It can happen so fast.
One moment, a family is eating dinner together like usual. Soon after, they go off to do other things before being brought back together by a child's scream.
That is what unfolded in the Beckman home in State College, Pa., one October evening three months ago. The youngest of the family's three children, 3-year-old Hazel, suffered a serious friction burn as her arm got trapped in an active home treadmill.
"Hazel's extraordinary. She's doing a great job healing. I think she handled it better than most adults would have," said her mom, Sarah Beckman.
For Sarah, it's been more challenging. "I feel terrible. I feel like I'm on a bit of a national apology tour as a mom, but if somebody else can benefit from it, it's so important," she said.
Sarah is hoping both that families will be aware of the potential dangers of exercise equipment in their homes, while also hoping to help people be more aware of the seriousness of a friction burn.
Cases like Hazel are certainly not unique -- Dr. Alejandro Garcia, director of the Pediatric Burn Center at Johns Hopkins Children's Center in Baltimore, said the burn center has seen a doubling of treadmill-related friction burns during the pandemic.
"Talking with families, the sense is that a lot of these kids are staying at home, particularly the younger kids. Because of COVID they can't either be at school or with caregivers," Garcia said. "And, also, that there's a lot more home exercise equipment. I think it's a combination of those factors that may be leading to the increase that we're seeing."
The family's treadmill was not one of Peloton's Tread and Tread+ exercise machines, which were recalled in May. At the time, the U.S. Consumer Product Safety Commission (CPSC) warned of more than 70 reports of adults, children and pets being pulled under the rear portion of the machines. One 6-year-old boy's injury was so severe that he died, The New York Times reported.
However, any treadmill brand can be dangerous to children, experts warn.
Happened so quickly
After dinner that October night, Hazel's dad, Matt Beckman, was helping 10-year-old daughter, Eden, play the xylophone, while Sarah was working on the computer. Hazel and 6-year-old brother, Jack, had gone downstairs.
Jack had gotten the treadmill going faster and faster, while Hazel was rolling around on a foam roller on the floor. The high-tech equipment operates so quietly that no one upstairs realized the treadmill was on. Soon Hazel's arm was trapped against it.
She screamed and Jack pulled her arm out.
"I would say Jack was maybe a little more traumatized by the experience than even Hazel. I think that's maybe the gift of being 3. Jack's a little older and that was pretty scary for him, but he feels really proud that he met the moment and helped out his sister," Sarah said.
Hazel was left with what is a 4-inch-long, ¼-inch deep friction burn on her left forearm, including on her wrist.
"What's really alarming about it is that when I saw her burn, I didn't know what I was looking at," Sarah said.
The friction had removed the outer layers of skin, which meant the wound had a white, leathery look and wasn't bleeding.
The first night, after finding one urgent care center closed and another locking up in which a nurse in the parking lot advised applying an over-the-counter cream and wrapping the wound, Sarah called a nurse's line the next day and received similar advice. After that, she checked with Hazel's pediatrician and was told to go to the emergency room for treatment. There, they made the diagnosis and referred the family to the burn center.
"The impression that I got was everybody was, 'Oh, she got an abrasion. It will be fine,' but I just don't think there's enough awareness of how deep these friction burns can go so quickly on a treadmill conveyor belt," Sarah said.
Potential for lasting damage
A friction burn can be caused by direct friction with the skin. Scarring can damage mobility. The burned area may need a skin graft to heal and needs care to avoid infection.
"These friction burns can be very severe, one because they tend to be deeper. And second, because they're always in areas that are sensitive, that if the patient develops the scar, it can affect their mobility, which for her since it is her wrist and hand, that's what we worry, that it could affect her in the future," Garcia said.
Hazel's burn was considered between second- and third-degree.
Hazel Beckman's friction burn. SOURCE: Sarah Beckman consumer.healthday.com
In Hazel's case, the burn center helped the family get through the first few weeks, checking to avoid infection and be sure the skin is starting to heal and regenerate.
Once it's healed and the patient develops a scar, the next phase may include massage, occupational therapy and compression garments. Around six months after the injury, the team reassesses to see if a scar is developing that would cause problems and whether they need to address that with surgery or laser treatment.
In Hazel's case, she did not need an initial skin graft. She will continue to wear compression bandages 23 hours a day for about the next year while the skin continues to heal.
"I think we still have to watch her over time to make sure she doesn't develop any contractures [a shortening and hardening of muscles, tendons or other tissue that can lead to deformity and rigidity of joints]," Garcia said.
The '10-second rule'
Dr. Ben Hoffman, medical director of the Child Injury Prevention Program at Oregon Health & Science University who also serves on the American Academy of Pediatrics Council on Injury, Violence and Poison Prevention, said while a lot of people have treadmills in their homes, they don't realize the risks they can present to kids.
This includes fractures and head injuries from treadmills rocketing kids backward, Hoffman said.
"I think a couple of things to highlight is, number one, kids are kids, right? And especially younger kids are just built to explore. They're incredibly curious. They're also very mobile and fast and impulsive," Hoffman said. "We like to think that our supervision is enough, but things happen quickly."
Hoffman suggests parents look at their homes through the lens of what risks they might pose to their children.
"I think about it in terms of the 10-second rule," Hoffman said. "Would I trust my child alone with this for 10 seconds? And if I don't trust them alone with it for 10 seconds -- because that's how quickly things can happen -- we need to think about how we can establish layers of protection to prevent something bad from happening."
For a treadmill, that would include unplugging it when it's not in use and removing the plastic key most require for operation. Close doors or put up a gate. Precautions might vary by child, with different layers of protection depending on age or impulsivity.
"I've talked to a lot of families whose kids have suffered catastrophic injuries. And I think there's often an assumption that it's never going to happen to me," Hoffman said.
"I think you don't want to get to the point where you're so frantic because you assume it's going to happen to you that you're not able to live your life and your kids don't have the opportunity to do some of that exploration, because I think that's important for development. But there's some place in the middle where the really dangerous things, you make sure they don't have access to," Hoffman said.
At the Beckman house, the treadmill's safety key is now in a separate place, and the family will probably sell it, Sarah said.
The experience also taught them about the challenges of other families whose children have burns and are being treated at a burn center. They used the opportunity to work with friends and family to gather and donate toys and activities for recovering children.
"Suffering or any kind of sad thing that happens like that gives you the opportunity to connect with a new group of people. My eyes were really opened to the process of healing burns for families who had it much worse than we even did," Sarah said.
The U.S. National Library of Medicine has more on burns.
SOURCES: Sarah Beckman, State College, Penn.; Alejandro Garcia, MD, director, Pediatric Burn Center, Johns Hopkins Children's Center, Baltimore; Benjamin Hoffman, MD, professor, pediatrics, Oregon Health & Science University School of Medicine, and medical director, Tom Sargent Safety Center, Doernbecher Children's Hospital, Portland, Ore.; Johns Hopkins Medicine, news release, Jan. 11, 2022