PLAYING WITH FIRE

 

“Doctor Gloria, I have bad news for you this morning. I am afraid we lost the child we referred yesterday”. The paediatric nurse said. For a few seconds, I was speechless. When I finally found my voice, I asked, “How is the mother?”. “I am told she is devastated.” She answered.

I had to say a silent prayer for the parents. To lose a child who had been so well to a preventable condition is one of the most difficult things to deal with in life.

This child was admitted to the hospital I work in with burn wounds. When I saw how extensive the injury was, I asked that we quickly stabilise and refer her to a tertiary centre where she could have access to a specialised unit for burns and health professionals who could properly manage her. The problem with extensive burns is that on a continent that is still battling with lots of infections, the risk of dying is very high even when the best care is given.

The skin provides a barrier that prevents harmful organisms from getting into the body. When the skin peels off in the case of burns, that protection is lost. There is also an impairment in the function of the immune system. Apart from battling infections, a person with burns also loses fluid excessively from the blood vessels and the body. That person can go into shock. There could be an imbalance in certain essential substances (electrolytes) in the blood. Some become anaemic from red blood cell destruction and may require a blood transfusion. Extensive burns can also lead to kidney failure. If the person had to inhale smoke and hot air from the flames, there could also be serious injury to the airways and lungs.

On that fateful day, the mother of the child was burning rubbish outside the house. And the mother kept adding to the pile that was burning. The child seeing what the mother was doing also grabbed a polythene bag and put it in the fire on the mother's blind side. Because she got too close to the fire, her clothes caught fire and then she started running, fanning the flames on her clothes in the process. Children are children. You can’t blame her. When the mother caught up with her, she pulled the dress forcefully over her head resulting in injuries in the head and neck area. Close to 50% of the skin was involved and unfortunately, we lost the child at the referral centre.

What parents should bear in mind.

Burn injuries commonly result from hot liquids, dry heat (e.g. flames), chemicals, and electricity. Children are particularly vulnerable when it comes to accidental burns. They don't fully appreciate danger when they see it. Children are adventurous in nature, especially boys, and love to explore. They also practice what they see others do. If a child sees someone ironing, lighting a match, or stirring soup, he/she is likely to do the same when the opportunity presents itself. They are also fascinated by flaming objects. I was quite disturbed when, as part of the gymnastics during the 67th Independence Day celebration, the men ran and jumped through the fire ring at a time when a lot of children could be watching. If a six-year-old boy was watching that, he might want to try to do the same. He would even start thinking of how to manufacture a ring like that.

 

How to reduce the risk of accidental burns in children.

Stoves should not be left unattended while cooking.

Younger children should be kept out of the kitchen when cooking.

Do not keep pot handles sticking out where a child can easily bump into them. They should be turned towards the back of the stove. Ladles should not be left in saucepans when cooking, a child may attempt to remove it and cause the contents to spill.

The edges of tablecloths should be tucked under the table and not left hanging. A child can easily pull on it and spill hot fluid.

Keep hot drinks, food, and other items like hot irons out of the reach of children and away from the edge of tables and counters.

In homes where hot water taps are used, the temperature can be lowered so that it is not so hot. The temperature of water in bathtubs must be checked by an adult before a child is put in it. These taps can also be fixed such that they are out of reach of the children.

If your child must go to a neighbour's house, ensure that the place is safe as well before he/she is allowed to go.

Children should be told in simple language that is understandable to them the danger of playing with certain objects. They must not be made to witness certain dangerous acts until they are old enough to appreciate how dangerous they are.

You can also install smoke detectors, and fire sprinklers in your home.

 

What to do in the case of accidental burns

Stop prolonging the injury by extinguishing the flames. The child must stop, drop to the floor/ground if it’s safe, and roll. This will cause the fire to be extinguished. The flaming clothes must not be forcefully removed from the child. Once the fire is out, remove the affected clothing gently if possible. The affected areas can be put under running water for about 20 minutes. This reduces the damage to the affected tissue/area. It is useful when done within the first 3 hours post-injury but it’s most effective in the first hour. Cover the wound with a non-adhesive material. Cling film is recommended for covering burn wounds as first aid.

In the case of burns from chemicals such as acid or alkali, dilute it by irrigating the area with water. If there is injury to the airways and the child is being transported to the hospital in an ambulance, oxygen can be administered en route to the hospital.

I will advise that all degrees of burns in a child must be examined by a clinician in a hospital after administering first aid. Even if it appears mild.

 

Remember that children are curious and would want to explore but they do not have a full sense of how dangerous certain items can be. They are particularly prone to burn injuries including burns in the early years of life. Let's ensure our homes are safe and the places we allow our children to play, or visit are also safe.

 

Dr (Med) Gloria Amponsah-Kodua

Paediatrician Specialist

 

Acknowledgment

Dr (Med) Mawuli Agbemafoh

General Surgery specialist