Burn prevention in child care centers
Part 1 - Bottle warmers
Every day, over 300 children are treated in emergency rooms for burn-related injuries and two children die as a result of being burned. Younger children are more likely to sustain injuries from scald burns that are caused by hot liquids or steam, while older children are more likely to sustain injuries from flame burns that are caused by direct contact with fire. (1)
In a review of child care center claims reported to Markel, the most common and most severe burns happen when scalding hot liquids or food come into contact with a child’s sensitive skin. Part one of this two-part series on burn prevention in child care centers will focus on bottle warming and how the practice of warming baby bottles can lead to serious burn injuries to children.
Anyone who cares for infants knows when it’s time to feed them a bottle they want it NOW, not in ten minutes, and sometimes a five minute wait seems like an eternity with crying babies. Commercial child care centers don’t have the advantage that mothers at home do, caring for children in small numbers or one on one, where they are able to better anticipate when the child is going to be hungry. The inability to accurately predict the hunger patterns of multiple infants combined with the insistence of heating bottles significantly increases the risk of burn injuries at child care centers. As a direct result of warming bottles, serious burn injuries to infants occur every year.
Consider the following: Bottles heated in microwaves can leave pockets of scalding liquid that can cause severe burns to infant’s mouths. If the bottle spills, the liquid can leave burns on a child’s face and body. Child care risk management professionals have been warning against the use of microwaves to heat bottles for over 20 years. As a result of the problems using microwaves to heat bottles, many child care centers began using slow cookers to warm bottles which also has resulted in unnecessary burn injuries. Slow cookers, sometimes referred to by a popular brand name, “Crock-Pot®”, typically have settings of low, medium, and high, with some having a keep-warm setting as well.
Slow cookers used to heat water to warm bottles have been blamed for several life changing burn injuries. Examples include cords being pulled spilling scalding water from crockpots onto children, cups of scalding water from a crockpot intended to warm a single bottle spilling on a crawling child, scalding water from a slow cooker splashed on a child sitting in an infant swing, and even drops of scalding water from a bottle taken out of a slow cooker dripping on a child causing burns and scarring.(3) The pain, injuries, and permanent scarring caused when scalding water spills onto a child is difficult to comprehend, and the legal costs and monetary damages can be very significant.
Many child care providers believed one solution to reducing the risk of burns is to switch to commercial bottle warmers designed to heat one bottle at a time. Unfortunately there have been several severe burn injuries to children where cords have hung low enough for a child to pull the bottle warmer and scalding water onto themselves. (2)
One recommendation to help reduce the risk for these types of burn injuries in child care centers is to remove the source of the burns, scalding hot water. Since young children have thinner skin than adults, hot liquids spilled on a child results in deeper burns than those sustained by an adult from liquids of the same temperature. Consider that water at 140 degrees Fahrenheit takes only five seconds to cause a 3rd degree burn to an adult. At a mere eight degrees hotter, water at 148 degrees will cause a 3rd degree burn in two seconds. (3) The “low” setting of many brands of slow-cookers is set to heat to a MUCH HIGHER temperature of 200 degrees Fahrenheit which is extremely likely to burn if it comes into contact with a person’s skin. A child’s thinner skin will burn quicker at a lower temperature than an adult’s skin. To reduce the risk of burns to children in child care centers hot liquids must be eliminated from anywhere children are present.
Board certified pediatrician Vincent Iannelli, MD recently wrote, “You don’t usually ever have to warm an infant’s milk or formula. It is more a personal preference than anything else.” He continues, “After all, once you switch to whole milk, you likely won’t be warming it up anymore and will offer it right out of the refrigerator.” (4) So why is the practice of warming baby bottles so common? It likely dates back to the late 1800’s and early 1900’s when the feeding bottle design gave in to the demands of modern society.
The long-tube feeding bottle, invented in 1860, was tough, practical, and inexpensive. A simple glass flask equipped with a rubber tube allowed for easy feeding of infants. This bottle was banned in 1910 due to design flaws which allowed bacteria to breed. In 1924 with the invention of heat-resistant Pyrex and other molded glass, straight feeding bottles became the norm. (5) The continued insistence on warming bottles was likely the result of a prior generation’s fear of bacteria related illnesses.
A website from the American Academy of Pediatrics dedicated to providing information helpful to raising healthy children from birth to adulthood, healthychildren.org, provides several pages on the practice of bottle warming and proper bottle safety. The information provided supports serving bottles at room temperature. The importance of a clean water source, clean bottles and nipples is stressed, however in most child care centers parents of infants send bottles already prepared for their child.
Change is often difficult, but change when it comes to protecting children is worthwhile. If the child care industry ever expects to eliminate burn injuries from scalding liquids an important first step is to eliminate scalding liquids from the child care centers. If parents continue to insist that their child’s bottles are warmed before serving, then tap water in a sink or allowing the bottle to warm to room temperature before serving are alternatives and the safest ways to reduce the risk of burns. Please be sure to look for Part 2 of our series on burn prevention in child care centers where we will address additional loss exposures to burn injuries and discuss further action you can take to reduce the potential for injuries.
- Based on analysis of reported burn injuries to children in child care centers insured by Markel Specialty Commercial during the years 1994 through 2017
- American Burn Association, Scald Injury Prevention, Educator’s Guide https://www.plainfieldmi.org/uploads/9/3/5/7/93577888/scaldinjuryeducatorsguide.pdf