Ashes to ashes: thermal contact burns in children caused by recreational fires

Recreational open fires are an important and preventable cause of burn. In contrast to adults, who often sustain flame burns, children are at higher risk of thermal contact burns caused by hot embers many hours after the fire was first lit. Cases of thermal contact injury in children due to recreational fires were reviewed and the potential of a small charcoal fire to cause burns over a prolonged period was tested. Between 1993 and 2007, 67 children were admitted for treatment, with a median age of 1.6 years. Total burn surface area ranged from 0.5% to 19.5% (median 4%) with burns most commonly affecting the hands and feet. The average length of stay was 7 days and a total of 81 surgical procedures were carried out. Injury was most commonly sustained after falling into (40%), or accidentally crawling or walking on (30%), the remnants of an unextinguished fire. Small charcoal fires retain sufficient heat to cause injury at least 16h after lighting. Strategies for prevention of these injuries are outlined.