155 burns caused by hair straighteners in children:A single centre’s experience over 5 years

Julia H. Sarginson *, Catalina Estela, Shirin Pomeroy

South West Regional Paediatric Burns Service, Frenchay Hospital, Frenchay Park Road, Bristol, BS16 1LE, UK

b u r n s 4 0 ( 2 0 1 4 ) 6 8 9 – 6 9 2

a r t i c l e i n f o

Article history:

Accepted 9 September 2013

Keywords:

Hair straighteners

Paediatric burns

Contact burns

Infants

a b s t r a c t

Hair straighteners have become a popular and common household appliance. The incidence

of burns from these devices is rising, and is of particular concern given that the main

casualties are infants. We present the largest case series in the literature of paediatric burns

from hair straightening devices.

Methods: Retrospective data collection of all burns by hair straightening devices presenting

to our unit between 2007 and 2011. Details on demographics, time and mechanism of injury,

size and depth of injury and treatment received were recorded.

Results: There were 155 cases in the five-year period. The mean age was 19 months. The

majority of the burns were caused by a ‘touch/grab’ (49%) or ‘stepped-into’ (14%) mecha-

nism. The area most frequently burnt was the hand with 60% of the injuries. 8 out of the 155

required excision and grafting.

Conclusion: Hair straightening devices can reach temperatures of over 220 8C and can cause

significant full thickness injuries. Our study shows that infants and toddlers are at most risk.

These are preventable burns that warrant our attention, and we would advocate the use of

heat-resistant pouches and closure clips on the devices to help minimise the risk of injury.

# 2013 Elsevier Ltd and ISBI. All rights reserved.

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1. Introduction

‘Hair straighteners’ are a hand-held, mains operated, elec-

tronic device consisting of two opposing heated metal or

ceramic plates which are ‘clamped’ across a section of hair

(Fig. 1). The hair is then drawn through the closed device,

heating and thereby straightening the hair as this is done. The

heated plates can reach maximum temperatures of over

220 8C, much hotter than many domestic heat sources which

are commonly recognised to be a source of infant burns (Fig. 2).

The specific feature of hair straighteners that makes them

such a significant burn risk to children, is the long period of

time it takes for the devices to cool after use. Previous studies

have shown that the heat-cooling curves of these devices

demonstrate an ability to cause a burn with 1 s of contact for

up to 15 min after the device has been turned off [1–3].

* Corresponding author. Tel.: +44 7733374751.E-mail address: julia.sarginson@bristol.ac.uk (J.H. Sarginson).

0305-4179/$36.00 # 2013 Elsevier Ltd and ISBI. All rights reserved.http://dx.doi.org/10.1016/j.burns.2013.09.025

Over the past decade, as hair straighteners have become

more popular due to commercial availability, fall in prices, and

the fashion for straight hair, we have seen a steady rise in the

number of children presenting to our service with burns from

these devices.

2. Method

The South West UK Paediatric Burns Centre based at Frenchay

Hospital in Bristol is one of four tertiary referral centres for

paediatric burns in the UK, and covers the South West and

South Central areas of England and South Wales.

We searched our departmental paediatric burns injury

database and weekly MDT meeting records to identify burns

caused by hair care devices in children less than 18 years of age

between 1st January 2007 and 31st December 2011. 161 cases

Fig. 2 – Comparative temperatures of domestic heat

sources.

Fig. 4 – Number of injuries by month of the year.

Fig. 5 – Number of injuries by time of day.

Fig. 1 – Hair straighteners.

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were identified, of which 155 were caused by hair straigh-

teners. The six burns that were caused by other hair care

devices consisted of two cases of burns from curling tongs and

a burn from a heated hair brush, all of which were partial

thickness finger tip burns, and three cases of mixed radiant/

contact burns from hairdryers which caused larger injuries of

2–2.5% total body surface area (TBSA). These six burns were

excluded from further analysis. We reviewed the case notes

and database entries of the hair straightener burns, and

collected details on; demographics, mechanism of injury, size

and depth of injury and treatment received.

3. Results

During the study period the department saw 3470 new burn

presentations in children, meaning that the 155 burns from

hair straighteners accounted for 4.5% of all injuries seen.

Over the five years, we noted a steady increase in the

number of burns from hair straightening devices, reflecting

the increasing popularity, availability and affordability of the

product (Fig. 3). Peak incidences of injury occurred following

Fig. 3 – Number of injuries by year.

Christmas and at the beginning of summer (Fig. 4). We also

noted that more than 1/3 of the injuries occurred between 8

and 11 am, with a second peak in the early evening, at times of

day when the household may be more chaotic and the

children inadequately supervised (Fig. 5).

The majority of the injuries, 70%, occurred in children under

the age of 2, when they came into contact with hair straightening

devices belonging to a sibling or parent. The mean age of injury

in those under 5 years of age was 17 months for boys and 21

months for girls. The incidence overall was equal in males and

females, but boys had a slightly higher incidence under the age

of five. These are similar to previously reported figures [4]. A

second peak is noted in teenage girls, who sustained burns from

the use of their own hair straighteners (Fig. 6).

There were seven main patterns of injury which corre-

spond to the age of the child and the mechanism of injury by

developmental ability (Table 1). Only four injuries were

documented to be larger than 1% total body surface area,

and none greater than 2%.

The commonest mechanism of injury, accounting for 49%

of presentations, was from a ‘touch or grab’ by a curious

toddler, resulting in small superficial burns to the palm. The

next most common injury was from stepping into or onto hot

hair straighteners on the floor, accounting for 14%. The third

most common mechanism was ‘cord-pull’, which is sustained

when the hair straightener is left on a high surface to cool and

a crawling infant or toddler pulls on the dangling cord, with

the open jaws of the device allowing the hot plates to fall either

side of the forearm.

Fig. 6 – Distribution by age.

Fig. 7 – Sites of injury.

Fig. 8 – Typical ‘touch/grab’ burn to the palm of a 14-

month-old boy. This was managed conservatively with

dressings.

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Overall 60% of the injuries were sustained on the hand, 17%

on the foot and 23% elsewhere (Fig. 7). Those on the hand were

typically superficial (Fig. 8) and all but one of these was

managed with dressings alone. The deepest burns were seen

on the foot and ankle – reflecting the prolonged contact time,

and were often seen on two surfaces (Figs. 9 and 10). Five

patients with burns to the feet or ankle required surgical

debridement and skin grafting.

All children presenting to our unit with burns are seen by

both the plastic surgery team and the paediatric team at the

time of their initial assessment. This is to assist in the

identification of any potential cases of non-accidental injury

(NAI) or neglect. Three children in the series were already

known to social services. In one case this was due to a previous

suspicious injury, another was due to the mother being a

recovering drug abuser, and another was due to previous

concerns over neglect. However, in each of these cases,

following investigation, there were no specific concerns about

Table 1 – Summary of injuries by mechanism.

Mechanism Incidence in ourpopulation (%)

Mean age

Touched/grab 49 20 months

Stepped into/onto 14 2 years 5 months

Cord pull 10 17 months

Crawl into 4 2 years

Fall onto/sat on 4 6 years

Whilst using 2 Teenage

Electrical 1 Teenage

the circumstances of the hair straightener burn injury. Three

other the children in the series were referred to the

community paediatricians or for health visitor assessment

due to concerns about delayed presentation and potential

neglect. There were no cases in which it was felt the burn was

caused intentionally.

24 of the 155 injuries had documented burns on two

surfaces of the affected limb. Traditionally, burns on two

surfaces of a limb has raised concerns about NAI, however,

none of the cases in our series were identified as NAI. In the

case of burns from hair straighteners it has to be understood

that many of the injuries occur when the limb is caught

between the two heated plates, particularly in the ‘stepped

into’ and ‘cord pull’ injuries. These injuries commonly involve

an element of entrapment and, as the child’s skin is in contact

with the heated plates for longer, often result in deeper burns.

In our series of 155 burns from hair straighteners, only nine

required operative procedures (6% of the cases). This was

cleaning and application of dressings under general anaes-

thetic in one case, and debridement and split skin grafting in

the other eight cases. No child had to return to theatre for a

second visit, and there were no recorded post-operative

complications. All patients receiving skin grafting were

referred to our scar management team for advice and

compression garments where appropriate.

A small number of burns were sustained by older children

whilst using hair straighteners on their own hair. Most of these

were small superficial burns to the ears and face which were

managed with dressings or moisturisers. One teenage girl

Injury pattern

Palm, superficial, <1% TBSA

Foot, often 2 surfaces, deep dermal to full thickness, �1% TBSA

Forearm, often 2 surfaces, deep dermal to full thickness, <2% TBSA

Hand or arm, superficial, <1% TBSA

Thigh/buttock, superficial to deep dermal, <1% TBSA

Face or ear, superficial, <1% TBSA

Fingers, contact, full thickness

Fig. 9 – Superficial burn to the sole of the foot from a ‘stepped

into’ type injury sustained in a 4-year-old girl. The outline

of the rectangular heated plate can be clearly seen. There

was a corresponding burn on the dorsum of the foot.

Fig. 10 – Full thickness burn to the dorsum of the foot/ankle

in an 8-month-old girl. This required excision and split

skin grafting.

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sustained small full thickness contact burns from a faulty wire

connection in the handle of the device. These were managed

conservatively.

4. Discussion

The findings of our study show that there are common

patterns of injury that are sustained from hair straightening

devices which relate directly to the developmental age of the

child. The clinician should be aware that mechanisms

involving entrapment of the limb can result in burns on two

surfaces and may not represent non-accidental injury. Burns

on the lower limb are likely to be deep and are at higher risk of

requiring skin grafting. In our series the deepest burns were

sustained around the ankle, which has potential concerns

regarding scar contracture over the joint.

Hair straightening devices are one of many domestic

appliances that can attract the interest of young children.

The UK Electrical Safety Council review of 2011 noted that

‘‘The hair straightener [may not be] shaped or decorated like

a toy . . . nevertheless, the brightly coloured enclosure might

still be considered appealing as a plaything by young

children’’ [5]. Many are now sold accompanied by a heat-

proof bag, or with a closure clip to keep the hot surfaces away

from exploring fingers, but in the absence of effective

legislation on the issue, the best preventative measure will

remain education of the users. There have been many

educational campaigns to warn the public about the dangers

of hair straighteners [6,7] and we would recommend that all

units treating burns in children include this hazard in their

prevention and educational work.

Conflict of interest

The authors declare that they have no conflict of interest.

Acknowledgements

With thanks to the staff at the South West Centre for

Children’s Burns for their help in compiling the data.

This study was presented at the 16th Congress of the

International Society of Burn Injuries in Edinburgh, September

2012.

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[3] Foong DP, Bryson AV, Banks LN, Shah M. Thermal injuriescaused by hair straightening devices in children: asignificant, but preventable problem. Int J Inj Control SafetyPromot 2010;17:87–93.

[4] Mehta S, Barnes D, Edwin A, Pape S. Burns in children causedby hair straighteners: epidemiology and investigation ofheating/cooling curves. J Burn Care Res 2008;29:650–4.

[5] Nemko Ltd. On behalf of the Electrical Safety Council (UK).Safety screening of health and beauty products – HairStraighteners. Report No. 42233. London: Nemko Ltd.; 2011.

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