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Case 125



Veena Ramaiah

Question

An 8-month-old was placed on the bed while his mother was cleaning out the crib. He fell off the bed onto the radiator that was between the bed and the wall. Upon seeing a wound developing, she brought him immediately to the emergency room. Due to the appearance of the burn and the pattern mark seen, a report was made for child welfare and police to investigate.

What      characteristics      would      prompt     an investigation? How is the investigation helpful?

Answer

Contact burns with a very distinct pattern can be concerning for inflicted injury, especially in a non- verbal child. Confirming the mechanism of injury or determining manner of injury often requires a multi-

disciplinary approach. Physicians may not be able to make these determinations at the bedside without other input or investigation. Reports to investigative agencies may be an integral component of the workup in order to provide additional information such as scene re-creation and interviewing of other corroborating witnesses.

During the scene investigation, the lettering from the radiator pipe was found that matched the imprint on the child’s leg. Based on the young age of the infant, ability to roll off bed, scene re-creation with the parents as to the position he was found in, and home investigation, the event was ruled accidental. The radiator did not have a cover and was “scalding hot” to the touch.

Contact burns are burns from a hot surface. This type of burn can be accidental or inflicted and distinguishing between the two is often difficult. In general, accidental burns are described as glancing, more superficial, on exposed areas of the body, and not patterned. In general, abusive burns are described as uniform, deeper, on covered areas of the body, and patterned. These are sometimes referred to as “branding” injuries. Movement of the child at the time of contact can create an unusual appearance if the child is struggling to get away and cannot.

This case illustrates a contact burn with a pattern to it that resulted from short contact with the object. This can occur depending on how hot the surface is. Investigation by child welfare and police including scene investigation is vital to elucidating the manner of injury.

Keywords: child abuse, mimickers, environmental

Bibliography

Hodgman EI, Pastorek RA, Saeman MR, Cripps MW, Bernstein IH, Wolf SE, Kowalske KJ, Arnoldo BD, Phelan HA. The Parkland Burn Center experience with 297 cases of child abuse from 1974 to 2010. Burns June 3, 2016; pii: S0305-

4179(16)00071-1.


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