns in Children-Excluding Sunburns and Electrical burns.” BC Children’s Hospital (CHIRPP) database, ages birth to six years of age,5 Safe KIDS Canada. “ Majority of Canadian Parents Don’t Know Biggest Burn Hazards.” Safe Kids Week media release6 Public Health Agency of Canada. “Burns and Scalds in 1999 CHIRPP Database.” (CHIRPP) database 2002:09 (21)7 Safe KIDS Canada. “ National Code for Changes to Prevent Hot Tap Water Injury." Brief to Ministers January 2003.Coggan C, Patterson P, Brewin M, Rhonda H, Robinson E. “Evaluation of the Waitakere Community Prevention Project.” Injury Prevention June 2000;Speller V, Mulligan J, Law C, Foot B. “Preventing Injury in Children and Young People: A Review of the Literature and Current Practice.” Database of Abstracts of Reviews of Effectiveness , Centre for Reviews and Dissemination 1995:61.(Cited November, 2005)Saluja G, Brenner R, Morrongiello B. “The Role of Supervision in Child Injury Risk: Definition, Conceptual and Measurement Issues.” Injury Control and Safety Promotion 2004; 11(1):17–22.
35References (continued) 11 Morrongiello B, Ondejko L, Littlejohn A. “Understanding Toddlers’ In-Home Injuries: Examining Parental Strategies and Their Efficacy for Managing Child Injury Risk.” Journal of Pediatric Psychology 2004; 29(6):12 Morrongiello B, Ondejko L, Littlejohn A. “Understanding Toddlers’ In-Home Injuries: Examining Parental Strategies and Their Efficacy for Managing Child Injury Risk.” Journal of Pediatric Psychology 2004;29(6): 433–446.13 Morrongiello B, Dayler L. “A Community-Based Study of Parents’ Knowledge, Attitudes and Beliefs related to Childhood injuries”. Canadian Journal of Public Health November-December1996;14 Morrongiello B, Ondejko L, Littlejohn A. “Understanding Toddlers’ In-Home Injuries: Examining Parental Strategies and Their Efficacy for Managing Child Injury Risk.” Journal of Pediatric Psychology 2004;29(6): 433–446.15 Hu S, Wesson D. “Pediatric Injuries: Parental Knowledge, Attitudes and Needs.” Canadian Journal of Public Health March–April 1996; 101–104.16 Morrongiello B, Kiriakou S. “Mothers’ Home-Safety Practices for Preventing Six Types of Childhood Injuries: What Do They Do and Why?” Journal of Pediatric Psychology 2004; 29(4):285–297.17 Health Canada. “For the Safety of Canadian Children and Youth.” 1997; 8:18 American Academy of Pediatric. “The Injury Prevention Program” A Guide to Safety Counseling in Office practice: Age-Related Safety Sheets (Cited June 2005)19 Health Surveillance and Epidemiology Division (Public Health Agency of Canada). “Injuries Occurring In and Around the Home.” (CHIRPP) database (unpublished report) 2005.20 Health Surveillance and Epidemiology Division (Public Health Agency of Canada). “Injuries Occurring In and Around the Home.” (CHIRPP) database (unpublished report) 2005.21 Wilson M, Baker S, Teret S, Shock S, Garbarino J. Saving Children: A Guide to Injury Prevention. New York, NY: Oxford University Press, 1991; 86–87.Public Health Agency of Canada. “Scalds associated with Hot Beverages” (CHIRPP) database, all age, 1996.23 Safe KIDS Canada. “Tap Water Scalds - Position Paper.” Position Paper 2000.24 Safe KIDS Canada. “Bathing your child.” Information by topic
36Reference (continued) BC Children’s Hospital, Safety Station. “Tips for a Child-Friendly Home, Your Fireplace.” September The American Journal of Pathology, National Social Marketing Center. “Big pocket Guide- Social Marketing, second edition. The community against Preventable Injuries 2007:63.
37FEEDBACK Going Forward FRANCES MACDOUGALL RN, BC Children’s Hospital Developing this program has been a true labour of love. With the help of many individuals, organizations and our friends at Senga Consulting who helped put together the presentations and handbooks – it wouldn’t have gotten off the ground and into your hands.However, now that it has been distributed we need to work on the next phase which is fine-tuning and improvement.Now it is time to work with you, our front line educators. We would very much like to obtain your feedback on the resource and program. We will do this through an on-line survey. We appreciate and welcome all constructive suggestions and comments.Together I know that we can make a huge difference in the lives of small children – I look forward to hearing from you.
38SUPPORTERS FOR THIS PROGRAM AND THEIR MISSION STATEMENTS BC Professional Fire Fighters’ Burn FundBC Children’s HospitalDedicated to burn prevention as well as survivor support and recovery programs in the province of British Columbia. The organization is committed to providing financial assistance for the purchase of equipment, training of medical staff and the operation of a children's burn survivor camp.Improve quality. Be safe.Educate, learn and discoverDeliver innovative sub-specialized careWork together as a caring teamPartner with familiesPlan provinciallyCollaborate to create novel, community-based approachesSafe Kids CanadaSafe Kids Worldwide is a global network of organizations with a mission of preventing unintentional childhood injury, a leading cause of death and disability for children ages 14 and under.BC Injury Prevention and Evaluation UnitTo reduce the societal and economic burden of injury among all age groups in British Columbia through surveillance, research and knowledge development, knowledge synthesis, translation and education, and public information for the support of evidence-based, effective prevention measures.Senga Consulting Inc.We are a communication and learning services company that works closely with our clients to create clear and vibrant messages. Our mission is to help people unleash the power of effective communication that educates, engages and influences others to achieve their aspirations.
39CONTACT INFOONGOING SUPPORTOngoing support will be provided by:The Burn Fund (www.burnfund.org) as well asBC Children’s Hospital Safe Start (www.bcchildrens.ca/safestart)If you require additional copies of these materials, please contact:
40For more information, visit us at www.bcchildrens.ca/safestart Early Childhood Injury Prevention ProgramTHANK YOU FOR CARING.For more information, visit us at40