The remains of the burnt oxygen nasal cannula belonged to a child with chronic lung disease on home oxygen therapy (HOT). He had always celebrated his birthdays with the usual cake and the appropriate number of candles. Admiring his fourth birthday cake, he lost balance and came too close to the candles. The nasal cannula went up in flames. His hair too. His older sister was cute enough to rip the cannula off his head. Physically, he only suffered from nasal second degree burns. His family feels guilty, even more so since everyone knew that oxygen was a combustive agent.

Only adult patients have been reported in the literature to have suffered from HOT induced burns, which varied from small superficial facial lesions to lethal inhalation injuries.¹ Most of these incidents were caused by cigarette smoking. Young children, luckily, do not normally smoke. They are thus probably less at risk of oxygen induced burns.

When prescribing HOT to paediatric patients, physicians should however remember children’s pleasures: birthday cakes and candles—and warn parents accordingly.