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Emergency: requires immediate attention
Burn marks of child abuse - Suspected Child Abuse
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Emergency: requires immediate attention

Burn marks of child abuse - Suspected Child Abuse

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Contributors: Mary Spencer MD, Noah Craft MD, PhD, Ann Lenane MD, Amy Swerdlin MD, Manasi Kadam Ladrigan MD, Carol Berkowitz MD
Other Resources UpToDate PubMed

Synopsis

Physical abuse is the most frequently reported form of child abuse, with skin being the most commonly injured organ system. Abuse by burning comprises approximately 6–20% of all child abuse cases. Most abusive burn injuries occur on victims aged between 1 and 3 years. Stressors such as inconsolable crying, toilet training, and physical disabilities have been shown to increase likelihood of abuse in caretakers who are already stressed by limited emotional and physical resources. Assessment of the origin of burn injuries in this young age group can be particularly challenging because many of the children victimized are not yet verbal. The mortality rate of burns caused by abuse is greater than that of noninflicted burns. In general, when compared with accidentally burned children, abused children were significantly younger, had longer hospital stays, and had a higher rate of mortality. Burns resulting from neglect are another form of child abuse, even if they result from an act of omission.

Burns to the skin can be electrical, chemical, thermal, or radiant in nature. Various factors can influence the severity of a burn injury including the thickness of the skin, the length of contact with the source, the temperature of the agent, and the blood supply to the affected tissue. Electrical burns are quite subtle, and skin lesions may be inconspicuous or even absent. Such injury can cause prolonged tetany of muscles and should be considered when unexplained death or loss of consciousness occurs. Chemical burns are either acidic or alkaline and cause a prolonged period of burning due to residual product on the skin. Alkaline burns result in liquefaction and deeper injury.

The most common mechanisms used to inflict injury include immersion in scalding water, branding, and cigarettes. Microwaves and stun guns are rarer causes for inflicted injury. Sadly, any hot medium can be used as an instrument of abuse including common appliances such as hair dryers and irons. As with bruises, the pattern of injury suggests which instrument was used to inflict harm. In branding/contact burns, the imprint of a hot object is distinguished by uniform depth and clear margins. In contrast, only part of an object may be seen in nonintentional burns, since instinctual reflex allows the child to pull away from the pain.

It is important to note that cultural practices such as cupping, coining, and moxibustion lead to burn-like lesions in distinctive patterns. Proper evaluation is necessary, as the use of cultural practices does not exclude the potential for child abuse. In these cases, significant attention should also be focused on educating the parents to explain the adverse outcomes, discourage future harmful behavior, and suggest alternative forms of treatment.

Childhood physical abuse is a problem of epidemic proportions affecting children of all ages and economic and cultural backgrounds. It is estimated that each year over 3 million children are victims of abuse, with close to 2,000 fatalities secondary to maltreatment. Differentiating inflicted burns from those sustained accidentally or secondary to benign skin conditions can be challenging. However, a careful evaluation including the distribution, pattern, and history of the skin lesion in the context of the developmental capabilities of the child can help assess whether the injury was intentional.

Codes

ICD10CM:
T76.12XA – Child physical abuse, suspected, initial encounter

SNOMEDCT:
371779005 – Physical child abuse

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Dermatological mimics of circular or patterned burns:
Other types of burns:

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 06/15/2018
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Emergency: requires immediate attention
Burn marks of child abuse - Suspected Child Abuse
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Burn marks of child abuse : Skin burns, Erythema, Skin erosion, Tense bullae, Blanching patch
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