Sitting around a backyard fire pit may seem like an ideal way to relax on a summer or fall evening. But parents may not want to get too comfortable if there are young children around.

A research study led by Massachusetts General Hospital investigators Michael Flaherty, DO, and Robert Sheridan, MD, has confirmed an increase in fire pit-related burn injuries in children and adolescents nationwide, with the youngest children at the greatest risk.

The good news is that there are some simple steps—such as education and awareness—that can help to keep kids safe.

A Growing Trend?

Flaherty, a physician in the pediatric intensive care unit (PICU) at Mass General and Sheridan, a burn surgeon at Mass General and the Chief of Staff at Shriners Hospital for Children Boston, started studying the issue after seeing an increase in the number of patients coming in with burns from backyard fire pits.

Using data from a database of emergency department (ED) visits drawn from a nationally representative sample of hospital emergency departments, they found there were almost 11,000 ED visits for burn-related injuries from fire pits in patients 19 years and younger from January 1, 2006 to December 31, 2017.

More than half of those injuries (53%) occurred in children ages 0 to 5, followed by children ages 6-11 (25%) and ages 12-19 (20%).

The majority of injuries (40%) were flame burns related to falls on or into fire pits. This was followed by thermal burns (33%) from accidentally touching a hot surface, and injuries caused by stepping on our touching hot ashes or coals from an extinguished fire (10%).

The most common injuries were to the upper extremities (hands and arms), followed by the lower extremities, the head and neck and the torso.

Looking at the number of injuries per year seems to confirm that these incidents are on the rise, Flaherty says. “The average increase per year from 2006-2017 is a little over 7 per 100,000 patients, but if you look at the curve, it’s gone up exponentially over the past decade.”

Most of the injuries are moderate in nature and do not require a hospital stay, Flaherty says. “They are not 50-90% burns that would get you into a burn intensive care unit, but they are bad enough that they require you go to an emergency department for treatment and then sent home.”

Study Limitations

Flaherty says one key limitation of the study is that there’s no way to determine how many people have fire pits in their backyards, as many make them out of bricks or just build them into landscape stones. So it’s tough to know if the overall number of fire pits has increased, or just the number of injuries.

He also notes the database only captured ED visits, so there may be additional patients with burn injuries who presented to urgent care facilities or their primary care physicians for treatment.

Reducing the Risk

Reducing the number fire pit-related injuries will likely require a combination of legislation, education and product-related modifications, Flaherty says.

“In the case of campfires, a lot of what has been successful has been educational campaigns. Letting people know that they have to observe children carefully, and that even if the child can’t access the flame itself, the outside of the fire pit can cause severe second or third-degree burns.”

One technique that could be adapted from campfires is the concept of a “circle of safety.” This involves drawing a circle around the fire pit using chalk or sticks. Adults can monitor the circle to make sure children don’t cross the line into the danger zone.

Product improvements such as heat-proof materials or design modifications that cover the flame a little more but still provide heat could also help reduce injury risk down the line.

But for now, Flaherty says, the take-home message is that vigilance is key. “If you’re going to have a fire pit in your backyard and you have small children, you just need to be mindful that things can happen very quickly and that children need to be watched at all times when a fire pit is lit and after it’s extinguished.”

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