Unintentional Burns in Children - Research Paper Example

Unintentional Burns in Children This research paper uses the Injury Iceberg Model to assess multiple risk factors predisposing children of ages 0 – 4 years to unintentional burns. The research paper is based on analysis of existing studies covering incidence of unintentional burns for children below fours old to find out why the age group is vulnerable to unintentional burn. It is noted that unintentional burns for children of this age group is caused by exposure to different mechanisms of injury including, thermal, electrical and chemical with children sustaining different degrees of injury from these mechanisms. Based on existing findings from different studies on unintentional burns for this age group, most of the incidences occur within the homestead with the kitchen being the specific area where there are more occurrences of burn injury that any other place. Mortality and morbidity rates caused by unintentional burns involving this age group are also high. The research paper highlights the risk factors for this problem based on the five levels of Injury Iceberg Model, which involves intrapersonal, interpersonal, organizational, community and society levels. Specific factors under these levels have been discussed to assess their roles in making children of ages 0 – 4 years vulnerable or at risk for unintentional burns. The paper has also discusses the implications of findings for registered nursing research, education and practice in order to determine future direction that prevention programs should take. Findings from the existing literature suggests the need for effective and efficient treatment and preventative mechanisms especially in low and middle income countries that have higher rates of unintentional burns but lack the necessary resources implement such extensive mechanisms. Introduction Burns has been identified by researchers as being among the main causes of injury to young children and is perceived as being the third behind vehicle accidents and drowning when assessing fatal causes of injury (Toon et al., 2011, p. 98). Mashreky et al (2008, p. 860) conducted a study to determine incidence of non-fatal burn for children below eighteen years old with the result indicating the highest reported occurrences were for children between 1 and 4 years (782.1/100,000 children-year), which was higher than in any other age category. The importance of addressing the issue of unintentional burns in children who are four years old and below is that this is a critical stage for the child’s growth and development as they attempt to form an understanding of the world around them (DelCarmen-Wiggins and Carter, 2004, p. 147). Children at this stage have yet to fully develop into individuals that can fully function independent of their caregivers as they continue with cognitive development (DelCarmen-Wiggins and Carter, 2004, 468). Consequently, there is need for comprehensive studies that analyses risk factors related to unintentional burn for this demographic group not only for the purpose of treatment, but to also introduce preventative measures that would lead to reduction in incidence and severity of burn related injuries (Toon et al., 2011, p. 99). This research paper focuses on unintentional burns in children of ages 0-4 using the iceberg model to determine how various socioecological contribute to children being at risk for unintentional burns. The research paper will also assess the implications of findings for future nursing research, education and practice to determine effective prevention mechanisms for unintentional burns in children of ages 0-4 years. According to Toon et al (2011, p. 99) risk of suffering burn injury for children of less than 6 years old is higher even for short-time exposure than for older children and adults due to their thinner skin layer. The thin skin for children of this age makes scalds the most common form of thermal injury given the estimation that it takes up to a quarter of the duration for children to suffer scalds than for adults (Toon et al., 2011, p. 99). Thermal injury resulting in scalds are caused by different types of hot liquid including, coffee, tea, tap water, coffee, soups, grease and tar (Toon et al., 2011, p. 99). For children of this age, chemical and electrical burns have also been reported; children sustaining injury due to electrical burns suffer extensive damage to their internal organs while severity of chemical burns depends on cause of injury such as digestion, splashed on the body or inhaled into respiratory system (Forjuoh & Gielen, 2008, p. 79 – 100). According to DSouza, Nelson, McKenzie (2009, p.1427) children who are below six years were over two times more likely to suffer burns that results from electrical appliances at home. Chemical injuries in pediatrics occur frequently as a result of exploratory tasting, although chemical burns results in about 1 percent of mortality and morbidity for this population (Reed, J. L. & Pomerantz, W. J. (2005, p. 118). Chemical burns on head and face for children of ages 0 – 4 years accounted for 73.2 percent of reported chemicals and cleaners burn-related injuries (DSouza, Nelson, McKenzie, 2009, p.1427). 1: Intrapersonal Level According to Golshan, Cyra and Hyder (2013, p. 393), the high number of burns reported for children of this age is blamed on their inquisitive behaviour especially when they have not developed the understanding and concept of fire. The researchers also find boys from 0 to 4 years to be more susceptible to unintentional burns than girls due to their higher rate of activity (Golshan, Cyra and Hyder, 2013, p. 393). The differences in number of girls and boys sustaining burn related injury is due to the fact that male toddlers like to run around their mothers, but as they grow, they tend to stay outdoor more than girls (Golshan, Cyra and Hyder, 2013, p. 393). Girls on the other hand increase their presence in the kitchen to help their mothers as they grow up while they have also been found to wear traditional loose clothing that exposes them to faulty appliances such as kerosene stoves (Golshan, Cyra and Hyder, 2013, p. 393). Mukerji et al. (2001, p. 36) supports findings that curious nature of children is a cause of most unintentional burns noting their inquisitive and adventurous nature leads to behavior that predisposes them burning such as running around the hearth, play with fireworks. Toon et al (2011, p. 99) notes behavior that predisposes toddlers to unintentional burns are related to what characterizes their developmental stages. Biological and psychological factors predisposing children to a high percentage of injury related to burns is associated with the fact that it is a period when they are learning to move and enjoying their new mobility, which results in them actively searching their physical environment for discovery reasons (Toon et al., 2011, p. 99). However, the increased risk of injury is because they are not aware of the dangers of such behavior and they enthusiastically meet risks at home, which indicates the development of motor skills is faster than cognitive development (Toon et al., 2011, p. 99). I think behavioral and psychological factors that increase the risk of children of 0 – 4 years old can be minimised through awareness of household arrangement that is safe for the child. Therefore, I see the caregiver playing a greater role in ensuring safety of the child at this stage by always observing the activities of the child as he/she interacts with objects in the environment while also removing objects that increase risks of the child sustaining burns. 2: Interpersonal Level Atiyeh, Costagliola and Hayek (2009, p. 185) note the domestic environment contains a number of predisposing factors that increase risks of children sustaining burns related injury. According to the authors, the risk factors have increased as homes have been modernized as a result of technological development to contain equipments that use gas, electricity and chemical substances (Atiyeh, Costagliola and Hayek, 2009, p. 185; Smith, 2000, p. 370). Additionally, parents spend considerable amount of time outside the home, therefore having reduced time spent with their children (Atiyeh, Costagliola and Hayek, 2009, p. 185; Smith, 2000, p. 370). Fatal injuries due to burns sustained by children of 0 – 4 years while at home happen mostly during daytime especially between 8:00 a.m. and 7:59 Pm while playing with lighters and matches resulted in highest number of fire ignitions leading to death or hospitalization(New Zealand Fire Service Commission and Kool, 2001, p. 2; Hettiaratchy and Dziewulski, 2004, p. 1428). The kitchen is an area that has increased risk for children of this age to sustain injury due to burns (Spinks etal., 2008, p. 486; Forjuoh, 2006; 530; Celko et al., 2009, p. 378). Additionally, scalding occurred mostly in the kitchen and was due to hot liquid or food falling on infants and children (Golshan, Cyra and Hyder (2013, p. 392). Family setup contribute to unintentional burn for children of ages 0 – 4 years especially in cases of large families, single parenting, recent pregnancy and mothers spending more time away from home (Edelman, 2007, p. 61; Delgado et al., 2002, p. 40; Bell, Schuurman and Hameed, 2009. P. 1136). Large family size results in increased injury related to unintentional burns due to overcrowding, lapse in supervision and neglect of the toddler as the caregiver concentrates on the rest of family members (Rayner and Prentice, 2011, p. 40). Studies conducted in Australia has indicated the presence of parental supervision in families that use wood stove and hot iron did not prevent children of ages 12 to 17 months from sustaining burn injuries (Choo, et al., 2002, p. 473; Simons et al., 2002, p. 590). Peer group does not represent significant risk of unintentional burns for children of ages 0 – 4 years as they are still at a developmental stage where actions are motivated by curiosity due to excitements of being mobile and the need to actively discover their surroundings (Atiyeh, Costagliola and Hayek, 2009, p. 185; Toon et al., 2011, p. 99). From the interpersonal factors predisposing children to increased risk of unintentional burns, I think parents have a greater role to play through creation of a family set-up that they can easily manage. According to my understanding, parents having the number of children that they can comfortably sustain can play a significant role in minimizing unintentional burns, since they will provide maximum attention to each child leading to improved safety within the home. 3: Organizational Level At organizational level work can be blamed for increased level of unintentional burns as parents leave their children unattended, unsupervised or sometimes in the care of siblings (Albertyn Bickler and Rode, 2006, p. 609). Additionally, health organizations especially in less developed countries have failed to develop primary and secondary fire and burns prevention mechanisms that will effectively respond to existing and future needs for such services (Golshan, Patel and Hyder, 2013, p 384). Although there has been progress in developed countries such as the United States, low and middle-income countries have not invested in sustainable research in the area of epidemiology and risk factors (Atiyeh, Costagliola and Hayek, 2009, p. 189). The consequence is that health corporations, authorities, personnel and agencies have not been trained or instructed to prioritize injury (including unintended burns for children of ages 0 – 4 years) prevention at the same level as disease prevention (Atiyeh, Costagliola and Hayek, 2009, p. 181). The consequence of such perception of injury sustained from burns is that governments do not allocate sufficient funds to respond to the needs of the population (Atiyeh, Costagliola and Hayek, 2009, p. 181). 4: Community Level Social class as a risk factor in unintended burns in children is based on the fact the level of income influences safety measures taken to prevent such injuries. Consequently, poverty increases the risk of unintended burns in children considering low income households and areas, including developing countries have increased risk of burns (Edelman, 2007, p. 563; Shai, 2006, p. 150-151; Ghosh and Bharat, 2000, p. 606). Social class also has implication on the causes of burns with studies indicating residents of poor neighborhoods that are characterized by illiteracy, overcrowding and existence of slums and shantytowns having access to limited safety measures (Peck et al., 2008, p. 309.). Consequently, shanties and slum areas experience a common occurrence of burns resulting from fire started by cooking and lighting appliances can easily burn houses which are in most cases constructed from plastic and wooden materials (Rayner and Prentice, 2011, p. 40). The experience is different when risk factors for children developing countries are compared with those from developed countries. This is because children of ages 0-4 five years from developed countries such as the United States suffer injury from burns that are mostly caused by noodle soups while instant soup containers cause scalding as they are easily tipped over by the child (Greenhalgh et al 2006, p. 478; Choo et al., 2008, p. 422). Other causes of burns for children from developed countries is the microwave ovens as children as young as 18 months old easily open oven doors (Lowell, Quinlan and Gottlieb, 2008, p. 781; Cagle et al., 2006, p. 327). There is significant association of cultural practices with unintended burns; therefore indicating ethnicity such as being among risk factors as seen in the Japanese case where high rate f bath related burns have been reported (Liao and Rossignol, 2000, p. 432). Additionally, research has indicated minority and aboriginal groups to have high incidence of unintended burns in children (New Zealand Fire Service Commission and Kool, 2001, p. 37). However, researchers have also noted that in most cases, it is not belonging to particular ethnic group that results in increased predisposition but poverty and low education associated with such groups that is to blame for the situation (Edelman, 2007, p. 163). 5: Society Level Lack of infrastructure has been blamed for high cases of motility and morbidity especially in low and middle income countries (LMICs) (Atiyeh, Costagliola and Hayek, 2009, p. 190). The countries lack the necessary resources to introduce infrastructural support that would ensure cases of unintentional burns involving children of ages 0 – 4 years are treated promptly when such cases have occurred (Atiyeh, Costagliola and Hayek, 2009, p. 181). Due to lack of effective infrastructure, it has become difficult to introduce measures focusing on prevention rather than treatment while cases that occur do not receive adequate attention (Lau, 2006, p. 963. While the health organization has a number of failures that increase risk of unintended burns in children, health facilities have also contributed to the situation as they do not retain enough data on the on treatment although poor health infrastructure is also a contributing factor (Golshan, Patel and Hyder, 2013, p 394). The economic situation of a society has implications on children predisposition to burn injuries as seen from data indicating the reported cases in developed countries continues to decrease over the years (Liao and Rossignol, 2000, p. 432). Data covering the number of children suffering from burn injury in for global scale is unavailable, but studies have indicated the distribution on regional, country and institutional basis. However, available data indicates Africa has continued to report the highest number of burn injuries for children with the Americas having the lowest cases (Cox and Rode, 2010, p. 115). There are significant variations in occurrence of burns in the world based on data indicating South Africa records approximately 1300 deaths resulting from burns annually while data from a major American pediatric burns center indicates 145 children died within a period of twenty years (Cox and Rode, 2010, p. 115; Williams et al., 2009, p. R183). Owing to its large population compared to other parts of the world, Asia reports over half of the global pediatric burn injuries (Atiyeh, Costagliola and Hayek, 2009, p. 185). These economically developed countries have invested in programs that support effective burn treatment and regulations although advancement in technology and burn treatment procedures also has considerable impact (Parbhoo, Louw and Grimmer-Somers, 2010, p. 169-173.).Based on the study conducted by Daisy et al. (2001, p. 270), the educational background of parents especially mother also has an impact on the safety of children of ages 0 – 4 years. Education is therefore a central issue in the discussion of burn injuries sustained by children as it is inversely related to burn (Delgado et al 2002, p. 39; Sarioglu-Buke et al., 2006, p. 1796). Part of blame for the high number of incidences of unintentional burns involving children of ages 0 – 4 years should be put on governments as they have failed to introduce effective policies to remedy the situation (Peden et al., 2008, p. 88). The high incidence of injury from burns for this age group is because of lack of effective laws and regulations on installation of building codes, smoke detectors and flammable clothing (Atiyeh, Costagliola and Hayek, 2009, p. 186; Peden et al., 2008, p. 88). My perception of the problem of unintentional burns for children of ages 0 – 4 years is that parents and families have minimal roles in ensuring safety of their children. This is considering that there are instances where injuries have occurred in the presence of adult caretakers (Choo, et al., 2002, p. 473; Simons et al., 2002, p. 590). I think the government from local to national level should play a bigger role in treatment and prevention through provision easy access to services when an incidence has occurred. In addition to introducing safety awareness initiative for parents and caretakers to create a safe environment for the children. Implications for Registered Nursing Research It is my perception that the risk factors associated with burns for children of ages 0 – 4 years calls for urgent intervention to ensure drastic reduction in injuries sustained by this group. Given the range of socioecological factors involved in cases, concerning unintentional burns in this group of children measures undertaken should be target-specific to ensure focus on main areas requiring preventative efforts (Atiyeh, Costagliola and Hayek, 2009, p. 188). Preventative efforts that been found to be effective in introducing legislation and educating caregivers are those that have sought to improve a predetermined aspect of the problem. As opposed to those that have a general focus since narrowing attention to specific risk factor leads to implementation of educational program, which covers all aspects around the factor (Atiyeh, Costagliola and Hayek, 2009, p. 188). I think there has been lack of effective mechanisms to handle unintentional burn for children between 0 – 4 years old due to diversity in the risk factors, which makes it difficult for concerned institutions to decide on whose responsibility it is to undertake certain aspects of preventative initiatives. For instance, people leaving in slums and shanty areas are affected by combination of factors that makes it difficult for effective intervention (Mondozzi and Harper Sr, 2001, p. 279.).Consequently, it is my opinion that research in nursing should include the assessment on how preventative efforts will get parents, local political institutions, communities, change agents, health providers and other interested groups to work together without exchanging accusations on who should bear the greatest responsibly for the situation especially in low-income households or areas. According to my understanding of the risk factors associated with unintended burns for children of 0 – 4 years, future research in this area must investigate the role of community-based interventions to improve their impact on parents and caregivers. My emphasis on community-based interventions as the best preventative strategy is based on the fact that most of the initiatives have resulted in a section of targeted caregivers indicating willingness to undertake behaviour change while others have continued to practice behaviour that predisposes children to burns. As noted by a number of researchers, poverty and low level of education have significant impact on the number of children suffering burn related injuries, which makes it necessary that any effort targeting such a group must also address their educational and economic needs (Edelman, 2007, p. 563; Shai, 2006, p. 151; Edelman, 2007, p. 163). Therefore, I think success in preventing the prevalence of unintentional burns in children will only be addressed by educational initiatives with programs that could be adopted to infuse into the daily activities of the people depending on their socioeconomic status. I believe most of the intervention efforts have not resulted into greater improvement of the situation because they have been perceived as foreign and therefore no compatible with the way of life of the targeted communities. This means future attempts to reduce the rate of unintentional burns in children should begin by studies on measures the target community perceive as being effective based on their way of life. Atiyeh, Costagliola and Hayek(2009, p. 188) note intervention programs will achieve wide support by being ‘‘community-based,’’ which implies the targeted community has a role to play by participating in areas such as providing labour, material and infrastructure necessary to complete the project. Conclusion From the foregoing research, unintentional burns area cause of injury for many children of ages 0 – 4 years, putting them at risk of complications due to physical impairments and disabilities in addition to emotional and mental consequences (Atiyeh, Costagliola and Hayek, 2009, p. 182). The research paper has used the Injury Iceberg Model in analysis of risk factors associated with unintentional burns for children of ages 0 – 4 years. This age group has increased risk of suffering burns due to different factors including the fact that they are just discovering their environment as they become mobile (Toon et al., 2011, p. 98). Therefore, there is need for caregivers to monitor the movements of these children keenly to ensure they do not handle appliances that will burn them since it has also been found that children still get burn in the presence of adults (Choo, et al., 2002, p. 473; Simons et al., 2002, p. 590). Families should also ensure children are not playing near or with things that might result in burns such as lighters and electrical appliances. However, there are other factors such as poverty that make it difficult for parents healthcare providers and governments to reduce or eradicate the problem of unintentional burns in children of ages 0 – 4 years as available resources cannot adequately provide for treatment and prevention facilities (Atiyeh, Costagliola and Hayek, 2009, p. 185,186; Rayner and Prentice 2011, p.39). This is because intervention programs in such cases will have to go beyond the risk factors to include improvement of family lifestyle, an initiative that might be impossible to undertake due to lack of enough resources. References Albertyn, R., Bickler, S. W., & Rode, H. (2006). Paediatric burn injuries in Sub Saharan Africa—an overview. Burns, 32(5), 605-612. DOI: http://dx.doi.org/10.1016/j.burns.2005.12.004. Atiyeh, B. S., Costagliola, M., & Hayek, S. N. (2009). 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