Case Study 1-12
This 33-month-old girl was taken to the ER by her parents who reported that they first noted the burns to her back after returning from a trip. The child was in the backseat of the car. They stated that although she was restless, she did not give them any reason to suspect that she was injured. They initially did not know how the injury had occurred.
Figure 1-12-a. Second-degree burns of the back to the gluteal crease on her left side, including the left buttock.
Figures 1-12-b and c. The burns extend laterally on the torso to the midchest of her right side and to a higher level on her left side.
Figure 1-12-d. Her right arm has a small area of burn medially and at the elbow. After the child’s examination, the parents suggested the injury resulted from a sunburn or that it was caused by the sun heating the back of the carseat. They also reported that she was wearing a bathing suit. The burns involved multiple surface areas. The patterns were not consistent with sunburn, since there were no clothing lines. Also, contact burns demonstrate contouring on the host surface. This child’s burns were more consistent with immersion burns caused by a hot liquid, and subsequently reported as abuse. The child was placed in foster care for 6 months, and then returned to her parents. One month later, she returned with a similar burn without any explanation.
Case Study 1-13
This 18-month-old girl was examined for second- and third-degree burns on both legs. She was also malnourished requiring nutritional support before skin grafting could be done. Investigation by social services determined that the burns were most likely unintentional.
Figures 1-13-a and b. Sustained second- and third-degree burns of both legs from hot water immersion.
The child was readmitted 6 months later with a large third-degree burn on her back. Her mother and stepfather stated that she was asleep in the back seat of their car when battery acid spilled onto her. According to their account, the child did not awaken when she was burned and they only noted the burn after they arrived home and were getting her ready for bed. After a thorough investigation, it was determined that her stepfather inflicted the burns. The child was initially placed in foster care and subsequently adopted.
Figure 1-13-c. Third-degree burn to this child’s back that occurred 6 months after the initial burns on her legs.
Case Study 1-14
This child was first seen when he was 26 months old. While in the care of a 14-year-old babysitter, he burned his right hand on a space heater. Initially, the burn was determined to be an unintentional injury. Four months later he returned to the ER with another burn. His mother reported that she had given him a bath the evening before and had not see the burns until the following day when she noticed that the skin on his buttocks was coming off. It was later revealed that the child was burned as a form of punishment.
Figure 1-14-a. Contact burn on this 26-month-old child’s right hand resulting from a space heater.
Figures 1-14-b, c, and d. This child has a large bruise on his lower back and a smaller one on his left thigh. These are confluent linear marks.
Case Study 1-15
This 3-year-old girl was taken to the ER for second- and third-degree burns of her hands. It was alleged that the child stuck her hands under running hot water. The child later stated that “mommy was mad at me and put my hands in the water.”
Figures 1-15-a and b. Compare these injuries with typical immersion injuries. There is no stocking-glove sign. The palms are relatively spared. In addition to the child’s history, the temperature of the water, as measured by the investigator, confirmed that it was not hot enough to cause an instantaneous burn.
IMMERSION BURNS
DELAY IN CARE
Case Study 1-16
After a considerable delay, this 9-month-old boy was brought for medical attention for burns. An older sibling reportedly burned him in a bathtub. Caregivers did not seek medical care initially as they did not appreciate the severity of the burns.
Figure 1-16-a. Immersion burn at least partial thickness deep. Note considerable burns on the buttocks bilaterally with burns extending onto the posterior legs. Depth of the water was relatively shallow.
Figure 1-16-b. On closer inspection, the burn reveals evidence of healing with granulation tissue as well as areas of secondary infection.
Figure 1-16-c. Burn to the knee appears to be full thickness. Other burns to the legs reveal a pattern more complex than a simple immersion burn—possibly due to hot water being poured from above.
This case represents medical neglect, supervisory neglect, and possible physical abuse, depending on who burned the infant. Delay in seeking medical care for a substantial burn can lead to further disfigurement, scarring, sepsis, and an increased risk of death.
IMMERSION BURNS
EXTENSIVE BATHTUB BURNS
Case Study 1-17
This 15-month-old boy was brought to the ER for burns that reportedly occurred in a bathtub. The mother stated that she left the child for just a couple of seconds after she had placed him in the bath. She stated that he turned on the hot water and burned himself. Extensive partial thickness burns resulted.
Figure 1-17-a. Burns to the right foot and lower leg.
Figure 1-17-b. Very painful partial thickness burns to the perineum, buttocks, and scrotum.
Figure 1-17-c. The position