Pediatric Burns:
During a 10-year period, from 1991 to 2001 , over 24 000 children in the United States were injured when they inserted foreign objects into electrical receptacles. Every year an average of at least 2 400 children are injured when tampering with electrical receptacles.
Attached is a summary of electrical burn and shock incidents occurring to children under the age of 10. This information is taken from the National Electronic Injury Surveilance System (NEISS) for the years 1991 to 2001 (
www.cpsc. govllbrary/neiss.html). The U.S. Consumer Product Safety Commission s (CPSC) National Electronic Injury Surveilance System (NEISS) is a national probabilty sample of hospitals in the u.s. and its territories.
Patient information is collected from each NEISS hospital for every emergency visit involving an injury associated with consumer products. From this sample, the total number of product-related injuries treated in hospital emergency rooms nationwide can be estimated. NEISS collects data from a statistically valid sample of hospitals nationwide. NEISS calculates historic estimates based on these samples using statistical tools (weights, sampling error, trend data, adjustment for changes in sampling frame.. .). NEISS provides at least 2 numbers for each query conducted on their web site: The first number is the actual sample for monitored hospitals. These are actual cases that were
communicated to NEISS.
The second number is the historic estimate calculated by NEISS as explained above.
For example, the attached 2002 NEISS report shows a sample count of 129 and a historical estimate of 3277.
For the purpose of this analysis, we calculated a ratio, based on 10 years of data, between sample and historic estimate (we queried outlet related incidents concerning children ages 1 month to 10 years old). We then applied this ratio to our analysis. The intent is not to provide exact values but to attribute weight to major topics (age type of injury, objects used... These estimates have been calculated to identify the major issues associated with
children tampering with electrical receptacles.
Analysis of the NEISS information shows that at least 71% of all incidents occur at home , making dwelling units the prime location for receptacle related pediatric electric burns. The vast majority of injured children are under age 6. Victims age 2 and under represent 39% of cases, while those age 3 to 6 represent 50% of all cases.
The incidents occurred as the result of the child inserting an object into a receptacle. The following is a breakdown of the percent of incidents in which a child inserted a specific type of object into a receptacle:
Hairpin 32%
Key 17%
Wire 7%
Plug and cord 11 %
Pin/needle/screw/nail 5%
Paper clip/staple 5%
Tweezers/fie/tool/knife 3%
Jewelry/belt buckle 1%
Body part(finger) 12%
Open outlet 1%
Unknown 6%Many of these objects are not perceived as dangerous by parents, perhaps explaining young children s easy accessto them and frequent rate of insertion.
The results of these incidents are very rarely fatal, but will result in electric shocks and mild to severe burns.
Most incidents are relatively superficial first or second-degree burns, where children are treated for reddened skin or blisters and released from the Emergency Room with topical treatment. Yet 8.7% - that is over 200 children per year - need to be hospitalized. 2% of all burns are 3 degree. These are burns so severe that they result in deeply charred skin and can require a skin graft if the burn is over 1 inch in size. Chidren are more susceptible to electric burns due to their tender skin and the frequent presence of liquid (saliva, juice, mil).
These burns can leave permanent, visible scars.
It is important to note that the NEISS report also includes the following four fatalities:
1991 - 2 year old male, Shawnee, OK, child placed key in electric receptacle
1994 - 23 month old male, Traverse City, MI , child stuck keys in electric receptacle
1995 - 3 year old female, Great Falls, MT, contact with electric receptacle , cardio respiratory arrest 1998 - 2 year old female, Springfield, MO, stuck unknown object into 1l0V receptacle In addition to the 1991-2001 reports, the 2002 National Electronic Injury Surveilance System (NEISS) report is included. The 2002 report states that there were 129 reported incidents, which indicates that there were an estimated total of 3 277 incidents in 2002 alone. The 2002 data covers all electrical outlet and receptacle
incidents occurring in dwellings and is the most recent information available. The 2002 data contains more detailed information than the NEISS reports for previous years and may be used to provide a better understanding of the reported incidents.
A study conducted by Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) reported similar data. For example: almost 80% of the Canadian incidents occurred in the home (compared with 71% in the US), 40% were 3-6 years of age (compared with 50% in the US). A recent presentation of the CHIRPP data concludes
that "legislated standards for the manufacture and use of child safe outlets along with education for parents and children" was called for. Attached is the CHIRPP raw data for electrical injuries to children aged 9 or less for 1996 - 2003.
Preventative Measures:
Parents, teachers , baby-sitters, grandparents and other caregivers are usually well aware of the dangers related to electricity and to receptacles in particular. Children are often taught to stay away from electric appliances and devices. Public health organizations such as hospitals, maternity wards and the CPSC provide adults with warnings and advice to "child-proof' their homes. There are several preventative measures available.
One option is to provide children with 24/7 permanent surveilance. No research is required to understand that this is an impossible request for the vast majority of parents or caregivers managing multiple chidren and tasks at any time.
Another commonly used solution is the "plastic receptacle cap . This small cap usually has 2 plastic blades that insert into the receptacle openings and block access to the live electrical contacts. Yet these caps can be poor protective systems. In 1997 , the Biokinetics Lab at Temple University in Philadelphia studied 4 different receptacle caps. They tested these caps with 47 children aged 2 to 4 years old. One type of cap was removed by 100% of the 2 year-olds in less than 10 seconds. Other caps were removed in less than a minute by most other chidren.
Since that test, UL has provided the industry with strict product guidelines, but this does not deal with existing older caps, and some caps stil remain un-listed. Also caps can only provide protection when they are inserted.
When they have been removed to plug in an appliance there is no longer any protection. When a child puls out a lamp cord there is no longer any protection. Receptacle caps provide protection only when they are in place.
Unfortunately, this can only be ensured by constant vigilance to be certain that the cap has not been removed.
There are also receptacle cover plates available in the market that are intended to provide increased protection for children. However, there is no standardized test program to evaluate these plates for tamper resistance and they are typically not UL listed as they can unintentionally introduce a hazard by restricting the full insertion of a plug. These "chid proof' plates must also be considered a temporary solution, as it is common practice for
homeowners to swap out cover plates for more decorative models from the huge selection at the local hardware store.
Listed Tamper Resistant receptacles provide the most effective means of preventing children from inserting foreign objects into receptacles. Tamper Resistant receptacles have the advantage of being passive protective devices. Once the Tamper Resistant receptacle is installed, a plug may be inserted and withdrawn for normal everyday operation, and the tamper resistant feature of the receptacle remains unaffected. The tamper resistant receptacle continuously provides protection without any user intervention. Decorative cover plates can be installed without affecting the protection. Tamper Resistant receptacles are a proven technology. Tamper Resistant receptacles have been used in hospitals for many years. Section 517. 18(C) of the National Electric Code
(NEC) recognizes the hazard of chidren inserting foreign objects into a receptacle and requires Tamper Resistance in Pediatric Locations. UL has established rigorous testing and evaluation requiements in UL498 for Tamper Resistant receptacles to insure that an object inserted into one of the plug blade openings cannot come into contact with a live part in the receptacle.
Tamper Resistant receptacles are permanently installed ... and forgotten, while providing the best child safety available.
NEMA Business Information Services Department estimates that the average increase in "retail" cost for tamper resistant receptacles wil be 50 cents each and that the average new home built in 2004 had 75 receptacles. This translates into $37. 50 increased cost for the average new home.
Tamper Resistant receptacles may not have prevented all the incidents in the NEISS reports but they undoubtedly would have provided a significant reduction in the injuries to children. Since most of the incidents occurred in homes, adopting an NEC requirement for Tamper Resistant receptacles in dwelling unit rooms where children are likely to come into contact with receptacles will substantially reduce the type of child injuries described in the NEISS reports.
