The mother of a 4-month-old boy tells you that he was in a bath seat in the sink when she turned away to get some soap and he turned on the hot water. The child has second-degree burns on both feet and ankles to just above the malleoli. Your management is to:
Admit the child and consult child protective services.
+Attempt to corroborate the history by contacting another caretaker.
+Call the state welfare agency to arrange a home visit.
+Teach the mother about burn prevention and water safety.
+Treat the burns and arrange outpatient follow-up.
A 4-month-old child does not possess the motor skills to turn on a water faucet. Scald burns are most commonly a result of partial immersion in hot water, and this is the typical distribution. All 50 states and the District of Columbia have mandatory reporting laws for suspected child abuse. A report must be filed with state or county child protective services. The family should be told that abuse is suspected and that a report has been filed. This conversation should demonstrate an attitude of seeking to help the child and family and so avoid vindictiveness.