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Contact burns

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.

 
There were no comparative studies that specifically set out to identify features that differentiate between intentional and unintentional non-scald burns.

 

The following data is taken from studies of intentional non-scald burns or studies that described cases of both intentional and unintentional non-scald burns (studies of unintentional cases alone were not analysed): 1-20

 

  • Contact burns were the most commonly described non-scald burns
  • Intentional burns were most commonly reported on the back, shoulders and / or buttocks
  • Intentional burns had sharply demarcated edges which could be matched to the specific implement in many cases
  • In contrast to other physical injuries, intentional non-scald burns occurred throughout childhood

 

Due to the paucity of literature, the inclusion criteria was lowered to include single case reports.

One comparative study confirmed that contact burns were the most common non-scald burns in maltreated and non-maltreated children, but no further details were offered 21.

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References

  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. Darok M, Reischle S. Burn injuries caused by a hair-dryer - an unusual case of child abuse. Forensic Science International. 2001;115(1):143-146 [Pubmed]
  3. Frechette A, Rimsza ME. Stun gun injury: a new presentation of the battered child syndrome. Pediatrics. 1992;89(5):898-901 [Pubmed]
  4. Gillespie RW. The battered child syndrome: thermal and caustic manifestations. The Journal of Trauma: Injury, Infection, and Critical Care. 1965;5:523-534 [Pubmed citation only]
  5. Grellner W, Metzner G. Kindesmißhandlung durch thermische Gewalt: Abgrenzung und Rekonstruktion [German] [Child abuse caused by thermal violence--determination and reconstruction]. Archiv für Kriminologie. 1995;195(1):38-46 [Pubmed]
  6. 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]
  7. Hicks RA, Stolfi A. Skeletal surveys in children with burns caused by child abuse. Pediatric Emergency Care. 2007;23(5):308-313 [Pubmed]
  8. Hobbs CJ. When are burns not accidental? Archives of Disease in Childhood. 1986;61(4):357-361 [Pubmed]
  9. Hobbs CJ, Wynne JM. The sexually abused battered child. Archives of Disease in Childhood. 1990;65(4): 423-427 [Pubmed]
  10. Johnson CF. Symbolic scarring and tattooing: unusual manifestations of child abuse. Clinical Pediatrics. 1994;33(1):46-49 [Pubmed citation only]
  11. Kibayashi K, Shojo H. Patterned injuries in children who have suffered repeated physical abuse. Pediatrics International. 2003;45(2):193-195 [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. Mukadam S, Gilles EE. Unusual inflicted hot oil burns in a 7-year-old. Burns. 2003;29(1):83-86 [Pubmed]
  14. Ofodile F, Norris J, Garnes A. Burns and child abuse. The East African Medical Journal. 1979;56(1):26-29 [Pubmed citation only]
  15. Petersen HD, Wandall JH. Evidence of physical torture in a series of children. Forensic Science International. 1995;75(1):45-55 [Pubmed]
  16. Prescott PR. Hair dryer burns in children. Pediatrics. 1990;86(5):692-697 [Pubmed]
  17. Ramakrishnan MK, Mathivanan T, Sankar J. Profile of children abused by burning. Annals of Burns and Fire Disasters. 2010;23(1)8-12 [Pubmed]

  18. Seifert D, Krohn J, Larson M, Lambe A, Püschel K, Kurth H. Violence against children: further evidence suggesting a relationship between burns, scalds, and the additional injuries. International Journal of Legal Medicine. 2010;124(1):49-54 [Pubmed]
  19. Shavit I, Knaani-Levinz H. Images in emergency medicine. Annals Of Emergency Medicine. 2008;51(5):579-582. [Article from Science Direct]
  20. Sudikoff S, Young RS. Burn from hairdryer: accident or abuse? Pediatrics. 1994;93(3):540 [Pubmed citation only]
  21. 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 burns from domestic irons 1-7

Location of intentional iron burns, where provided:

 

  • Leg, back of hand
  • A burn to the palm of the hand as punishment
  • Shoulder / upper arm
  • Back and crest of pelvis

Burn characteristics of intentional iron burns (where provided):

  • Intentional burns had clear demarcation of burn margins

Age range: 0 – 14 years

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References

  1. Grellner W, Metzner G. Kindesmißhandlung durch thermische Gewalt: Abgrenzung und Rekonstruktion [German] [Child abuse caused by thermal violence--determination and reconstruction]. Archiv für Kriminologie. 1995;195(1):38-46 [Pubmed]
  2. 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]
  3. Hicks RA, Stolfi A. Skeletal surveys in children with burns caused by child abuse. Pediatric Emergency Care. 2007;23(5):308-313 [Pubmed]
  4. Hobbs CJ. When are burns not accidental? Archives of Disease in Childhood. 1986;61(4):357-361 [Pubmed]
  5. Petersen HD, Wandall JH. Evidence of physical torture in a series of children. Forensic Science International. 1995;75(1):45-55 [Pubmed]
  6. Ramakrishnan MK, Mathivanan T, Sankar J. Profile of children abused by burning. Annals of Burns and Fire Disasters. 2010;23(1)8-12 [Pubmed]

  7. Seifert D, Krohn J, Larson M, Lambe A, Püschel K, Kurth H. Violence against children: further evidence suggesting a relationship between burns, scalds, and the additional injuries. International Journal of Legal Medicine. 2010;124(1):49-54 [Pubmed]

Unintentional burns from domestic irons 1

Location of unintentional iron burns (total: two cases):

  • Palm of hand (one case)
  • Back of hand (one case)

Burn characteristics of unintentional iron burns:

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References

  1. Hobbs CJ. When are burns not accidental? Archives of Disease in Childhood. 1986;61(4):357-361 [Pubmed]

Intentional burns from hairdryers 1-5

Location of intentional hairdryer burns (total: eight cases):

  • Both buttocks
  • Face
  • Soles of feet
  • Back
  • Abdomen

Burn characteristics of intentional hairdryer burns:

  • All intentional burns had clear demarcation of burn margins
  • Some cases had precise imprints of the grid on the face of the dryer, enabling the exact matching of the implement used
  • Intentional burns – 2nd to 3rd degree or full thickness

Age range: 0 – 6 years

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References

  1. Darok M, Reischle S. Burn injuries caused by a hair-dryer - an unusual case of child abuse. Forensic Science International. 2001;115(1):143-146 [Pubmed]
  2. Hicks RA, Stolfi A. Skeletal surveys in children with burns caused by child abuse. Pediatric Emergency Care. 2007;23(5):308-313 [Pubmed]
  3. Prescott PR. Hair dryer burns in children. Pediatrics. 1990;86(5):692-697 [Pubmed]
  4. Seifert D, Krohn J, Larson M, Lambe A, Püschel K, Kurth H. Violence against children: further evidence suggesting a relationship between burns, scalds, and the additional injuries. International Journal of Legal Medicine. 2010;124(1):49-54 [Pubmed]
  5. Sudikoff S, Young RS. Burn from hairdryer: accident or abuse? Pediatrics. 1994;93(3):540 [Pubmed citation only]

Unintentional burns from hairdryers 1

Location and characteristics of unintentional hairdryer burns (total: one case):

  • Shoulder, back of neck and edge of ear, clearly demarcated (one case)
  • Rank of accident: B

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References

  1. Prescott PR. Hair dryer burns in children. Pediatrics. 1990;86(5):692-697 [Pubmed]

Intentional burns from cigarettes 1-7

  • No studies defined the characteristics of an unintentional cigarette burn
  • Many studies mentioned intentional cigarette burns and six studies recorded the characteristics of these 

Location of intentional cigarette burns:

 

  • Fingers 3
  • Base of thumb 4
  • Palm of hand 2
  • Hand and back 5
  • Trunk 7

Burn characteristics of intentional cigarette burns:

 

  • Circular punched out burn, 1 cm diameter 4
  • Deep circular burn 2,3
  • Covering small areas, often in groups 1
  • Small rounded scars 5
  • One study containing detailed images described multiple cigarette burns, all regular in size and round, some with a vesicular appearance and others that were raised 7

Age of cases: 2-13 years

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References

  1.  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]
  2. Hobbs CJ. When are burns not accidental? Archives of Disease in Childhood. 1986;61(4):357-361 [Pubmed]
  3. Hobbs CJ, Wynne JM. The sexually abused battered child. Archives of Disease in Childhood. 1990;65(4): 423-427 [Pubmed]
  4. Johnson CF. Symbolic scarring and tattooing: unusual manifestations of child abuse. Clinical Pediatrics. 1994;33(1):46-49 [Pubmed citation only]
  5. Petersen HD, Wandall JH. Evidence of physical torture in a series of children. Forensic Science International. 1995;75(1):45-55 [Pubmed]
  6. Seifert D, Krohn J, Larson M, Lambe A, Püschel K, Kurth H. Violence against children: further evidence suggesting a relationship between burns, scalds, and the additional injuries. International Journal of Legal Medicine. 2010;124(1):49-54 [Pubmed]
  7. Shavit I, Knaani-Levinz H. Images in emergency medicine. Annals Of Emergency Medicine. 2008;51(5):579-582. [Article from Science Direct]

Intentional burns from cigarette lighters 1,2

  • One fatal case with multiple burns from a cigarette lighter

Location of intentional burns:

  • Face, chest, abdomen, back and forearms (total: one case)

Burn characteristics of intentional cigarette lighter burns:

  • Clearly demarcated lesions matching the top of the cigarette lighter

Age: 3, 13 years

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References

  1. Kibayashi K, Shojo H. Patterned injuries in children who have suffered repeated physical abuse. Pediatrics International. 2003;45(2):193-195 [Pubmed citation only]
  2. Seifert D, Krohn J, Larson M, Lambe A, Püschel K, Kurth H. Violence against children: further evidence suggesting a relationship between burns, scalds, and the additional injuries. International Journal of Legal Medicine. 2010;124(1):49-54 [Pubmed]

Intentional burns from grease / oil

Three studies described intentional burns from grease / oil (total: four cases):

  • In two cases, the location of the burns were not given 1
  • In one case the child was burnt on the back and shoulder 2
  • In another case the child was burnt on the thighs and arms  3

Burn characteristics of intentional grease / oil burns:

  • Where noted, the burns were 2nd degree burns
  • In one case the mother admitted burning the child with a metal spatula dipped in boiling oil leaving 30 circular / oval shaped burns 3

Age range: 0 – 14 years

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References

  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. 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]
  3. Mukadam S, Gilles EE. Unusual inflicted hot oil burns in a 7-year-old. Burns. 2003;29(1):83-86 [Pubmed]

Intentional burns from unidentified objects 1

Location of intentional burns (total: nine cases):

  •  Trunk and buttocks were most frequent

Age range: 1 month – 12 years

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References

  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]

Intentional burns from other objects 1-8

Intentional single cases:

  • Stun gun injury to chest, abdomen and thighs 1
  • Frostbite to feet (two cases) 2,3
  • Stove or radiator (four cases) 2,3
  • Light bulb 3
  • Melted plastic 3
  • Curling tongs burn to leg 3,4
  • Radiator burns to back of hand/ wrists 4
  • Car bonnet 5
  • Burning cloth to calf of leg 6
  • Electric water heater to the leg 7
  • Glowing knife (one case) 8

Age range: 0 – 14 years

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References

  1. Frechette A, Rimsza ME. Stun gun injury: a new presentation of the battered child syndrome. Pediatrics. 1992;89(5):898-901 [Pubmed]
  2. Gillespie RW. The battered child syndrome: thermal and caustic manifestations. The Journal of Trauma: Injury, Infection, and Critical Care. 1965;5:523-534 [Pubmed citation only]
  3. Hicks RA, Stolfi A. Skeletal surveys in children with burns caused by child abuse. Pediatric Emergency Care. 2007;23(5):308-313 [Pubmed]
  4. Hobbs CJ. When are burns not accidental? Archives of Disease in Childhood. 1986;61(4):357-361 [Pubmed]
  5. Ofodile F, Norris J, Garnes A. Burns and child abuse. The East African Medical Journal. 1979;56(1):26-29 [Pubmed citation only]
  6. Petersen HD, Wandall JH. Evidence of physical torture in a series of children. Forensic Science International. 1995;75(1):45-55 [Pubmed]
  7. Ramakrishnan MK, Mathivanan T, Sankar J. Profile of children abused by burning. Annals of Burns and Fire Disasters. 2010;23(1)8-12 [Pubmed]

  8. Seifert D, Krohn J, Larson M, Lambe A, Püschel K, Kurth H. Violence against children: further evidence suggesting a relationship between burns, scalds, and the additional injuries. International Journal of Legal Medicine. 2010;124(1):49-54 [Pubmed]

 

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