ABSTRACT
These pictures show burns on both feet of two different children. They have a similar appearance. The first two images (Images 126a and 126b) show burns on the feet of a 4-year-old boy who was left in the care of his mother’s boyfriend overnight while his mother was at work. The child had language and developmental delays and did not speak. Upon returning home in the morning, his mother found his feet wrapped in bandages. The boyfriend stated that the child had stepped into a pan of hot grease the night before. The second two images (Images 126c and 126d) show burns on the feet of a 9-month-old girl. Her mother stated that she was rinsing the baby in the utility tub in the laundry room after the baby had a dirty diaper. The baby screamed and mother noted burns immediately as she placed the baby feet-first in the tub. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig126a.jpg"/> https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig126b.jpg"/> 286 https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig126c.jpg"/> https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig126d.jpg"/>
Which of these cases should be reported to Child Protective Services (CPS)?
What features help to make the diagnosis of non-accidental immersion burns?
288Both cases should be reported to Child Protective Services (CPS). CPS can make a referral to local law enforcement who can investigate the scene of the injury and in the case of burns, measure the water temperature at the scene.
The first case was felt to be clearly non-accidental. The history of the child stepping into hot grease seemed highly implausible. 1 , 2 Humans step one foot at a time. If the child were stepping into something hot he would withdraw his foot and not step in with the other foot. In addition, it is unclear where the pan of hot grease that the child could step into was located. 3 , 4 The second case was also reported to CPS. After thorough questioning and scene investigation, the mother’s account of the incident was corroborated. In the emergency room she stated that she was rinsing the baby in the laundry tub because there were multiple workers in her home doing reclamation work and she did not want to leave them to go upstairs. She was distracted and did not realize how hot the water was. Investigators confirmed the presence of the workers, reviewed the recording of the call for emergency medical services and measured the water temperature to be 160°F (71°C).
