15th June 2020
Since lockdown measures were implemented towards the end of March, the Burns Centre at Birmingham Children’s Hospital, Birmingham, UK, has received a 30-fold increase in the number of scalds directly resulting from steam inhalation.
On average, the unit admits two patients per year with scalds related to steam inhalation. Over the past month alone, they have admitted six children with burn injuries due to this mechanism, with the youngest child aged 2 weeks, and the most severe case involving 8% of the child’s total body surface area, requiring excision and skin grafting. The mechanism is most frequently accidental spillage of boiling water from a bowl or from a kettle. Children have occasionally been left unsupervised.
The team surveyed Burns Services across England. With an 86% response rate, they found that 50% of centres have had an increase in scalds relating to steam inhalation. This correlated with regions of England with higher prevalence of COVID-19 (London and South East; West Midlands; North West). Two-thirds of centres reported an association with Asian ethnicity (Indian, Pakistani, Bangladeshi, or Other).
Steam inhalation is traditionally used as a home remedy for common colds and upper respiratory tract infections. The evidence base of the practice is weak, with unproven theories that the steam loosens mucus, opens nasal passages, and reduces mucosal inflammation, or that the heat inhibits replication of viruses. Social media and home-made tutorials from unverified sources have a role in misleading parents into practising this dangerous habit.
Scald injuries are the commonest cause of burns in children. Steam inhalation is a hazard to children. Resulting scalds can ultimately lead to hospital admission, surgery, and life-long disfigurement.
Parental education is paramount to preventing these injuries. Clinicians should actively discourage steam inhalation and educate parents about alternative treatments for their child.