A 3-year-old girl is brought to the emergency department by her babysitter for evaluation of burns. The babysitter states that she was bathing the child when the child turned on the hot water. The child began crying and was quickly removed from the water. The patient lives with her biological parents, who are at work, and has been cared for by this babysitter for the last 6 months. Examination reveals an alert child who is crying inconsolably and in severe pain. The back, buttocks, and legs have patches of blistered, waxy, red skin. If found in this patient, which of the following burn characteristics would be most concerning for child abuse?

Question

A 3-year-old girl is brought to the emergency department by her babysitter for evaluation of burns.  The babysitter states that she was bathing the child when the child turned on the hot water.  The child began crying and was quickly removed from the water.  The patient lives with her biological parents, who are at work, and has been cared for by this babysitter for the last 6 months.  Examination reveals an alert child who is crying inconsolably and in severe pain.  The back, buttocks, and legs have patches of blistered, waxy, red skin.  If found in this patient, which of the following burn characteristics would be most concerning for child abuse?

Quizplus · Accepted Answer

11ec25c8_d640_a428_bc81_f519773fa852_MD0003_00 Scald injuries account for the majority of burns in pediatric patients. Child abuse can present as a scald injury and should be considered in all cases. Deliberate immersion burns usually involve the buttocks, back, and legs if the child is forced into a bathtub with hot water. These burns typically spare flexural creases due to ankle, knee, and hip flexion at the time of forced immersion. A stocking or glove burn distribution with a sharp line of demarcation and uniform burn depth may also be seen if an extremity is forced into hot liquid. An absence of burn in the distribution of splash marks is often noted as well. Additional red flags for child abuse include a caregiver's history of an injury that is inconsistent or does not correlate with physical findings (eg, hot liquid spill without splash marks). A delay in seeking treatment should also raise concern for child abuse. If a health care provider suspects that a child has been abused or neglected, the local child protective services agency should be notified immediately. (Choices A, B, C, and D) Unintentional scald injuries are characterized by the presence of splash marks, nonuniform burn depth, and poorly defined and asymmetric wound margins. The most common unintentional scald injury in young children occurs after a hot liquid spill from an elevated surface and results in facial, proximal upper extremity, and superior trunk burns. Educational objective: Child abuse in the form of deliberate scald injuries is characterized by burns with sharp lines of demarcation, uniform depth, lack of splash marks, and spared flexural creases. References: Diagnosis and management of physical abuse in children. (http://www.ncbi.nlm.nih.gov/pubmed/24364482) A systemic review of the features that indicate intentional scalds in children. (http://www.ncbi.nlm.nih.gov/pubmed/18538478)

A 3-Year-Old Girl Is Brought to the Emergency Department by Her