Burns as a consequence of child maltreatment

Over 25,000 children a year attend emergency departments in the UK with burns. Scalds predominate, with infants aged one year being 10 times more likely to sustain a burn than any other age group. Identifying which burns result from abuse or neglect is challenging, but inflicted injuries are more likely to have certain characteristics and differences in the causative agent, mechanism and pattern of burns have been observed in children with non-accidental burn injuries. Children have been subjected to every type of burn as a consequence of abuse including scalds, contact, caustic, flame and radiation burns, thus careful scrutiny of all burns cases for possible maltreatment is warranted. Whilst neglectful burns outnumber inflicted burns by 9:1, these are most challenging to discern. A detailed history is vital to determine whether the burn pattern is consistent with the child's developmental stage, and the agent and mechanism offered, in addition to evaluating supervision, and previous or co-existent injuries. Social features such as domestic violence in the home or being previously known to social services are also key indicators. If abuse is suspected, full investigations including skeletal survey in those aged less than 2 years is required, consideration of cranial neuro-imaging in younger infants and possible scene assessment.