Case 97

A 13-month-old baby girl presented with burns to both of her lower extremities and genitals as pictured (Image 97). Her mother stated that she placed the baby in the bathtub, turned on the water and left the room to answer a phone call. She reported that she checked the water temperature and it was fine before she left the bathroom. When she came back into the room, she noticed the water was too hot and immediately pulled the baby out of the water. She brought her to the emergency department right away. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig97.jpg"/>

What is your diagnosis?

What other features of the burn raise your concerns?

220

This child has symmetric scald burns to both lower extremities that are consistent with immersion burns. Scald burns – both accidental and intentional – account for the majority of childhood burns seen by healthcare providers. This child had a burn with a stocking pattern, which was consistent with an abusive immersion burn. Forced immersion scald injuries are the most common mechanism of intentional scalding of children. ¹ The patterns of these intentional scald injuries are mostly bilateral and symmetric, with clear upper margins and involving the lower extremities. This description clearly fitted this child’s burn, and, coupled with the poor history of the event provided by the mother, our suspicion for an intentional scald injury was high. The genital burns were consistent with flexion of the hips and knees during the immersion and most likely occurred simultaneously.

There are several features of scald burns that are suggestive of intentional burns, including (1) an absence of splash marks (indicating that the child was held tightly in position); (2) a uniform depth; (3) a well-demarcated burn area; (4) an involvement of dorsal hands or feet, face, buttocks or the backs of arms or legs; (5) a stocking or glove pattern; (6) a poor history of the event or an unwitnessed event; and (7) a delay in seeking treatment. ² The presence of one or more of these features should raise a provider’s index of suspicion for abusive scald burns.