CHAMP Education for Child Abuse Medical Providers

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The most common types of burns in the pediatric population are thermal, chemical, and electrical burns. Burns caused by radiation and friction are less common, particularly within our specialty. The most common burns in children overall are thermal burns, which are caused by excessive heat, and a majority are scald burns caused by tap water. Most scald burns we encounter in child maltreatment are called splash/spill burns and immersion burns. Splash/spill burns are common accidental and/or burns secondary to neglect, for example, when a child reaches for a pot on the stove or a hot liquid on a table. Their positioning and the volume of liquid determines the location and pattern of burn which results. The upper, anterior part of the body are common locations for these burns. Near the site of impact, splash marks may be apparent. As the water flows down their body, the water temperature decreases and burns may appear less severe compared to areas closer to the site of impact. In contrast, immersion burns are commonly inflicted and occur when a child’s body and/or extremities are forcefully held in hot liquids, again usually hot water. Both burn patterns can occur by accidental, non accidental trauma, and/or neglect as there is sometimes overlap. CONTACT burns occur in young children when hot objects directly touch the child’s skin leaving a pattern that is often identifiable. Most accidental contact burns occur in the home when a child touches or grabs an object, such as an iron or curling iron, so up to 65% occur on the hands, specifically the palms. As opposed to an object that is forcefully held onto skin, cigarettes are a common inflicted contact burn we see). They usually have well-defined borders, the burns may be more severe, more uniform, and may be in areas where the children cannot accidentally brush up against a cigarette, such as the back, neck, and gluteal area. They may be solitary or in groups, in different stages of healing, with diameters approximately 8 mm – 1.2 cm. FLAME burns are caused by fire and often occur on the face and hands with local spread because fuel and lighters are often used. CHEMICALs may cause burns in a variety of locations. They can be ingested, inhaled, or touched. The chemicals are often found in the home, such as bleach, oven cleaner, and button batteries. Bleach may leave behind a reddish-brown pigmentation that can assist with the diagnosis. Alkali ingestions are more severe than acids due to the risk of GI perforations, such as when children swallow button batteries. These children should always be evaluated clinically. ELECTRICAL burns are much less prevalent, and the visible injury may be much smaller than the actual tissue injury. They can be associated with severe morbidity and mortality. They may have joint contractures, compartment syndrome, and even cardiac arrhythmias.