ABSTRACT
A 10-year-old boy who had immigrated from the Middle East 5 years ago reported being burned by his sibling. He told his teacher that his older brother had taken a hot iron from the stove and burned his leg ‘because I was bad’. He said this happened a week previously and he was worried about whether it would heal. He said it hurt ‘a lot’ and he told his mother, who reportedly told his brother to ‘stop doing that’. The child reported this had happened before ‘in my country’ and that he had seen another child ‘punished’ with similar burning before he came to the United States. During examination, you noticed a healing lesion on his anterior thigh (Image 55a). https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig55a.jpg"/>
What does Image 55a show?
Is this consistent with the child’s disclosure?
Is this a commonly accepted cultural practice for discipline?
126 https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig55b.jpg"/> https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig55c.jpg"/>The image shows a pattern skin lesion measuring 2 by 3 cm, with a hyperpigmented outline and pink, new skin with granulation. No eschar formation or superinfection is apparent. There is increased pigmentation at the base of the triangle shape. One possible interpretation is that the point or tip of the triangle-shaped object (consistent with an iron) was hotter or had longer contact with the skin, resulting in a deeper burn and pink skin formation.
Given the healing nature and shape of the lesion, the disclosure seemed consistent with the injury. The cultural explanation for the injury and whether it was caused by another child were unclear. However, when you examined the 7-year-old sibling, she made similar disclosures and showed similar lesions (Images 55b and 55c). These appear smaller, healed and with uniform hyperpigmentation.
There is consensus against using extremely harsh methods of physical punishment such as burning or smothering. 1 Many children have reported receiving violent punishment in countries ranging from Bosnia and Herzegovina (33%) to Yemen (94%); 1%–44% have experienced severe physical discipline. More violent discipline is used in countries where more domestic violence, polygamy and child labour are reported. More education and more books in the home were associated with a greater use of non-violent discipline strategies. In the United Kingdom, such violent discipline is not acceptable and is reported to Child Protective Services. However, it is usually managed by education for the parents rather than taking them to court for child abuse.
