Contact with hot oven doors is an important cause of burns in pediatric patients. These burns are of particular concern because of their frequent localization to the hands, with the resulting negative implications for financial cost, long-term cosmesis, and hand function. A 5-year review of pediatric oven door burn cases admitted to a burn referral center was conducted. Of the 14 cases identified, the median age was 12 months. The median total body surface area (TBSA) was 1.75% (range, 0.5%-4.5%). Twelve of 14 cases involved 1 or both hands. The median length of hospital stay was 10 days. In 7 cases, burns were sustained from contact to an external surface of the oven. Based on the results obtained, we propose several prevention strategies.
Each year, a large number of people, particularly children, are burned by contact with kitchen appliances or their contents.1,2 While a number of studies have discussed the epidemiology and prevention of scald and stove-top burns, a careful review of the English-language literature reveals little information regarding burns sustained by contact with oven doors. Although the numbers of oven door contact burns are few compared with the number of scald burns, it is, nevertheless, an important, underrecognized source of preventable injury. From the 5-year period (1994-1999), the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission recorded 15 cases of pediatric burns sustained by contact with oven doors.3 The median age of these patients was 12 months; 9 of 15 patients were male. In 12 of the cases, there was involvement of 1 or both hands.
Cases of oven door contact burns were identified from the database of New York Presbyterian–Weill-Cornell Medical Center's Burn Unit. The database includes every patient admitted to the Burn Service over the past 5 years. The 5-year period from June 1994 through June 1999 was examined. Cases were reviewed for age, sex, race, extent of burn, length of hospital stay, mechanism of injury, home setting, complications, number of readmissions, socioeconomic status, social work involvement, and the presence of safety devices.
Of the 1491 pediatric patients admitted to the burn center during the 5 years examined, 201 had contact burns. Of these, 14 cases (7.0%) of burns resulting from contact with a hot oven door were identified (Table 1). The age range was 8 to 24 months, with a median age of 12 months. Eight patients (57%) were male and 6 (43%) were female. Two patients sustained full-thickness burns; the rest had partial-thickness burns. The extent of burns varied from 0.5% total body surface area (TBSA) to 4.5% TBSA (median TBSA, 2.0%). Twelve cases involved burns to the hands, always to the palmar surface; 7 were bilateral. Of the 5 unilateral hand burns, all of them were to the right hand. Of the 2 cases sparing the hands, 1 involved the thigh and 1 involved the left arm. In 7 cases, burns were sustained from contact with the outside of the oven (ie, door handle). In the other 7 cases, the burns resulted from contact with the inside of an open oven door. There was no seasonal predilection of the burns. Most occurred in the late afternoon and early evening (11 of 14 cases occurred between 3 PM and 9 PM). The length of hospital stay had a median length of 10 days (range, 1-26 days). There were no readmissions or significant complications reported; however, 2 children required skin grafting. The burns took place in different home settings (10 apartments, 3 houses, and 1 shelter). There was no significant difference in the socioeconomic classes of the families. In those cases in which the presence of home safety devices was ascertained, kitchen gates were notably absent.
The results of this study suggest that while pediatric burns from oven doors occur relatively infrequently, they are still a serious problem. The burns typically involve the hands. Barret et al,4 in their review of 120 pediatric patients admitted to a major burn center with isolated palm injuries, found that oven doors were the cause of 23.7% of the contact burns. This is significant for 2 reasons. First, there is the potential for permanent loss of hand function and cosmetic damage secondary to scarring and contracture formation.5 In the pediatric palm burn series of Barret et al,4 13.3% of patients developed sequelae, more than half of which required reconstructive procedures. Second, patients with hand burns must be hospitalized because of the need for careful monitoring of the healing process and aggressive physical therapy.4,6 Localized, partial-thickness burns not involving the hands or other sensitive areas of the body (ie, foot, genitals, and face) can usually be treated on an outpatient basis.7 The hospitalization costs of the typical oven door burn, based on a median length of stay of 10 days and the burn center step-down unit per diem rate of $3550, is $35 500. While precise data for the costs of outpatient burn treatment were not available, the difference in cost is substantial. Thus, the morbidity and financial cost of hand burns are often more significant than those of larger TBSA burns without hand involvement.
The fact that the median age of patients with oven door burns was 12 months is not surprising. Children in this stage of development have just started walking independently, have a keen interest in exploring their environment, have little comprehension of danger, and do not like to be removed from their caregivers for long periods.
In each of the cases we examined, the cause of the burns was determined to be unintentional. As per standard hospital protocol, a social worker interviewed the patient's guardian in each case. None of the cases were felt to warrant referral to the Agency for Children's Services, New York State's child abuse reporting agency. The results from our study suggest a typical pattern for pediatric oven door burns. Cases reported as oven door burns falling far from this norm should thus be viewed with an increased degree of suspicion. For example, a burn to a patient's buttock, foot, dorsum of the hand, or face would have to be investigated.
Given the widespread use of ovens in the household and their intrinsic danger in causing accidental burns in children, the importance of continuing to develop a prevention strategy is immense. During a child's health supervision visit to the pediatrician, a number of points of anticipatory guidance are offered. The hazards of oven doors should be addressed along with other burn prevention topics, such as smoke detectors and hot water handling. Parents should be advised to inspect their ovens to ensure that the external temperature is not excessive, keeping in mind that what may simply feel warm to an adult's skin may be hot enough to seriously burn a young child's thinner skin. Parents should be reminded to turn off their ovens promptly after use and to allow for adequate cooling before allowing children into the kitchen. Oven doors should be kept closed except when food is placed in or removed from the oven. Under no circumstances should an oven be used as a heating source for the living space. This not only increases the risk for serious contact burns, but poses a significant fire hazard as well. If the child is in or has access to the kitchen when the oven is in use, he or she should be placed in a playpen or high chair, preferably within sight of the caregiver. If the child is not in a playpen (eg, in the living room playing with an older sibling), the use of a kitchen gate to prevent access to the oven should be strongly advocated. Another possible deterrent to this injury is to install ovens out of the reach of a young toddler when a single oven rather than a range is used.
On a public level, pediatricians should challenge manufacturers to develop a nonconductive covering for the handles and inside of oven doors as many burns occur on these surfaces. Similar initiatives have been proposed for other potentially hazardous household appliances, including gas fireplaces.8 Additionally, local and national government should be pressured to provide a living environment that includes a safe cooking appliance and home heating source for all families with small children. With the implementation of a few simple prevention measures, the incidence of pediatric oven door burns can hopefully be diminished.
Check the oven door's outside temperature. If it is uncomfortably warm to your touch, then it is more than enough to burn your child.
Turn off the oven immediately after use. Allow enough time for the oven to cool before allowing children to enter the kitchen.
Close the oven door as soon as you transfer food in or out of it.
Do not ever use the oven as a room-heating source.
Report any defective, unsafe cooking appliance to your landlord or, if you are a homeowner, invest in a safe, energy-efficient range or an oven mounted out of a child's reach.
While your child is not under direct supervision, place him in a crib or playpen.
Restrict your child's entry into the cooking area with the use of a kitchen gate.
Accepted for publication September 19, 2000.
Corresponding author: Karl L. Yen, MD, Department of Pediatrics, Naval Hospital Oak Harbor, 3475 N Saratoga St, Oak Harbor, WA 98278-9900 (e-mail: email@example.com).
Karl L. Yen, David E. Bank, Andrea M. O'Neill, Roger W. Yurt. Household Oven DoorsA Burn Hazard in Children. Arch Pediatr Adolesc Med. 2001;155(1):84–86. doi:10.1001/archpedi.155.1.84