Every year, thousands of children in the United States suffer from scalding burns caused by hot liquids or steam. These injuries can cause severe pain, infection, scarring, disfigurement, and even death. One of the most common sources of scalding burns is in improper handling and warming of bottles used to feed infants and young children.

Bottle warming is a common practice in childcare centers that serve infants and toddlers who drink breast milk or formula. However, bottle warming can be dangerous if not done properly and can lead to serious scalding burns or infections for the children who drink from them. The following information is to help organizations ensure they are providing the safest environment possible to the children in their care.

Why are Scalding Injuries from Bottle Warming a Risk?

A child's skin is much thinner and more fragile than that of an adult, which means it can burn more easily and deeply. According to the American Burn Association, a child can suffer a third-degree burn from exposure to a 140 degrees Fahrenheit liquid for just five seconds, or a 148 degrees Fahrenheit liquid for only two seconds. To put this in perspective, consider that:

• The low setting of a slow cooker (crock-pot) can be between 164-182 degrees Fahrenheit , while the warm setting can reach 280 degrees Fahrenheit
• A cup of water reaches boiling, or 212 degrees Fahrenheit, after only two minutes in a microwave

Scalding injuries from bottle warming can happen in various ways, including:

• Using improper warming techniques, such as using a microwave, a crock-pot, or boiling water to heat the bottle or the water used to warm the bottle
• Hot water used to warm the bottle gets on the child, either by dripping, splashing, or dropping
• The liquid in the bottle is heated unevenly or over-heated, creating hot spots that can burn the child's mouth or throat
• The child gets ahold of the container holding the hot water or the bottle-warming device
• The child pulls a cord from a bottle-warming device and the hot water or the device falls onto the child
  
  

How to Prevent Scalding Injuries from Bottle Warming

The good news is that scalding injuries from bottle warming are preventable. What many may not realize is that the best way to prevent these terrible injuries is to avoid warming the bottle altogether. According to the Centers for Disease Control and Prevention (CDC), formula and breast milk do not need to be warmed before they are fed to infants and children. However, many parents may still request bottle warming or it may be medically required (such as for some premature babies).

If bottle warming is still needed, here are some guidelines and best practices to keep children safe:

• Avoid using microwaves, stovetops, or crockpots to warm bottles. These methods can overheat the liquid, create hot spots, or damage the bottle. Instead, use a bottle warmer that has a thermostat, a timer, and an automatic shut-off feature. Follow the manufacturer's instructions carefully and test the temperature of the liquid before feeding
• Warm the bottle to no more than 104 degrees Fahrenheit . This will prevent scalds and will also avoid altering the nutritional value of the milk
• Never use boiling water to warm the bottle. Boiling water can scald the child and the bottle
• Hold the chilled milk under warm running water (110 degrees Fahrenheit or less) for a few minutes, or place the bottle in a container of warm tap water (110 degrees Fahrenheit or less) for no more than five minutes
• If mixing formula, water that is 110 degrees Fahrenheit or less can be mixed directly with the formula, given a safe water source
• Always test the milk on the inside of your wrist before serving it to a child. If it feels warm, it is too hot
• Always dry the outside of the bottle before serving. This will prevent any hot water from dripping or splashing on the child
• Ensure that all cords are properly secured and out of reach of children. Cords to bottle warmers and any other appliance or equipment should not be accessible by children as they can pull them and cause the appliance or the hot water to fall on them.
• Never hold a child while warming a bottle. This can distract from the warming process and put the child at risk of getting burned
• Never allow children to be near, under, or around bottle warming devices. Keep them away from any source of hot water or heat
• It is safest to have bottles warmed in a separate area not accessible by children
• Discard any leftover liquid after feeding. Do not reheat or reuse a bottle that has been partially consumed, as this can increase the risk of bacterial growth and contamination. Store unused breast milk or formula in the refrigerator and use it within 24 hours. Label each bottle with the date and time of preparation and the child's name.
• Educate your staff and parents about the dangers of scalding burns and the proper procedures for bottle warming and have a formal, documented policy. Provide regular training and supervision to ensure that everyone follows the safety guidelines. Post signs and reminders in the kitchen and feeding areas. Communicate with parents about their preferences and expectations for bottle warming and feeding.
  
  

How to Provide First Aid for Scalding Injuries

If a child suffers a scalding injury from bottle warming, you should act quickly and follow these steps:

• Remove any clothing from the burned area, including diapers. Clothing can retain heat and worsen injury. However, do not remove any clothing that is stuck to the skin or any material that is adherent, such as nylon
• Cool the burn with cool or lukewarm running water for up to 20 minutes. Do not use ice or cold water, as this can cause more damage to the skin
• After cooling the burn, cover it with a non-stick dressing, such as cling-wrap or a clear plastic bag. Do not wrap the dressing, only cover the burn. If cling-wrap or a plastic bag is not available, use a clean, dry cotton sheet
• Keep the child warm, as hypothermia can set in quickly in children. Use blankets or clothing to cover the child, but avoid the burned area
• Do not apply any topical creams, oils, lotions, butter, powder, ice, or anything else to the burn, as this can worsen the injury or cause infection
• Seek medical attention as soon as possible. Call 911 or your local emergency number if the burn is severe, large, deep, or involves the face, hands, feet, or genitals
• Complete all required reporting procedures, including incident reports and communicating to proper agencies where required

Scalding injuries from bottle warming are a serious and preventable risk. By following the best practices for bottle warming and handling, you can provide a safe and nurturing environment for the children in your care.

Additional Resources

• Scalding Injuries: What You Need to Know to Protect Your Clients and Your Organization
• Bottle Warming Dos and Donts Infographic - RMIQ ED
• Keeping Food Safe for Baby (mass.gov)
• National Resource Center (nrckids.org)
• scaldinjuryeducatorsguide.pdf (dc.gov)
  
  

_{IMPORTANT NOTICE - The information and suggestions presented by Philadelphia Indemnity Insurance Company are for your consideration in your loss prevention efforts. They are not intended to be complete or definitive in identifying all hazards associated with your business, preventing workplace accidents, or complying with any safety related, or other, laws or regulations. You are encouraged to alter them to fit the specific hazards of your business and to have your legal counsel review all of your plans and company policies.}