cold injuries where child maltreatment should be considered

Last reviewed 10/2022

Burns in physical abuse may have the following characteristics:

• cigarette burns may be over a variety of parts of the body, and are usually symetrical and circular. They are often "explained" as splash burns, which would tend to be on exposed parts, and are less perfectly circular.
• other shapes of burns can suggest the instrument used - in particular an iron
• a child who has been placed into hot water will tend to resist the movement; the scald will therefore involve a stocking like distribution on both feet and maybe a circular patch over the bottom, as the child draws up the feet. By contrast, the child who climbs into a hot bath unattended - which is often the explaination given - will have a burn only on one foot or leg.

NICE have outlined the features of thermal injuries where should suspect child maltreatment (1):

• burns or scald injuries
  • child maltreatment should be suspected if a child has burn or scald injuries:
    • if the explanation for the injury is absent or unsuitable or
    • if the child is not independently mobile or
    • on any soft tissue area that would not be expected to come into contact with a hot object in an accident (for example, the backs of hands, soles of feet, buttocks, back) or
    • in the shape of an implement (for example, cigarette, iron) or
    • that indicate forced immersion, for example: scalds to buttocks, perineum and lower limbs scalds to limbs in a glove or stocking distribution scalds to limbs with symmetrical distribution scalds with sharply delineated borders
• cold injuries where child maltreatment should be considered:
  • consider child maltreatment if a child has cold injuries (for example, swollen, red hands or feet) with no obvious medical explanation
  • consider child maltreatment if a child presents with hypothermia and the explanation is unsuitable

Notes:

• for the purposes of this guideline, to suspect child maltreatment means a serious level of concern about the possibility of child maltreatment but is not proof of it
• for the purposes of this guideline, to consider child maltreatment means that maltreatment is one possible explanation for the alerting feature or is included in the differential diagnosis

Reference:

• 1. NICE (July 2009). When to suspect child maltreatment.