Children's burns unit braces itself for grim winter influx of patients

Every winter, staff at the Red Cross Children’s Hospital in Cape Town brace themselves for a spike in burn injuries that leave emotional scars as well as physical ones.

“Flame burns are devastating injuries with substantial lifelong physical and psychosocial consequences for the affected survivors and their families,” said Dr Gary Dos Passos, head of the hospital burns unit and an executive committee member at the Burn Society of SA.

So far this year, the unit has admitted almost 200 children, and the number is expected to rise dramatically during winter.

Fluid burns account for the majority of admissions, with 155 so far this year. Hot drinks, burst hot water bottles, electric kettles and bath water are the main culprits. 

Heat contact and flame injuries account for the rest of the injuries.

Nine in 10 children admitted to the burns unit sustain their injuries at home, usually in the kitchen.

According to the hospital's injury prevention unit, ChildSafe, under-5s make up 80% of patients in the burns unit.

The 16 children admitted with flame injuries between January and March had burns to a quarter of their body surface, on average.

Such injuries are considered so significant that in some African countries, children with burns of 30% or more are considered too complicated to treat.

Dos Passos said lack of adult supervision is often the root cause of burn injuries among young children. 

“Five of these 16 injuries were directly due to unsupervised children playing with either matches or lighters,” he said.

“Two of these injuries resulted when children were near open flames that had accelerants — petrol, lighter fluid and paraffin — thrown onto them in attempts to revive a failing fire. One child was severely burnt when a paraffin heater was knocked over while playing.

“Burn injuries increase dramatically during the winter months and caregivers need to be extra careful to ensure the safety of their children.”

Burn prevention is a crucial component of burn management, said Dos Passos.

“Liquid burns such as coffee, tea, porridge, pap, soup, bath water are most prevalent in the  younger toddler age group up to about 3 years old. This is likely due to them becoming more mobile and exploring their environment. Flame burns are fewer but much more significant and carry an increased risk of dying.”

While not all burns need admission, all burns need “appropriate wound care, rehabilitative intervention and prevention education”.

Dos Passos said: “Factors that are used to decide on admission include, but are not limited to, type of burn, the location of the burn such as face, leg or torso, extent of the burn or total body surface area and depth of the burn.”

Dwayne Evans, spokesperson for the Red Cross Children’s Hospital, said Covid-19 had seen tighter restrictions at hospitals, including reduced visiting hours.

But the hospital has made exceptions for caregivers and parents who are considered  essential partners in the wellbeing and recovery of the young patients.

“We cannot exaggerate the important role they play at bedside, and home, to support the young child who is going through this very traumatic event,” said Dos Passos.

“Caregivers are essential partners in the wellbeing and recovery of our patients. As a paediatric facility we allow one carer per bed in most cases.”

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