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Characteristics of intentional scalds

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

 

Physical features of intentional scalds

 

Agents of intentional scalds:
The majority of intentional scald injuries are caused by hot tap water Comparative studies 1-8 Intentional alone 1-6

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References

Comparative studies:

  1. Ayoub C, Pfeifer D. Burns as a manifestation of child abuse and neglect. American Journal of Diseases in Children. 1979;133(9):910-914 [Pubmed]
  2. Daria S, Sugar NF, Feldman KW, Boos SC, Benton SA, Ornstein A. Into hot water head first: distribution of intentional and unintentional immersion burns. Pediatric Emergency Care. 2004;20(5):302-310 [Pubmed]
  3. Dressler DP, Hozid JL. Thermal injury and child abuse: the medical evidence dilemma. Journal of Burn Care & Rehabilitation. 2001;22(2):180-185 [Pubmed]
  4. Hayek SN, Wibbenmeyer LA, Kealey LDH, Williams IM, Oral R, Onwuameze O, Light TD, Latenser BA, Lewis RW 2nd, Kealey GP. The efficacy of hair and urine toxicology screening on the detection of child abuse by burning. Journal of Burn Care and Research. 2009;30(4):587-592 [Pubmed]
  5. Hobbs CJ. When are burns not accidental? Archives of Disease in Childhood. 1986;61(4):357-361 [Pubmed]
  6. Lowell G, Quinlan K, Gottlieb LJ. Preventing unintentional scald burns: moving beyond tap water. Pediatrics. 2008;122(4):799-804 [Pubmed]
  7. Ojo P, Palmer J, Garvey R, Atweh N, Fidler P. Pattern of burns in child abuse. American Surgeon. 2007;73(3):253-255 [Pubmed]
  8. Wibbenmeyer L, Liao J, Heard J, Kealey L, Kealey G, Oral R. Factors related to child maltreatment in children presenting with burn injuries. Journal of Burn Care & Research. 2014;35(5):374-381 [Pubmed]

Intentional alone:

  1. Caniano DA, Beaver BL, Boles ET. Child abuse. An update on surgical management in 256 cases. Annals of Surgery. 1986;203(2):219-224 [Pubmed]
  2. Heaton PA. The pattern of burn injuries in childhood. New Zealand Medical Journal. 1989;102(879):584-586 [Pubmed]
  3. Heredea LS. Diagnostic problems of burns produced by physical abuse towards children. Archives of the Balkan Medical Union. 2008;43(3):171-176 [Abstract from Archives of the Balkan Medical Union]
  4. Ofodile F, Norris J, Garnes A. Burns and child abuse. The East African Medical Journal. 1979;56(1):26-29 [Pubmed citation only]
  5. Purdue GF, Hunt JL, Prescott PR. Child abuse by burning — an index of suspicion. The Journal of Trauma. 1988;28(2):221-224 [Pubmed]
  6. Zaloga WF, Collins KA. Pediatric homicides related to burn injury: a retrospective review at the Medical University of South Carolina. Journal of Forensic Sciences. 2006;51(2):396-399 [Pubmed]

Mechanisms of intentional scalds
Forced immersion scald injuries are the commonest 1-20

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References

Non-comparative studies:

  1. Brinkmann B, Banaschak S. Verbrühungen bei einem Kleinkind: Unfall oder Kindesmißhandlung? Monatsschrift für Kinderheilkunde. 1998;146(12):1186-1191 [Abstract from SpringerLink]
  2. Daria S, Sugar NF, Feldman KW, Boos SC, Benton SA, Ornstein A. Into hot water head first: distribution of intentional and unintentional immersion burns. Pediatric Emergency Care. 2004;20(5):302-310 [Pubmed]
  3. Deitch EA, Staats M. Child abuse through burning. Journal of Burn Care & Research. 1982;3(2):89-94 [Abstract from Journal of Burn Care & Research]
  4. Durtschi MB, Kohler TR, Finley A, Heimbach DM. Burn injury in infants and young children. Surgery, Gynecology & Obstetrics. 1980;150(5):651-656 [Pubmed]
  5. Galleno H, Oppenheim WL. The battered child syndrome revisited. Clinical Orthopaedics and Related Research. 1982;162:11-19 [Pubmed]
  6. Grosfeld JL, Ballantine TVN. Surgical aspects of child abuse (trauma-X). Pediatric Annals. 1976;5(10):106-120 [Pubmed citation only]
  7. Hashimoto I, Nakanishi H, Nagae H, Yamano M, Takeuchi N, Nameda Y, Arase S, Nii M, Taguchi Y, Kuroda Y. Child abuse-related burns: Two cases of severe burns related to child abuse syndrome. Japanese Journal of Plastic and Reconstructive Surgery. 1995;38:149-154
  8. Heaton PA. The pattern of burn injuries in childhood. New Zealand Medical Journal. 1989;102(879):584-586 [Pubmed]
  9. Heredea LS. Diagnostic problems of burns produced by physical abuse towards children. Archives of the Balkan Medical Union. 2008;43(3):171-176 [Abstract from Archives of the Balkan Medical Union]
  10. Hicks RA, Stolfi A. Skeletal surveys in children with burns caused by child abuse. Pediatric Emergency Care. 2007;23(5):308-313 [Pubmed]
  11. Holter JC, Friedman SB. Etiology and management of severely burned children. American Journal of Diseases in Children. 1969;118(5):680-686 [Pubmed citation only]
  12. Lung RJ, Miller SH, Davis TS, Graham WPI. Recognizing burn injuries as child abuse. American Family Physician. 1977;15(4):134-135 [Pubmed citation only]
  13. Ofodile F, Norris J, Garnes A. Burns and child abuse. The East African Medical Journal. 1979;56(1):26-29 [Pubmed citation only]
  14. Patscheider H. Zwei ungewöhnliche Fälle von tödlicher Kindesmißhandlung [German] [Two unusual cases of fatal child abuse]. Archiv für Kriminologie.1975;155(1):19-27 [Pubmed citation only]
  15. Phillips PS, Pickrell E, Morse TS. Intentional burning: a severe form of child abuse. Journal of the American College of Emergency Physicians. 1974;3(6):388-390 [Abstract from ScienceDirect]
  16. Purdue GF, Hunt JL, Prescott PR. Child abuse by burning — an index of suspicion. The Journal of Trauma. 1988;28(2):221-224 [Pubmed]
  17. Russo S, Taff ML, Mirchandani HG, Monforte JR, Spitz WU. Scald burns complicated by isopropyl alcohol intoxication: a case of fatal child abuse. The American Journal of Forensic Medicine and Pathology. 1986;7(1):81-83 [Pubmed]
  18. Schlievert R. Child abuse or mimic? Is there a medical explanation? Consultant. 2004;44:1160-1161
  19. Stratman E, Melski J. Scald abuse. Archives of Dermatology. 2002;138(3):318-320 [Pubmed citation only]
  20. Zaloga WF, Collins KA. Pediatric homicides related to burn injury: a retrospective review at the Medical University of South Carolina. Journal of Forensic Sciences. 2006;51(2):396-399 [Pubmed]

Distribution of intentional scalds

  • Usually lower limbs Comparative studies 1-4 Intentional alone 1-9,11
  • Bilateral lower extremity scald Comparative studies 1,2 Intentional alone 5,8,11
  • A multivariate analysis identified children less than five years old, hot tap water scalds, bilateral scalds and posterior location as significant indicators of intentional burns  Comparative studies 3
  • Lower extremities may be unilateral Comparative studies 4
  • Buttock and perineal scald Comparative studies 1,2 Intentional alone 3-8,10,11
  • Combination buttock / perineal + bilateral lower extremity scalds Comparative studies 1,2 Intentional alone 1-11
  • Posterior location of the burn is significantly associated with abuse (OR 2.6, 95% CI 1.3, 4.16) Comparative studies 3

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References

Comparative studies:

  1. Bajanowski T, Verhoff MA, Wingenfeld L, Püschel K. Forensische Pädopathologie – Tod nach Verbrühung. Drei Fälle mit sehr unterschiedlichen Kausalbedingungen [German] [Forensic paedopathology – death by scalding. Three cases with very different causal conditions]. Rechtsmedizin. 2007;17(4):218-222 [Abstract from SpringerLink]
  2. Daria S, Sugar NF, Feldman KW, Boos SC, Benton SA, Ornstein A. Into hot water head first: distribution of intentional and unintentional immersion burns. Pediatric Emergency Care. 2004;20(5):302-310 [Pubmed]
  3. Hayek SN, Wibbenmeyer LA, Kealey LDH, Williams IM, Oral R, Onwuameze O, Light TD, Latenser BA, Lewis RW 2nd, Kealey GP. The efficacy of hair and urine toxicology screening on the detection of child abuse by burning. Journal of Burn Care and Research. 2009;30(4):587-592 [Pubmed]
  4. Ojo P, Palmer J, Garvey R, Atweh N, Fidler P. Pattern of burns in child abuse. American Surgeon. 2007;73(3):253-255 [Pubmed]

Intentional alone studies:

  1. Caniano DA, Beaver BL, Boles ET. Child abuse. An update on surgical management in 256 cases. Annals of Surgery. 1986;203(2):219-224 [Pubmed]
  2. Galleno H, Oppenheim WL. The battered child syndrome revisited. Clinical Orthopaedics and Related Research. 1982;162:11-19 [Pubmed]
  3. Heaton PA. The pattern of burn injuries in childhood. New Zealand Medical Journal. 1989;102(879):584-586 [Pubmed]
  4. Heredea LS. Diagnostic problems of burns produced by physical abuse towards children. Archives of the Balkan Medical Union. 2008;43(3):171-176 [Abstract from Archives of the Balkan Medical Union]
  5. Hicks RA, Stolfi A. Skeletal surveys in children with burns caused by child abuse. Pediatric Emergency Care. 2007;23(5):308-313 [Pubmed]
  6. Lung RJ, Miller SH, Davis TS, Graham WPI. Recognizing burn injuries as child abuse. American Family Physician. 1977;15(4):134-135 [Pubmed citation only]
  7. Phillips PS, Pickrell E, Morse TS. Intentional burning: a severe form of child abuse. Journal of the American College of Emergency Physicians. 1974;3(6):388-390 [Abstract from ScienceDirect]
  8. Purdue GF, Hunt JL, Prescott PR. Child abuse by burning — an index of suspicion. The Journal of Trauma. 1988;28(2):221-224 [Pubmed]
  9. Russo S, Taff ML, Mirchandani HG, Monforte JR, Spitz WU. Scald burns complicated by isopropyl alcohol intoxication: a case of fatal child abuse. The American Journal of Forensic Medicine and Pathology. 1986;7(1):81-83 [Pubmed]
  10. Stratman E, Melski J. Scald abuse. Archives of Dermatology. 2002;138(3):318-320 [Pubmed citation only]
  11. Zaloga WF, Collins KA. Pediatric homicides related to burn injury: a retrospective review at the Medical University of South Carolina. Journal of Forensic Sciences. 2006;51(2):396-399 [Pubmed]

Patterns of intentional scalds

  • Scald margins have clear upper limits Comparative studies 2-4 Intentional alone 1,3,9,13,14
  • Scalds are symmetrical Comparative studies 1,4 Intentional alone 5,8,11,14
  • Skin fold sparing is found, e.g. in the popliteal area Intentional alone 3,4,9,10,13,14
  • Central sparing of buttocks, sometimes referred to as “doughnut ring” pattern, may be found in immersion injuries Intentional alone 10,11
  • Circumferential (glove or stocking distribution) scalds to upper or lower limbs Intentional alone 2,5,7,11,12,14
  • Stocking distribution scald involving just one limb, has also been noted Intentional alone 6,11,12
  • Uniform scald depth found Intentional alone 1,5,12

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References

Comparative studies:

  1. Bajanowski T, Verhoff MA, Wingenfeld L, Püschel K. Forensische Pädopathologie – Tod nach Verbrühung. Drei Fälle mit sehr unterschiedlichen Kausalbedingungen [German] [Forensic paedopathology – death by scalding. Three cases with very different causal conditions]. Rechtsmedizin. 2007;17(4):218-222 [Abstract from SpringerLink]
  2. Daria S, Sugar NF, Feldman KW, Boos SC, Benton SA, Ornstein A. Into hot water head first: distribution of intentional and unintentional immersion burns. Pediatric Emergency Care. 2004;20(5):302-310 [Pubmed]
  3. Wibbenmeyer L, Liao J, Heard J, Kealey L, Kealey G, Oral R. Factors related to child maltreatment in children presenting with burn injuries. Journal of Burn Care & Research. 2014;35(5):374-381 [Pubmed]

  4. Yeoh C, Nixon JW, Dickson W, Kemp A, Sibert JR. Patterns of scald injuries. Archives of Disease in Childhood. 1994;71(2):156-158 [Pubmed]

Intentional alone  studies:

  1. Brinkmann B, Banaschak S. Verbrühungen bei einem Kleinkind: Unfall oder Kindesmißhandlung? Monatsschrift für Kinderheilkunde. 1998;146(12):1186-1191 [Abstract from SpringerLink]
  2. Caniano DA, Beaver BL, Boles ET. Child abuse. An update on surgical management in 256 cases. Annals of Surgery. 1986;203(2):219-224 [Pubmed]
  3. Daria S, Sugar NF, Feldman KW, Boos SC, Benton SA, Ornstein A. Into hot water head first: distribution of intentional and unintentional immersion burns. Pediatric Emergency Care. 2004;20(5):302-310 [Pubmed]
  4. Deitch EA, Staats M. Child abuse through burning. Journal of Burn Care & Research. 1982;3(2):89-94 [Abstract from Journal of Burn Care & Research]
  5. Grosfeld JL, Ballantine TVN. Surgical aspects of child abuse (trauma-X). Pediatric Annals. 1976;5(10):106-120 [Pubmed citation only]
  6. Heaton PA. The pattern of burn injuries in childhood. New Zealand Medical Journal. 1989;102(879):584-586 [Pubmed]
  7. Heredea LS. Diagnostic problems of burns produced by physical abuse towards children. Archives of the Balkan Medical Union. 2008;43(3):171-176 [Abstract from Archives of the Balkan Medical Union]
  8. Lung RJ, Miller SH, Davis TS, Graham WPI. Recognizing burn injuries as child abuse. American Family Physician. 1977;15(4):134-135 [Pubmed citation only]
  9. Patscheider H. Zwei ungewöhnliche Fälle von tödlicher Kindesmißhandlung [German] [Two unusual cases of fatal child abuse]. Archiv für Kriminologie.1975;155(1):19-27 [Pubmed citation only]
  10. Phillips PS, Pickrell E, Morse TS. Intentional burning: a severe form of child abuse. Journal of the American College of Emergency Physicians. 1974;3(6):388-390 [Abstract from ScienceDirect]
  11. Purdue GF, Hunt JL, Prescott PR. Child abuse by burning — an index of suspicion. The Journal of Trauma. 1988;28(2):221-224 [Pubmed]
  12. Schlievert R. Child abuse or mimic? Is there a medical explanation? Consultant. 2004;44:1160-1161
  13. Stratman E, Melski J. Scald abuse. Archives of Dermatology. 2002;138(3):318-320 [Pubmed citation only]
  14. Zaloga WF, Collins KA. Pediatric homicides related to burn injury: a retrospective review at the Medical University of South Carolina. Journal of Forensic Sciences. 2006;51(2):396-399 [Pubmed]

Further details

Associated features of intentional scalds

Historical and social features of intentional scalds

 

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