Flammability of sleepwear (legislation)

Conclusion: Indications for effectiveness

No systematic reviews are available about the effectiveness of legislative interventions in preventing child burn injuries. Therefore, we looked at articles that present single studies on this issue.

McLoughlin et al. (1998; reprint of original article of 1977) showed that the data on child burns, due to ignition of children's sleepwear, merely shows a suggested downward trend after the introduction of a legislative measure. In addition, the authors indicate that there could have been other factors that affected the downward trend. Laing and Bryant (1991) re-analyzed the dataset used by McLoughlin et al. (1998) and analyzed additional data. They found a very strong linear downward trend for all child clothing ignition burns and an even stronger downward trend for cases specifying nightwear. The rate of decrease of events involving nightwear was greater than that for the total; this result demonstrates even more clearly the effectiveness of the legislative intervention in the children's nightclothes market. However, the study design (it does not concern a controlled study design) makes it impossible to rule out potential alternative explanations for the decrease in burn injuries. In sum, both articles provide indications that legislative measures could be effective.

McLoughlin et al. (1986) showed a sharp and annual decrease in the involvement of children's sleepwear in accidents of patients (i.e., children) treated by a particular burns institute in the USA. The decline correlated with introduction of the law. In addition, the authors indicate that there could have been other factors that affected the downward trend. In sum, the current article provides indications that legislative measures could be effective.

MacKay et al. (2006) state that legislation regulating flammability of sleepwear is effective in reducing burn injuries when enforced. Legislation passed in the USA in 1972 resulted in a 75% reduction in burn unit admissions due to sleepwear related burns [this outcome is based on the study conducted by McLoughlin et al. 1998].

Note: MacKay et al. (2006) statement is based on a review done on this topic by the Harborview Injury Prevention & Research Center. They present the outcomes of McLoughlin et al. (1998) research as the most prevalent finding. They conclude that "legislation regulating flammability of sleepwear is effective in reducing burn injuries". They include one additional reference in their review; they discuss the work of Knudson et al. (1980). We do not elaborate on this study because it merely corroborates the finding of McLoughlin et al. (1998). The link to the review of the Harborview Injury Prevention & Research Center is: http://depts.washington.edu/hiprc/practices/topic/fireburns/fabricslaw.html.

Recommendations (for research & practice)

Suggestions for future research:
- Important note is that all articles are based on data that is obtained more than 20 years ago (because changes in legislation occurred in 1970-1980). Many data on type of nightwear (i.e., boys wearing pyjamas and girls wearing nightdresses), the origin of nightwear (i.e., nightwear that is home sewn) or source of ignition (i.e., type of domestic fuel burner) could be outdated. These factors all influence level of ignition and thus also influence the amount of child burn injuries. Therefore, one can wonder whether the effects of the legislation remain constant when these factors change. Future research is needed.
- Additional data must be sought that inconclusively determines the actual effect of the fabric flammability legislation on severity and injury rate resulting from ignition of children's sleepwear.

Suggestions for practice/policy:
- Legislation is most effective when supported by educational activities. Level of enforcement will impact the effectiveness.
- Future emphasis in preventing burn injuries from clothing ignition needs to be focused on care in dealing with sources of ignition (e.g., matches, cigarette lighters) rather than on further constraints on nightwear.

Review Date: 23/03/2011
Version: 2.0
Status: Publish

Articles (reviews) and reports were included that were published between 1980 and 2010, in English and Dutch. The outcomes of the study were reviewed by the Dutch Consumer Safety Institute.

Strategy: An online literature search was performed by a researcher of the Consumer Safety Institute and after this a more thorough search was performed by the documentation centre of CSI (Catalog CenV, Pubmed, Injury lit, Google, Websites, 'Grey' literature). Results of each search were compared on differences and potential missed studies were added. First the titles and then abstracts were scanned in order to include relevant studies. In the case of insufficient information obtained from abstracts the full text articles were obtained. Relevant articles were scrutinized and background documents were created. In addition, relevant references of included articles were checked on new and relevant articles (i.e., snowball search).

The outcomes of the study were reviewed by an expert in the field of child safety in the winter of 2010.

Background documents

Child Safety Good Practice Guide : good investments in unintential child injury prevention and safety promotion (version 1)
M. MacKay, J. Vincenten, M. Brussoni, L. Towner ...[et al.] (2006)

Prevention of burn injuries to children involving nightwear (version 1.0)
Raechel M. Laing, Virginia Bryant (1991)

Prevention of children's burns : legislation and fabric flammability (version 1.0)
Elizabeth McLoughlin, John D. Langley, Raechel M. Laing (1986)

One pediatric burn unit's experience with sleepwear related injuries : 1977 (version 1.0)
Elizabeth McLoughlin, Nicola Clarke, Kent Stahl, ... [et al.] (1998)