Figure 1-17-d. Pattern reveals that the right foot was in the water more than the left.
Figure 1-17-e. The heel of the left foot is burned but the dorsum spared, indicating the left foot was held up, perhaps as the child was being placed into the hot water.
Figure 1-17-f. The thicker skin of the soles is relatively spared. The burn pattern indicates that the right leg was only slightly bent.
If there was no water in the bathtub initially, it would have taken a long time to get water to the depth indicated by the burns. If the water had already been in the tub, the mother would be neglectful for leaving the child alone; however, incoming hot water would take a long time to heat the existing water to a temperature that could cause such burns, and the screams of the child would have alerted the mother. Also, it is doubtful that this child would have stayed relatively still in this position. He would have moved away from the painful stimulus and prevented these burns. Thus, these burns represent immersion into very hot water that would have already been in the bathtub to this depth. It was determined that this was a case of physical abuse and not neglect—the mother’s history was false.
Case Study 1-18
3-year-old male reportedly placed in the bathtub with existing water in the tub and water running from the faucet. The mother’s boyfriend reportedly pulled the lever to turn on the mobile shower head. He then pulled it down and moved the spray over the child to rinse child off. This child also had multiple other bruises, including genital bruising. The child stated, “Father hurt me.”
Figures 1-18-a, b, and c. Burns on the boy’s face, shoulder, and back.
IMMERSION BURNS
SAME BURN, DIFFERENT MANNER
Case Study 1-19
22-month-old male with immersion burns. The mother reported that, initially, the water running from the faucet was cold. She then adjusted the faucet but did not check the water temperature again. The mother sat the child on the edge of the tub with his feet outside the tub. Her hands were placed under his axilla, and while holding him, she slid him backwards off the edge of the tub into the water. His buttocks entered the water first while she was still holding him. His feet were still over the edge of the tub. He screamed immediately when he entered the water. His mother was uncertain how far his buttock entered the water but reported she removed him immediately once he screamed. She noted that his skin was red and peeling. Although it is difficult to determine if the etiology of his burn was unintentional, the history offered was plausible.
Figures 1-19-a and b. Immersion burns on the child’s buttocks and scrotum.
Case Study 1-20
2-year-old with immersion burns. This mother stated that she placed the child in an empty bathtub, facing the faucet. She then turned the water on and left it running, while she left the room for approximately 5-10 minutes. Although she heard the child crying, she assumed the child was upset about having to take a bath. When the mother returned, the child appeared frightened, and immediately stood up in the tub gesturing to be removed. The mother noted that the water was still running and steam was rising from the bath water. She immediately removed the child from the tub and estimated that there was approximately 5-6 inches of water remaining in the tub. The mother later confessed that the child “went potty” and that she held her under the tub faucet. The feet should have been burned had the child stood in the water, as initially stated by the mother.
Figures 1-20-a and b. Immersion burns on the child’s buttocks.
IMMERSION BURNS
PERINEAL BURNS
Case Study 1-21
This toddler suffered an abusive bathtub burn.
Figure 1-21-a. Note the perineal burns with sparing of the buttock areas that were pressed against the cooler bathtub.
Figure 1-21-b. With spreading of the labia majora, urethral prolapse can be seen. Urethral prolapse most commonly presents as painful genital bleeding in prepubertal African-American girls. It is not an indication of concomitant sexual abuse.
IMMERSION BURNS
STOCKING-GLOVE PATTERN BURNS
Case Study 1-22
A toddler was brought to the ER with a burned foot. The mother stated this child stood in the bathtub and turned on the hot water.
Figure 1-22-a. Deep partial thickness burn to the inner aspect of the left foot. Note blisters on the toes corresponding to less severe burning.
Figure 1-22-b. Deep partial thickness burn to the right foot. If the history offered were true, the stream of water would have to have fallen symmetrically between both feet; however, it is evident that the child was immersed in several inches of water of a lesser temperature. A further inconsistency is that the child would have reacted by moving away from the stream of hot water.
Case Study 1-23
21-month-old female with bilateral glove-stocking pattern scald burns. A cousin was running water for a bath when the child reportedly put her hands under the hot water. If this child had leaned over and fallen on her hands, there would not be a clean line of demarcation for the burn, especially while the water was still running.
Figure 1-23. Glove stocking pattern scald burn on child’s right hand.
IMMERSION BURNS
HEALING IMMERSION BURNS
Case Study 1-24
This 3-year-old child was brought to the outpatient department of a childrens hospital.
He was found to have burns that were healing. He reportedly burned himself in a bathtub. There were no burns to the hands or feet, indicating that this was an immersion burn. This child was lowered into hot water.