CARE OF THE CRITICALLY ILL CHILD: MAJOR BURNS

Burns are the third most important cause of accidental death in childhood, outranked only by automobile casualties and drownings1. In the United States 12,000 deaths occur annually, but over the same period 2,000,000 patients are hospitalized for burns2. Among these, a very large numher of children must undergo prolonged, painful, and restrictive hospitalization from which they emerge with scars to both body and personality profoundly affecting their social and emotional development. The tragedy is that the great majority of burn injuries are preventable. In the toddler stage the most common accident occurs when the youngster reaches up and pulls on a pot handle at the front of the stove, resulting in a scald of the extended arm, shoulder, and chest. With the advent of summer, burns from the outdoor barbecue become epidemic. These are flash flame burns of face, hands, arms, and chest, usually in boys, that follow explosive ignition of the outdoor fire on which the victim has poured gasoline, kerosene, or other highly flammable starter fluid. The pant-leg burn is prevalent during the autumn when the burning of leaves is common. At all seasons one encounters burns, principally of the chest when the loose, frilly nightdresses of young girls ignite from too close proximity with the open fire, gas range, or candelabrum. Mandatory treatment of cloth with fire retardants could greatly reduce the incidence of these injuries at a negligible cost. As early as possible children should be taught never to run should their clothing ignite but rather to fall to the ground and smother the fire by rolling.