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Inflicted Burns

Clinical Summary

Burns in children are frequently the result of child abuse. The most common types of pediatric burns from abuse are immersion burns and contact burns. Certain clues may assist the physician in differentiating accidental burns from inflicted burns, but often considerable doubt remains even after a careful evaluation.

In an immersion burn, a child is held firmly and deliberately immersed and will have burn margins that are sharp and distinct. If the child has little opportunity to struggle, few or no burns from splashing liquid will occur. In contrast, a child who accidentally comes into contact with a hot liquid will move about in an attempt to escape further injury. This movement causes the burn margins to be less distinct and may result in additional small burns as hot liquid splashes onto the skin. Children who are "dipped" into a bath of hot water often show sparing of their feet and/or buttocks because they are held firmly against the tub's relatively cooler porcelain bottom. A child who has had a hand dipped into hot water and held there may reflexively close the fingers, sparing the palm and fingertips.

Contact burns usually have a distinct and recognizable shape. Contact burn patterns most commonly associated with abuse include burns from curling irons, hair dryers, heater elements, and cigarettes. A child who has multiple contact burns or burns to areas that are unlikely to come in contact with the hot object accidentally should be evaluated for abuse.

Emergency Department Treatment and Disposition

Document thoroughly all burns that may be due to abuse. Draw sketches and take photographs of the injuries. Obtain a skeletal survey in children under the age of 2 years. Report any suspected abuse immediately to local child protective agency before discharge from the emergency department. Provide standard burn therapy.

Figure 15.1.

Immersion Burns. Immersion burns are often associated with toilet-training accidents. This girl was plunged into hot water after soiling herself. She shows sparing of the buttocks, which contacted the surface of the bathtub and avoided being burned. (Courtesy of The Visual Diagnosis of Child Physical Abuse. American Academy of Pediatrics, 1994.)

Figure 15.2.

Contact Burn (Curling Iron). Multiple contact burns on the chest and abdomen from a curling iron. Accidental curling iron burns occur, but because this infant has so many burns, the injury is suspicious for abuse and should be reported. (Photo contributor: Robert A. Shapiro, MD.)

Figure 15.3.

Contact Burn (Hair Dryer). The heated grid from the end of a hair dryer caused this child's burns. The burn size and pattern marks of ...

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