ABSTRACT
A 4-year-old girl was brought to the emergency room 2 days after sustaining a burn. Her mother reported she was making hot tea and placed it on the table in the dining room and the child walked up to the table and pulled the cup, spilling its contents onto herself. The mother removed her clothes, applied aloe and bandaged the skin and did not seek medical care because she thought Child Protective Services would be notified. The child sustained the injury over her abdomen as depicted in Image 103.
What does the image show?
What are the possible causes for this finding?
What are important next steps to determine the aetiology for this patient’s presentation? https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig103.jpg"/>
234The child had an asymmetric skin lesion with hyperpigmentation surrounding new tissue/granulation tissue, with increasing width caudally. There was a ‘sweep’ from the left to the right, moving from left mid-quadrant to suprapubic location. There was also eschar formation present centrally, with diffuse crusting but no evidence of cellulitis. There were separate areas of granulation tissue, suggesting separate areas of superficial and deep partial thickness burns. There was sparing of the umbilicus, inguinal creases and genitals.
The pattern was consistent with an accidental drip or splash burn, modified by the position of the child, clothes and temperature of the liquid involved. 1 Clothing can modify burn patterns either by increasing contact time (and therefore increasing burn depth) or by absorbing heat and liquid to decrease thermal energy transmission. A thermal liquid burn as reported was likely, but chemical burns are possible.
In addition to routine care of the burn, the child should be interviewed. A normally developing child at this age should be able to disclose important details concerning how the burn occurred. Consideration should also be given to evaluation for other trauma and some have noted the value of skeletal surveys in detecting occult trauma in younger children. 2
