Legislation for safe pre-set temperature for water heaters to prevent burn and scald injuries in children

Conclusion: Indications for effectiveness

One study (Thomas et al., 1991) showed that legislation requiring pre-set temperature of 49oC for all new water heaters led to a 56% reduction in hospital admission rate due to tap water scald burns, from 5.5 children per year to 2.4 children per year. The severity of the burns was reduced. In sum, there is some indication that legislation requiring a safe pre-set temperature for all water heaters is effective in reducing the number of scalds and the severity of the scald burns.

Note: Concerning the temperature needed to prevent scalds Waller et al. (1993) indicated that as the temperature of the water increases above 54°C, the duration of exposure needed to suffer third-degree burns decreases rapidly. Healthy adult skin requires 30 seconds of exposure to water at 54°C before third-degree burning occurs, but only 5 seconds at 60°C and less than one second at 70°C. The skin of children and the elderly is even more sensitive to extreme temperatures.

Recommendations (for research & practice)

Suggestions for future research:
There is little published evidence concerning the effectiveness of legislation on pre-set water temperature for water heaters. There is a need for a systematic review to further adress this issue.

Review Date: 15/06/2010
Version: 2.0
Status: Publish

Articles (reviews) and reports were included that were published between 1991 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 summer of 2010.

Background documents

Tap water burn prevention : the effect of legislation (version 1)
Thomas C. Erdmann, Kenneth W. Feldman, Frederick P. Rivara ...[et al.] (1991)

An evaluation of a program to reduce home hot tap water temperatures (version 1.1)
Anna E. Waller, Judith A. Clarke, John D. Langley (1993)