The costs of burns

July 2012

Thousands of children and young people are treated in hospital for burns and scalds each year. Most of these injuries occur in the home and are highly preventable. Serious injuries can cause lifelong scarring as well as significant psychosocial problems. This article gives an overview of the financial and emotional costs of burns and scalds among children. As NHS treatment costs vary widely, all of the costs shown should be treated as a guide.

 

National burns and scalds conference

Find out what matters and what works at our first national burns and scalds conference in Manchester on Tuesday 24 September.

 

Gas hob flame

The scale of the problem

Each year in England and Wales around 3,750 under 15s are admitted to hospital with burn and scald injuries1. Children under 2 years make up half of admissions and under 5s account for three quarters of admissions.2 This means that 8 babies and young children are admitted to hospital with a burn or scald every day.

95% of these accidents happen in the home and scalds from hot drinks and other fluids account for 64% of admissions.1 Children from the most deprived one-fifth of wards are three times as likely to be admitted to hospital with burns and scalds as those from the most affluent fifth.3

Table 1: Key costs for treating burns in children and young people

Item
Cost
Ambulance transfer to hospital per person4 £255
A&E treatment per person4 £108-141
Cost of 57,200 A&E attendances each year4 £6.3 million
Cost of a bed day in a specialist burns facility, to treat a minor burn or scald5 £750
Cost of a bed day in a burns centre intensive care unit, to treat a very serious burn or scald5£2,500
Average cost of inpatient treatment for a minor scald (covering less than 10% of body) from a hot drink6 £1,850
Average cost of inpatient treatment for a major burn (covering 30-40% of body) including high dependency unit care7 £63,157
Cost to the economy of a parent taking two weeks off work while their child is in hospital8 £7,600

The financial costs

Emergency care

Many children who have suffered a burn or scald will be taken to hospital in an ambulance, at a cost of £2554. Once in the emergency department, treatment leading to admission costs £141 or £1084 if the child is discharged to be looked after at home. An average of 57,200 under 14s attend A&E with burn and scald injuries each year, at a cost of around £6.3 million.9

Acute inpatient treatment

In England and Wales, around 3,750 children aged 0-15 years are admitted to hospital with burns and scalds each year.1 Many are admitted to specialist burns services, which can involve transfers by ambulance or helicopter. The most complex injuries are treated by highly specialist teams in regional burns centres. An average of 250 children each year suffer a major burn, which is a burn of more than 10% of the body.

The cost of treating burns and scalds varies widely depending on the severity of the injury. Research from the South West Paediatric Burns Service shows that the average cost of treating a minor scald (covering less than 10% of the body) is £1,850,6 while for a 30-40% major burn the cost is £63,1577 even without paediatric intensive care.

Table 2: Example inpatient treatment costs for a major burn in a 4 year old girl with 40% burns from falling onto a gas hob flame7

Item
Cost
Bed days - 24 days in a burns service high dependency unit £20,472
Bed days - 18 days in a burns service ward £6,894
Surgery - 17 theatre trips totalling 30 hours £25,286
Imaging and tests £4,964
Invasive procedures£1,430
Dressings £3,253
Medication £1,461
Therapy £1,731
Hospital overheads£9,004
Total cost of inpatient care£74,495

Watch our video interview with Dr Amber Young, Consultant Paediatric Anaesthetist at Frenchay Hospital in Bristol, who talks about the financial and emotional costs of burns in children.

Long-term treatment

Children who have suffered a serious burn or scald often need follow-up treatment after being discharged from hospital. This can include:

  • dressings and post-discharge clinic visits
  • pressure garments
  • scar review consultations
  • surgical procedures
  • annual outpatient appointments
  • psychological therapy.

These follow-up costs will be substantial for a child with a major burn or scald, with treatment and procedures continuing until they stop growing. A severe bath water scald, for example, would require around 16 years of follow-up treatment, at an average cost of £16,116 but rising to as much as £50,000.More information on the costs of bath water scalds

Other costs

For a parent who is employed full-time, taking two weeks off work while their child is in hospital costs the economy £7,600.8 Time off work in these situations is often taken as unpaid leave, leading to significant loss of earnings for the family. Parents could also have to pay the costs of travelling to a regional burns centre hundreds of miles from home.

The emotional costs

Burns and scalds are extremely painful. Hospitals do all they can to make treatment as pain-free as possible, but the experience can still be traumatic. Many children admitted to hospital with burns and scalds will recover well and have little or no scarring, but a significant number of children will be left with lifelong scarring. They may have to use moisturising creams daily and wear pressure garments for up to two years. Severe scarring can be associated with chronic pain, itching and disturbed sleep, and the child may require frequent hospital admissions for further treatment.

Scarring from burns or scalds can trigger social and psychological problems, and it’s often these ‘invisible scars’ that need the most attention. The child may have difficulties coming to terms with their changed appearance and they will have to cope with other people’s reactions, which can include staring, insensitive comments, name-calling and bullying. They may develop social anxieties, particularly around occasions when they will be expected to expose their scars, for example during swimming or sports events, and they might feel angry or depressed.

All of these factors can reduce confidence and affect friendships and schoolwork. The scars left behind may be a permanent reminder of the accident and the child may be at risk of developing post-traumatic stress disorder. For some people, the anxiety and self-consciousness never goes away and can make important parts of life like applying for jobs and forming relationships seem very daunting.

The effect on families

Serious burns and scalds can create a lifetime of guilt for parents and they may also be at risk of post-traumatic stress. If one parent was absent at the time of the accident, they may blame the parent who was there. Parents and siblings will have to help the child adjust to any change in their appearance – something which can also be difficult for families to adjust to.

Parents could have to spend significant periods of time away from home if their child is treated at a regional burns centre and then commit time to outpatient appointments and managing their child’s injuries at home. These demands can be highly disruptive to family life and have a particular effect on siblings.

The child's perspective: Michael's story

Twenty-three year old Michael Boateng suffered a severe burn injury when he was just eight months old. He was lying asleep on his mother’s bed alone and when he woke up, he crawled to the edge and fell over the side, where he got trapped next to a hot water pipe. He was taken to hospital where he spent three days in a coma and underwent four skin graft procedures and other operations.

The accident left Michael with partial sight in his left eye and a scar covering the left side of his face. Throughout his childhood Michael had a number of further skin grafts and he has scarring on his thighs and hamstrings from these procedures.

At school Michael was teased and bullied about his appearance. He found himself getting into fights. “One particular name ‘two-face’ was the one that really made me tick. My grades suffered and I think I could have done a lot better,” explains Michael.

The facial disfigurement also had a significant impact on Michael’s life outside school. “When I was only 11 I had a horrible experience on the train. I was sitting next to my mum and I could feel the piercing glares of everyone around me. I couldn’t handle it so I pulled my coat over my head and left it there the whole journey as I shed a few tears.”

Michael and his mother sought help from the charity Changing Faces, who supported Michael with counselling over a number of years, giving him a chance to talk about his experiences, learn techniques for tackling stares and develop the confidence to lead an active and fulfilling life.

How could it be prevented?

The majority of childhood burns and scalds take place at home and are highly preventable. Half of serious burns and scalds among under fives take place in the kitchen.10 The leading causes of admissions are scalds, contact burns and burns from flames.1

Individual burns services report a growing number of contact burns from hot hair straighteners.11 National data12 also shows a rising trend in burns from hot household appliances, which would include hair straighteners. Hair straighteners can get as hot as an iron and can take up to eight minutes to cool down after they have been switched off.

Table 3: Causes of burn and scald admissions in children and young people1

Cause
0-5 years
5-15 years 0-15 years
Scald72%39% 64%
Contact 22% 18% 21%
Flame 2% 21% 7%

Community education campaigns can help to raise awareness of these issues. Posters, leaflets, and other activities can engage parents with the topic of home safety and encourage them to spend time checking their homes for possible hazards and to modify their behaviour to reduce the risk of burns and scalds. Although very young children have problems identifying potential burn hazards in the home, interactive safety centres provide educational opportunities for older children.

CAPT resources

Our DVD resource pack Too hot to handle covers three serious scenarios: hot drink scalds, bath water scalds and contact burns from oven hobs. The pack provides a ready-made safety session in a box, with:

  • a DVD featuring true stories, interviews with experts and attention-grabbing ‘child’s eye view’ accident reconstructions
  • support cards for practitioners
  • flyers for parents and carers.

Our leaflet How safe is your child from burns and scalds leaflet reinforces safety messages around the issue of burns and scalds – it’s an ideal resource to distribute to parents or carers as part of a community education project.

Burns in your area

Are burns one of the priority issues in your area? Are you running any programmes that aim to reduce the number of children suffering burn injuries? Email us at info@makingthelink.net and we can publish the information on this website.

Other articles in our costs of accidents series

Acknowledgements

We would like to thank the following people for their help with compiling information for this article:

  • Ken Dunn, Consultant Burn and Plastic Surgery, Manchester Burn Service
  • Amber Young, Consultant Paediatric Anaesthetist, Frenchay Hospital
  • Children’s Burns Trust
  • Case study provided by Changing Faces with kind permission of Michael Boateng.

Notes for this feature

  1. Data compiled by Ken Dunn using information from the International Burns Injury Database (iBID) and Hospital Episode Statistics Online (HES).
  2. Data from iBID provided by the Children’s Burns Trust.
  3. Hippisley-Cox et al, Unintentional injury increases with deprivation, BMJ, 2002.
  4. NHS trusts and PCTs combined reference cost schedules 2010-11, Department of Health.
  5. Financial costs compiled by CAPT, the British Burn Association and others in 2008, for the Hot Water Burns Like Fire coalition response to the Building Regulations Part G consultation.
  6. Griffiths et al, The cost of a hot drink scald, Burns, 2006.
  7. Pellatt et al, The cost of a major paediatric burn, Burns, 2010.
  8. CBI absence and workplace health survey 2011.
  9. Number of A&E attendances compiled by Ken Dunn from IBID and HES data. Percentage of children attending A&E identified from HASS and LASS data.
  10. Government Consumer Safety Research: Burns and scalds accidents in the home (PDF), Department of Trade and Industry, 1999.
  11. See, for example, this June 2012 press release from North Bristol NHS Trust and the Child Safety Week 2009 press release (PDF).
  12. HES data on external causes of injury shows X15 – Contact with hot household appliances increased from 333 in 1998/99 to 554 in 2010/11.

July 2012

Updated August 2013