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Educator’s Handbook WELCOME to the Developed by: Frances MacDougall RN

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1 Educator’s Handbook WELCOME to the Developed by: Frances MacDougall RN
“Too Hot For Tots” © 2010 Frances MacDougall and BC Children’s Hospital Early Childhood Injury Prevention Program WELCOME to the Educator’s Handbook Developed by: Frances MacDougall RN With support from Safe Kids Canada and Senga Consulting Funding provided by the BC Professional Fire Fighters’ Burn Fund and BC Children’s Hospital

2 TABLE OF CONTENTS Beginnings Slide 3 Objectives Slide 4
Best Practice Guidelines Slide 7 Key Message Slide 11 Characteristics leading to Injury Slide 15 Images Slide 22 Prevention & First Aid Slide 26 References Slide 34

3 “It only takes a second to change a life forever.”
BEGINNINGS Frances MacDougall This 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?

4 OBJECTIVES Resource Objectives Structure Key Concepts
For this Resource Resource Objectives Increase caregiver awareness about the high risk of burn and scald injuries to children 5 years and under. Structure This 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 Concepts Burn 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 Procedure Review 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.

5

6 Introduction The video Too Hot for Tots!© was developed as a tool to help community educators teach parents about how to prevent burn injuries to young children in the home. The recommendations provided in this program were developed from the guide, Safer Homes for Children produced by Safe Kids Canada. The video begins with Dr. Cynthia Verchere, Director for the BC Children’s Hospital Burn Unit explaining how common these injuries are, where in the home they occur and why it’s critical to provide immediate first aid when a burn happens to reduce the damage caused by the injury. Caregivers will also learn The Three B’s of Burn Prevention: 1. Be Aware of the burn hazards in the home and the serious risk they pose to a child. 2. Be Close within arm’s reach when a child is near or around a burn hazard. 3. Burn Proof the family home. Following these simple, yet effective strategies will help to reduce the risk of a burn injury which happen all too frequently to young children in the home.

7 program Resources and best practice Guidelines
Early Childhood Injury Prevention Program Information to Support You program Resources and best practice Guidelines

8 World Health Organization: Safe Communities Model 8
Too Hot for Tots!© incorporates these Best Practice recommendations from the WHO (World Health Organization): Target groups at high risk – parents of children from birth to five years of age. Target the caregiver, not the child. Focus on a single cause of injury – Thermal injuries. Develop intervention strategies targeting different causes of injury: The Three B’s which target the three most common sources of thermal injury in children under 5; hot liquids, hot water, and hot surfaces. Link Injury Prevention Programs to a healthcare setting – Community Health Units and B.C Children’s Hospital. Aim of the program should be to increase caregivers’ beliefs that their own child is vulnerable to injuries and that those injuries can be serious. Educator’s can stress the serious nature of burn injuries and how common these injuries are in this age group, while parents share the story of how their child was injured and how quickly the injury happened. Include short and long term goals with injury outcomes as a measure. Short term goals: an Impact Evaluation has been conducted in Vancouver Costal Health units to establish whether there was significant change in parental knowledge, attitudes and practices around the prevention of scald and burn injuries after being exposed to the Too Hot for Tots! program. Long term goals: to reduce the number of pediatric burn injuries in the province of British Columbia.

9 Education Environment Enforcement
To achieve long term change and success, injury prevention programs should include a multi-dimensional approach known as The Three E’s. 9 Education Changing parental knowledge, attitudes and behaviors Environment Enforcement Minimizing or eliminating hazards in the home Legislative changes

10 The Three E’s Education Enforcement Environment
The Too Hot for Tots!© program is based on a behavior change Model known as: The Ecological Theory of Risk Perception10 This model provides insight into what motives parent to implement injury prevention strategies based on the perceived risk of injury to their child. Enforcement Modifying the home environment to reduce hazards is an essential component of successful injury prevention programs. Environment Refers to the enactment of legislation and product safety regulations which help to make home products and environments safer. For example, changing building code legislation so that water delivery temperature to bathtubs is no greater than 49°C (120o F).

11 PROGRAM’S KEY MESSAGE What We Want Everyone to Know
Early Childhood Injury Prevention Program What We Want Everyone to Know PROGRAM’S KEY MESSAGE

12 Why 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. 1 For injuries that occur in the home, burns are the second leading cause of emergency room visits for children under 5 in British Columbia. 2 Infants and 1 year olds suffer a disproportionately high percentage of these serious burns. 3 Approximately 130 children in this age group are treated for burn related injuries at B.C Children’s Hospital every year. 4 70% 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. 5 Medical care following a scald injury is approximately two times higher than the average for all injuries in the CHIRPP Database. 6 Tap 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.

13 The average annual decline of burn injuries since 1993 was 0.07%.
Emergency Department Surveillance of Pediatric Burn Injuries (CHIRPP) database The average annual decline of burn injuries since 1993 was 0.07%.

14 Treatment Required Following Burn Injuries CHIRPP Database, B
Treatment Required Following Burn Injuries CHIRPP Database, B.C Children’s Hospital, Total number of admissions = 406 Advice only = 24 Treated and Followed up as needed= 23 Treated and follow up required = 310 Admitted to hospital = 42 Direct admissions to ICU= 6 Died = 1

15 Characteristics that lead to tragic injuries
Early Childhood Injury Prevention Program Social and Cultural Context Characteristics that lead to tragic injuries

16 The Ecological Theory of Risk Perception
Social and Cultural factors that impact parenting behaviour by raising risk perception Caregiver Characteristics Parenting experience Beliefs Parenting style Knowledge Perception Child Characteristics Developmental Age Activity Level Cognitive Ability Risk Taking Temperament Environmental Characteristics Risks/Hazards present Hot water Hot surfaces Hot liquids

17 Actions Taken based on Risk Perception
Passive Strategies One-time actions Active Strategies On-going actions Lower the temperature of the hot tap water Secure a barrier around the fireplace Childproof bathroom and laundry room doors Use a mug with a lid* Provide constant close supervision when around burn hazards Keep appliances and cords out of reach Really 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.

18 Caregiver Characteristics
Parenting Style Injuries 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. 11 Parenting Experience Parents often underestimate or overestimate their child’s abilities and do not adjust those expectations based on the child’s development.12 Parenting Beliefs Parents may believe that children learn from being injured and that injuries are a natural consequence of play. 13 Parents 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 Experience Parents 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 Beliefs Parents 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. Perceptions Mother’s were more likely to follow safety precautions and practices when they perceived the risk of injury to be serious.16 Knowledge As parent’s education level increased, so did their belief that injuries could be prevented.15

19 Child Characteristics
Developmental Age The 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.17 Activity Level Around 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.21 Cognitive Ability Burn 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.20 Temperament Some children are naturally more inquisitive and active which puts them at greater risk for injury.18 Risk Taking Boys are more likely to be injured than girls.19

20 Emergency Department Surveillance of Pediatric Burn Injuries (CHIRPP) database 1990-2008
Public Health Agency of Canada

21 Environmental Characteristics
Hot Liquids More than half of the children treated for scald injuries in the CHIRPP Database were burnt from hot beverages such as tea, coffee and soup. 22 Hot Water Children 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.23 Tap 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.24 Hot Surfaces The 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

22 Contact 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 Scald Hot Water Scald Contact burn from fireplace 22

23 Time & Temperature Interaction Associated with Scald Burns 26
Temperature: (°F) Burn Risk Exposure Time (seconds) Possible Exposure in Environment 130° 30 Adults can consider this a reasonable temperature for hot drinks. 145° 2.5 Too hot to drink for most people. 150° 1.8 Dishwasher water temperature before cycle begins. 170° 0.03 When the "rolling" metallic sound is heard in a metal teapot on stove. 175° 0.01 The temperature of water or hot drinks from some home/office counter-top brewing units. 180° instant Coffee/hot chocolate temperatures found in some family restaurants. 185°

24 Emergency Department Surveillance of Pediatric Burn Injuries (CHIRPP) database 1990-2008
7% Electrical Public 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.

25 Emergency Department Surveillance of Pediatric Burn Injuries (CHIRPP) database 1990-2008
Percentage of Hot Water and Beverage Scalds by Circumstance 7% Tap water Public Health Agency of Canada

26 Prevention and First aid strategies
Early Childhood Injury Prevention Program Prevention and First aid strategies

27 Best Practices and Balanced Approach
Best approach to injury prevention Passive Methods Active Methods Lower 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

28 The 3B’s Be Aware BE CLOSE BURN PROOF Burn Prevention .
Of the burn hazards in the home and the serious danger they present to a child Using these three strategies in combination is the most effective way to reduce the risk of a burn injury When environments are not burn proofed, the other two strategies need to be heightened – being aware of the hazard and being close. . Burn Prevention The 3B’s BE CLOSE within arm’s reach when a child is near or around a burn hazard BURN PROOF the home environment

29 What 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

30 Butter, 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 cloth Because 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 should never be used on a burn.

31 When to get help: If the burn is on the face, hands, feet or groin
If blisters develop If the burn is larger than the size of a loonie Parents should have someone else drive them to the hospital. Otherwise, call an ambulance!

32 Knowledge and Behaviour
Behaviour is influenced by more than “what we know” or “what we believe”27 Studies 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.

33 Through education and advocating for legislative change, we can make a difference and reduce the number of these preventable injuries.

34 References The 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) database 4 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 release 6 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.

35 References (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

36 Reference (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.

37 FEEDBACK 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.

38 SUPPORTERS FOR THIS PROGRAM AND THEIR MISSION STATEMENTS
BC Professional Fire Fighters’ Burn Fund BC Children’s Hospital Dedicated 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 discover Deliver innovative sub-specialized care Work together as a caring team Partner with families Plan provincially Collaborate to create novel, community-based approaches Safe Kids Canada Safe 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 Unit To 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.

39 CONTACT INFO ONGOING SUPPORT Ongoing support will be provided by: The Burn Fund (www.burnfund.org) as well as BC Children’s Hospital Safe Start (www.bcchildrens.ca/safestart) If you require additional copies of these materials, please contact:

40 For more information, visit us at www.bcchildrens.ca/safestart
Early Childhood Injury Prevention Program THANK YOU FOR CARING. For more information, visit us at 40


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