Case 67

You were asked to review pictures in the possession of the police. A 4-year-old boy was being cared for by his grandfather. When his mother returned home, the child told her that ‘pop pop hurt me’ and she saw a lesion on the boy’s leg (Image 67a). She wrapped the leg in a cloth and immediately took him to an emergency room, where a more detailed examination revealed more characteristics of the lesion (Image 67b). Child Protective Services were notified.

What do the images show?

Is this accidental or intentional?

What steps should be taken to protect the child during the investigation?

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This image shows a recent pattern burn on the posterior calf, with evidence of at least partial thickness injury with sloughing and some sparing of the skin in the shape of holes in the heating plate of the iron. The entire shape is not depicted, but it appears that a good portion of the iron came in contact with the skin (Image 67b). No additional burns elsewhere on the legs are depicted. The second image highlights that one side of the burn appears deeper, suggesting the iron was applied with more force and/or at an angle to the leg, causing deep tissue injury on one side.

Additional history was required to determine the mechanism of injury other than being caused by an iron since a plausible history of accident could be constructed based on the physical findings alone. ¹ Additional information should be sought from witnesses (child, mother, grandfather) about the location of the iron, if it had been turned off, and the circumstances surrounding its contact with the child. If the iron had fallen off a table while hot onto the child’s leg or whether the iron was on the floor and the child was playing/walking would help differentiate the mechanism of injury. Pictures of the iron and/or the iron itself should be obtained, and the temperature reached during use and the iron’s settings should be noted by investigators.

Regardless of whether the injury was intentional or accidental, there was an element of supervisory neglect present and steps should have been taken to supervise further contact with the grandfather pending investigation. Issues regarding discharge, home safety and appropriate supervision needed to be addressed before the child was discharged from medical care. Some legal authorities would prohibit any contact with the grandfather as to not taint any further interviews with the child. Education to be provided to the family to prevent burns must include the dangers of leaving hot irons and children unattended and encouraging parents to unplug irons when not in use, safely store the iron and the cord out of the child’s reach, and not to leave irons on the floor or low tables. ²