Fusing Research and Advocacy to Prevent Scald Burns in Young Children

I worked at a large academic medical center in Chicago where, like much of the country, more than half of the burn unit patients were children. Most were there for severe scalds.

The scald burns, which often were devastating enough to require surgery, happened in so many ways. A 1-year-old being held on his mom’s lap grabbed at her coffee mug. A toddler climbed on a table and tipped over a bowl of hot noodle soup. A 2-year-old reached the handle of a pot of boiling water that was heated to cook hot dogs.

However, a common thread connected many of these scald burns. In a conversation nearly 15 years ago with my colleague Dr. Larry Gottlieb, a reconstructive plastic surgeon who specialized in treating burn patients, he mentioned that a significant number of children’s burns involved a microwave.

Microwave ovens: opening a door to scald injuries

Doing what they’d seen their parents and caregivers do, young children would open a microwave oven door themselves and pull out the heated contents, but then they would spill it onto themselves. The piping hot contents typically would splash down the front of the child, severely burning the face, neck, chest and abdomen.

Scald burns are terribly painful, and some children end up permanently disfigured with extensive scarring. One patient, a two-year-old girl, opened a microwave and took out scalding hot ramen noodles that spilled all over the front of her. Even after multiple surgeries and a prolonged burn unit stay, she will have scar tissue covering her entire chest and abdomen for the rest of her life.

My colleagues and I resolved to find a way to help prevent these burns. Inspired by the way putting child resistant caps on pill bottles dramatically reduced toddler poisoning risk years ago, we realized that if we could make it so the doors were harder for young children to open, young children would be protected.

To bring about change, however, we realized we’d need evidence to show how much it was needed. We got to work, performing and publishing three studies on this topic between 2008 and 2016.

Gina Lowell, MD, FAAP, led one of our studies in which we analyzed three years of burn unit data and found that about 10% of our child scald burns were from this single mechanism: a young child getting ahold of scalding hot food or liquid by being able to pull open a microwave oven door. Analysis of National Electronic Injury Surveillance System data revealed the extent of the problem beyond our institution.

During the decade we studied, more than 7,000 young children in the United States were treated in emergency departments after opening microwave oven doors and being scalded. In fact, we learned, an average of two children each day are brought to a U.S. emergency department for one of these burns.

Marla Robinson, an occupational therapist in the burn unit, led another of our studies for which we recruited healthy, normally developing young children to better understand the acquisition of skills needed to get at food inside a microwave oven. We found that toddlers as young as 17 months could handily open a microwave door.

Next, we educated ourselves about how to change the way microwaves are made. We learned that, to be sold in the United States, microwaves must meet the microwave standard administered by Underwriters Laboratories (UL). After publishing our first two studies, and with the help of Jonathan Midgett, PhD, from the Consumer Product Safety Commission and the guidance of UL’s Joe Musso, I wrote a proposed  change in the microwave standard to make microwave doors child resistant.

But nearly half of the voting members of the Standards Technical Panel are microwave makers themselves, who were generally against the new requirement. No microwave maker had ever received a customer complaint about this. Their products had functioned exactly as designed. Several commented that parents should supervise their children more carefully. This first try did not pass.

​“It took a decade and a half of effort, but within the next two years new microwave ovens sold in the United States will be required to have “child-resistant” doors”

Presenting the evidence and changing minds

So, we tried again. We presented our evidence to the microwave makers. We made a short video that told the story of one child and his experience of being burned when he pulled noodle soup from a microwave at age 3. We gave presentations at national meetings. We worked with Kids In Danger, a national children’s product safety organization, and enlisted college engineering students to design “child-resistant” microwave doors to demonstrate feasibility.

In 2017, we became active members of a National Task Group convened by UL on this issue. Several of the microwave makers slowly became convinced of both the problem and the need to address it. Marla Robinson and I became voting members on the 17-member national microwave Standards Technical Panel.

Building off our original proposal, the Association of Home Appliances Manufacturers introduced a new proposal to require "two distinct actions" (similar to the “push and turn” of pill bottles) to make it harder for a child to open a microwave oven door. Multiple related concerns were addressed, including how this might impact on seniors.

For the proposal to pass, at least half of the voting members had to submit a ballot and at least two-thirds needed to vote "yes." Knowing how close the vote might be, we lobbied members who appeared undecided.

On September 17, 2018, the UL 923 Standards Technical Panel passed the measure by a one-vote margin. It took a decade and a half of effort, but within the next two years new microwave ovens sold in the United States will be required to have “child-resistant” doors.

It will still take some time before existing microwaves are slowly replaced with the newer, safer models. But young children will soon be protected from these pervasive yet preventable scald injuries.

Taking care of patients in the clinical setting puts us in the unique position to see patterns. We have a particularly good vantage point to see what might work to keep a certain type of injury from happening again and again. Prevention often takes us leaving the office, joining forces with those in other fields, and finding solutions together.