ABSTRACT
This small boy attended the emergency department with a burn on the back of his hand as shown in Image 36a. He was too young to give an explanation, but his mother said he touched the hot front of a cooker (Image 36b). The doctor was concerned about non-accidental injury.
What is the nature of the injury?
Why was the doctor worried about its origin?
https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig36a.jpg"/> 82 https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig36b.jpg"/>The boy has sustained a burn to the dorsum of his right hand. It is most probably a contact burn.
Many emergency department attendances are for burns in infants and young children. They usually occur from one of three causes, fleeting inattention of the parents, more prolonged inattention at the level of neglect and deliberate infliction of the burn. 1 There are various types of burns, including scalding, the most frequent type in infants and young children, contact burns and flame burns. Non-accidental burns are most commonly scalds or contact with hot objects. Children of single parents or whose parents have a low income are more at risk. 1 , 2 The doctor was worried about the origin of this burn as the history given does not fit with the injury. A young infant explores the world with the palms of the hands, not the back of the hands, and this injury (Image 36a) is on the dorsum of the hand, making accidental injury less likely. In addition, there was no history consistent with the injury and there was delay in presentation, as the injury occurred more than 24 hours before presentation and the parent did not appear to be concerned about the injury. All these factors led to the increasing suspicion that the burn had been inflicted on the child. In contrast, the burn to the hand shown here (Image 36b) had a history of how it occurred which was consistent with the injury in addition, the burn was on the palm of the hand, an area which the child uses to reach out and grab things.
