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Associated features 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.


Associated features

(These were confirmed in studies of intentional scalds, and in some cases the corollary was found in non-abusive data also. This is indicated in each reference list)


  • Child sustained previous burn Intentional alone 2,6,9,10,12,13,15
  • Child’s development is inconsistent with the history of the injury Intentional alone 3,4
  • Associated neglect or faltering growth Comparative studies 2 Intentional alone 3-6,14,15
  • Passive / fearful child on examination Comparative studies 1 Intentional alone 3,5,11,12 Unintentional alone 1,2
  • Co-existing fractures found on skeletal survey Comparative studies 1,4,7 Intentional alone 5,8,11 Unintentional alone 2
  • Associated injury noted on examination at the time of the scald Comparative studies 1,3,7 Intentional alone 1,2,5-7,11-15 Unintentional alone 2
  • History incompatible with the physical examination Comparative studies 1,3,5,6 Intentional alone 1-4,6,11,12,15,16 Unintentional alone 2
  • Hair samples for illicit drug use (cocaine, benzoylecgonine, cannabinoids and methamphetamine) were more commonly found in abused than unintentionally injured children Comparative studies 4,6

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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. 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]
  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. 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. 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]

  7. 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. 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. Grosfeld JL, Ballantine TVN. Surgical aspects of child abuse (trauma-X). Pediatric Annals. 1976;5(10):106-120 [Pubmed citation only]
  5. 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
  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. Hicks RA, Stolfi A. Skeletal surveys in children with burns caused by child abuse. Pediatric Emergency Care. 2007;23(5):308-313 [Pubmed]
  9. 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]
  10. Leonardi DF, Vedovato JW, Werlang PM, Torres OM. Child burn: accident, neglect or abuse. A case report. Burns. 1999;25(1):69-71 [Pubmed]
  11. 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]
  12. 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]
  13. Purdue GF, Hunt JL, Prescott PR. Child abuse by burning — an index of suspicion. The Journal of Trauma. 1988;28(2):221-224 [Pubmed]
  14. 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]
  15. Schlievert R. Child abuse or mimic? Is there a medical explanation? Consultant. 2004;44:1160-1161
  16. 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]

Unintentional alone studies:

  1. Sheridan RL. Recognition and management of hot liquid aspiration in children. Annals of Emergency Medicine. 1996;27(1):89-91 [Pubmed]
  2. Titus MO, Baxter AL, Starling SP. Accidental scald burns in sinks. Pediatrics. 2003;111(2):e191-e194 [Pubmed]


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