Modifiable risk factors for scald injury in children under 5 years of age: A Multi-centre Case–Control Study

Highlights

• Largest case–control study examining risk factors for scalds in young children.

• Identifies modifiable risk factors for scald injuries in young children, notably;

  • Leaving hot drinks in reach of young children.

  • Not teaching young children safety rules to prevent scalds.

Abstract

Objective

To determine the relationship between a range of modifiable risk factors and medically attended scalds in children under the age of 5 years.

Methods

Multicentre matched case–control study in acute hospitals, minor injury units and GP practices in four study centres in England. Cases comprised 338 children under 5 presenting with a scald, and 1438 control participants matched on age, gender, date of event and study centre. Parents/caregivers completed questionnaires on safety practices, safety equipment use, home hazards and potential confounders. Odds ratios were estimated using conditional logistic regression.

Results

Parents of cases were significantly more likely than parents of controls to have left hot drinks within reach of their child (adjusted odds ratio (AOR) 2.33, 95%CI 1.63 to 3.31; population attributable fraction (PAF) 31%). They were more likely not to have taught children rules about climbing on kitchen objects (AOR 1.66, 95%CI 1.12 to 2.47; PAF 20%); what to do or not do when parents are cooking (AOR 1.95, 95%CI 1.33 to 2.85; PAF 26%); and about hot things in the kitchen (AOR 1.89, 95%CI 1.30 to 2.75; PAF 26%).

Conclusions

Some scald injuries may be prevented by parents keeping hot drinks out of reach of children and by teaching children rules about not climbing on objects in the kitchen, what to do or not do whilst parents are cooking using the top of the cooker and about hot objects in the kitchen. Further studies, providing a more sophisticated exploration of the immediate antecedents of scalds are required to quantify associations between other hazards and behaviours and scalds in young children.

Introduction

Globally, scald injuries are an important public health issue and cause considerable morbidity and mortality [1], [2], [3]. They can be the most distressing and painful injuries a child can receive and may result in long-term physical and psychological effects. Paediatric scald injuries also have significant economic implications for families and health services[1].

It is noteworthy that the majority of scalds in childhood occur at home [1], [4], [5], [6] and are most commonly caused by hot liquids from kettles, cups and baths [2], [5], [6], [7], [8]. Children under the age of 5 years are most at risk of sustaining a scald in the home [9], [10] and the burden of paediatric scalds falls most heavily on those from the most disadvantaged groups [4], [5], [11], [12]. Preventing scalds requires understanding of modifiable risk factors for scalds. Several small case control studies have been conducted which demonstrate increased risks of thermal injuries associated with composite burn and scald hazard scores [3], [13], with drinking hot drinks from their original containers rather than vacuum flasks [14] and with having cooking equipment within reach of children [15]. However, these studies were not restricted to scald injuries, some had small sample sizes and limited power, used hospital controls, explored only a limited number of exposures or used composite exposure measures which precluded assessment of risk associated with single items within the composite measure, included exposures not relevant to the UK or failed to adjust for a range of confounding factors. We therefore undertook this study to determine the relationship between a wide range of modifiable risk factors and medically attended scalds in children under the age of 5 years, and to inform development of prevention programmes designed to address this important public health problem.