CHILD PHYSICAL ABUSE
- burns in suspicious locations such as flat palm of hand, back of hand, top side of forearm
- hot water burns from bath should be on tips of feet or back of heels - not up the back of the legs or up to the ankle
- burns to children where there is previous history of physical abuse
- burns up to ankles, on buttocks and up backs of upper legs
- imprint burns, branding burns or suspicious shapes i.e shape of the top of a lighter, cigarette - look at position, shape, severity and frequency of burns
Burns account for around 10% of physical abuse cases and is usually not the first act of physical abuse to a child. In cases where you are aware of previous physical abuse on a child all burns should be considered as suspicious. Studies indicate that 10 to 25% of burns on children are abusive, and most of these occur on Preschool aged children.
Burns can be approached in a similar way to bruising to determine which ones are suspicious. For example, the location of the burn is important. Accidental minor burns on children will normally be on the fingertips where curious little fingers reach up to hot barbeques, stoves, irons or hot water. Burns on the flat palm of the hand, or the back of the hand, are suspicious – and more consistent with the hand being forced onto or into something hot.
Similarly round burns under the forearm or burns on the top of the forearm can be suspicious – and consistent with deliberate burning with naked flame or a hot spoon – both of which are used by some parents to punish children or teach them not to touch hot things.
Burns on the feet should usually be on the tips of the toes or back of the heels – typically where they would first enter hot water – but burns up to the ankles or along the backs of thighs, buttocks and genitals are more consistent with being forced into hot water. Usually accidental burning with liquids will leave uneven patterns of burn marks – but if you can see a clear line between the burned and unburned skin then that indicates the skin has been held in the hot liquid forcefully.
Imprint burns such as burns in the shape of the top of a lighter, or the shape of a cigarette butt, or burns that look like a branding – should always be treated with suspicion. Cigarette burns are often found in varying stages of healing. They are usually all the same size, and leave punched out ulcers with dry purple crusts. One note here – just be aware that impetigo or school sores can present in a very similar way to cigarette butt burns.
So look at the position and shape of burns, the severity and frequency, and if you think they are in an usual spot, or of an unusual shape, or they happen more often than is normal, then document and report your concerns. Remember that too many genuine accidental burns can also be an indicator of a lack of parental supervision – so reporting can do no harm in that case.