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Household Oven Doors
A Burn Hazard in Children
Karl L. Yen, MD;
David E. Bank, MD;
Andrea M. O'Neill, RN, MS;
Roger W. Yurt, MD
Arch Pediatr Adolesc Med. 2001;155:84-86.
ABSTRACT
Contact with hot oven doors is an important cause of burns in pediatric
patients. These burns are of particular concern because of their frequent
localization to the hands, with the resulting negative implications for financial
cost, long-term cosmesis, and hand function. A 5-year review of pediatric
oven door burn cases admitted to a burn referral center was conducted. Of
the 14 cases identified, the median age was 12 months. The median total body
surface area (TBSA) was 1.75% (range, 0.5%-4.5%). Twelve of 14 cases involved
1 or both hands. The median length of hospital stay was 10 days. In 7 cases,
burns were sustained from contact to an external surface of the oven. Based
on the results obtained, we propose several prevention strategies.
INTRODUCTION
Each year, a large number of people, particularly children, are burned
by contact with kitchen appliances or their contents.1, 2
While a number of studies have discussed the epidemiology and prevention of
scald and stove-top burns, a careful review of the English-language literature
reveals little information regarding burns sustained by contact with oven
doors. Although the numbers of oven door contact burns are few compared with
the number of scald burns, it is, nevertheless, an important, underrecognized
source of preventable injury. From the 5-year period (1994-1999), the National
Electronic Injury Surveillance System of the US Consumer Product Safety Commission
recorded 15 cases of pediatric burns sustained by contact with oven doors.3 The median age of these patients was 12 months; 9
of 15 patients were male. In 12 of the cases, there was involvement of 1 or
both hands.
MATERIALS AND METHODS
Cases of oven door contact burns were identified from the database of
New York Presbyterian–Weill-Cornell Medical Center's Burn Unit. The
database includes every patient admitted to the Burn Service over the past
5 years. The 5-year period from June 1994 through June 1999 was examined.
Cases were reviewed for age, sex, race, extent of burn, length of hospital
stay, mechanism of injury, home setting, complications, number of readmissions,
socioeconomic status, social work involvement, and the presence of safety
devices.
RESULTS
Of the 1491 pediatric patients admitted to the burn center during the
5 years examined, 201 had contact burns. Of these, 14 cases (7.0%) of burns
resulting from contact with a hot oven door were identified (Table 1). The age range was 8 to 24 months, with a median age of
12 months. Eight patients (57%) were male and 6 (43%) were female. Two patients
sustained full-thickness burns; the rest had partial-thickness burns. The
extent of burns varied from 0.5% total body surface area (TBSA) to 4.5% TBSA
(median TBSA, 2.0%). Twelve cases involved burns to the hands, always to the
palmar surface; 7 were bilateral. Of the 5 unilateral hand burns, all of them
were to the right hand. Of the 2 cases sparing the hands, 1 involved the thigh
and 1 involved the left arm. In 7 cases, burns were sustained from contact
with the outside of the oven (ie, door handle). In the other 7 cases, the
burns resulted from contact with the inside of an open oven door. There was
no seasonal predilection of the burns. Most occurred in the late afternoon
and early evening (11 of 14 cases occurred between 3 PM and 9 PM). The length
of hospital stay had a median length of 10 days (range, 1-26 days). There
were no readmissions or significant complications reported; however, 2 children
required skin grafting. The burns took place in different home settings (10
apartments, 3 houses, and 1 shelter). There was no significant difference
in the socioeconomic classes of the families. In those cases in which the
presence of home safety devices was ascertained, kitchen gates were notably
absent.
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Sex, Age, Total Body Surface Area (TBSA), Burn Involvement, Length
of Hospital Stay (LOS), and Mechanism of Injury of Pediatric Oven Door Burns*
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COMMENT
The results of this study suggest that while pediatric burns from oven
doors occur relatively infrequently, they are still a serious problem. The
burns typically involve the hands. Barret et al,4
in their review of 120 pediatric patients admitted to a major burn center
with isolated palm injuries, found that oven doors were the cause of 23.7%
of the contact burns. This is significant for 2 reasons. First, there is the
potential for permanent loss of hand function and cosmetic damage secondary
to scarring and contracture formation.5 In
the pediatric palm burn series of Barret et al,4
13.3% of patients developed sequelae, more than half of which required reconstructive
procedures. Second, patients with hand burns must be hospitalized because
of the need for careful monitoring of the healing process and aggressive physical
therapy.4, 6 Localized, partial-thickness
burns not involving the hands or other sensitive areas of the body (ie, foot,
genitals, and face) can usually be treated on an outpatient basis.7 The hospitalization costs of the typical oven door
burn, based on a median length of stay of 10 days and the burn center step-down
unit per diem rate of $3550, is $35 500. While precise data for the costs
of outpatient burn treatment were not available, the difference in cost is
substantial. Thus, the morbidity and financial cost of hand burns are often
more significant than those of larger TBSA burns without hand involvement.
The fact that the median age of patients with oven door burns was 12
months is not surprising. Children in this stage of development have just
started walking independently, have a keen interest in exploring their environment,
have little comprehension of danger, and do not like to be removed from their
caregivers for long periods.
In each of the cases we examined, the cause of the burns was determined
to be unintentional. As per standard hospital protocol, a social worker interviewed
the patient's guardian in each case. None of the cases were felt to warrant
referral to the Agency for Children's Services, New York State's child abuse
reporting agency. The results from our study suggest a typical pattern for
pediatric oven door burns. Cases reported as oven door burns falling far from
this norm should thus be viewed with an increased degree of suspicion. For
example, a burn to a patient's buttock, foot, dorsum of the hand, or face
would have to be investigated.
Given the widespread use of ovens in the household and their intrinsic
danger in causing accidental burns in children, the importance of continuing
to develop a prevention strategy is immense. During a child's health supervision
visit to the pediatrician, a number of points of anticipatory guidance are
offered. The hazards of oven doors should be addressed along with other burn
prevention topics, such as smoke detectors and hot water handling. Parents
should be advised to inspect their ovens to ensure that the external temperature
is not excessive, keeping in mind that what may simply feel warm to an adult's
skin may be hot enough to seriously burn a young child's thinner skin. Parents
should be reminded to turn off their ovens promptly after use and to allow
for adequate cooling before allowing children into the kitchen. Oven doors
should be kept closed except when food is placed in or removed from the oven.
Under no circumstances should an oven be used as a heating source for the
living space. This not only increases the risk for serious contact burns,
but poses a significant fire hazard as well. If the child is in or has access
to the kitchen when the oven is in use, he or she should be placed in a playpen
or high chair, preferably within sight of the caregiver. If the child is not
in a playpen (eg, in the living room playing with an older sibling), the use
of a kitchen gate to prevent access to the oven should be strongly advocated.
Another possible deterrent to this injury is to install ovens out of the reach
of a young toddler when a single oven rather than a range is used.
| Oven Door Burn Prevention Tips for Parents
- Check the oven door's outside temperature. If it
is uncomfortably warm to your touch, then it is more than enough to burn your
child.
- Turn off the oven immediately after use. Allow
enough time for the oven to cool before allowing children to enter the kitchen.
- Close the oven door as soon as you transfer food
in or out of it.
- Do not ever use the oven as a room-heating source.
- Report any defective, unsafe cooking appliance
to your landlord or, if you are a homeowner, invest in a safe, energy-efficient
range or an oven mounted out of a child's reach.
- While your child is not under direct supervision,
place him in a crib or playpen.
- Restrict your child's entry into the cooking area
with the use of a kitchen gate.
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On a public level, pediatricians should challenge manufacturers to develop
a nonconductive covering for the handles and inside of oven doors as many
burns occur on these surfaces. Similar initiatives have been proposed for
other potentially hazardous household appliances, including gas fireplaces.8 Additionally, local and national government should
be pressured to provide a living environment that includes a safe cooking
appliance and home heating source for all families with small children. With
the implementation of a few simple prevention measures, the incidence of pediatric
oven door burns can hopefully be diminished.
AUTHOR INFORMATION
Accepted for publication September 19, 2000.
From the Department of Pediatrics, Naval Hospital Oak Harbor, Oak Harbor,
Wis (Dr Yen); the Department of Pediatrics, Division of Pediatric Emergency
Medicine (Dr Banks) and Surgery, Burn Center (Ms O'Neill), New York Presbyterian
Hospital–Weill Medical College, New York; and the Department of Emergency
Medicine, New York University Medicine Center, New York (Dr Yurt).
Corresponding author: Karl L. Yen, MD, Department of Pediatrics,
Naval Hospital Oak Harbor, 3475 N Saratoga St, Oak Harbor, WA 98278-9900 (e-mail: karlyen{at}pol.net).
REFERENCES
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3. The National Electronic Injury Surveillance System. Available at: http://www.cpsc.gov/about/clrnghse.html.
Accessibility verified October 26, 2000.
4. Barret JP, Desai MH, Herndon DN. The isolated burned palm in children: epidemiology and long-term sequelae. Plast Reconstr Surg. 2000;105:949-952.
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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Hand Injuries in Young Children
LJUNGBERG et al.
J Hand Surg Eur Vol 2003;28:376-380.
ABSTRACT
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