Skin Injury: Bruises and Burns

  • Erin E. Endom
  • Angelo P. Giardino


Careful examination of the child’s skin is an essential component of the abuse evaluation. Injuries to the skin are common findings in maltreated children and may include (a) contusions (bruises), abrasions, lacerations; (b) burns from scalding, direct contact with flame or hot objects, and electricity; (c) frostbite (O’Neill, Meacham, Griffin, & Sawyers, 1973); and (d) scars resulting from these injuries (Richardson, 1994). In one study examining the injuries of 616 children suspected of having been abused, at least 80% of the 775 primary injuries involved the skin, including (a) bruises/ecchymoses/hematomas (56%); (b) erythema/marks (9%); (c) burns (8%); and (d) abrasions/scratches (7%) (Johnson & Showers, 1985).


Necrotizing Fasciitis Hereditary Hemorrhagic Telangiectasia Partial Thickness Maltreated Child Partial Thickness Burn 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Ahlgren, L. S. (1990). Burns. In S. S. Gellis & B. M. Kagan (Eds.), Current pediatric therapy (13th ed., pp. 682–683). Philadelphia, PA: W. B. Saunders.Google Scholar
  2. Alexander, R. C., Surrell, J. A., & Cohle, S. D. (1987, February). Microwave oven burns to children: an unusual manifestation of child abuse. Pediatrics, 79(2), 255–260.PubMedGoogle Scholar
  3. American Academy of Pediatrics Committee on Child Abuse and Neglect. (2002, September). When inflicted skin injuries constitute child abuse. Pediatrics, 110(3), 644–645.CrossRefGoogle Scholar
  4. American Board of Forensic Odontology. (2000, December). Guidelines and standards: bitemark guidelines and standards. Colorado Springs (CO): The Board; 2000. Referenced in: Bell K. Sexual assault: clinical issues: identification and documentation of bite marks. Journal of Emergency Nursing, 26(6), 628–630.CrossRefGoogle Scholar
  5. Ayoub, C, & Pfeiffer, D. (1979). Burns as a manifestation of child abuse and neglect. American Journal of Diseases of Children, 133, 910–914.PubMedGoogle Scholar
  6. Baptiste, M. S., & Feck, G. (1980). Preventing tap water burns. American Journal of Public Health, 70, 727–729.PubMedCrossRefGoogle Scholar
  7. Bays, J. (1994). Conditions mistaken for child abuse. In R. M. Reece (Ed.), Child abuse: Medical diagnosis and management (pp. 358–385). Philadelphia, PA: Lea & Febiger.Google Scholar
  8. Besner, G. E. & Otabor, I. A. (2009). Burns: Surgical perspective. eMedicine. March 10, 2009.
  9. Carpenter, R. F. (1999, April). The prevalence and distribution of bruising in babies. Archives of Disease in Childhood, 80(4), 363–366.PubMedCrossRefGoogle Scholar
  10. Casella, J. F. (1990). Disorders of coagulation. In F. A. Oski, C. D. DeAngelis, R. D. Feigin, & J. B. Warshaw (Eds.), Principles and practice of pediatrics (pp. 1550–1563). Philadelphia, PA: J. B. Lippincott.Google Scholar
  11. Coffman, K., Boyce, W. T., & Hansen, R. C. (1985). Phytodermatitis simulating child abuse. American Journal of Diseases of Children, 139, 239–240.PubMedGoogle Scholar
  12. Cotran, R. S., Kumar, V., & Robbins, S. (Eds.) (1989). Cellular injury and adaptation. In Robbins’ pathologic basis of disease (4th ed., pp. 25–26). Philadelphia, PA: W. B. Saunders.Google Scholar
  13. Darok, M., & Reischle, S. (2001, January 1). Burn injuries caused by a hair-dryer—An unusual case of child abuse. Forensic Science International, 115(1–2), 143–146.PubMedCrossRefGoogle Scholar
  14. Daria, S., Sugar, N., Feltman, K., et al. (2004). Into Hot Water Head First: Distribution of Intentional and Unintentional Burns. Pediatric Emergency Care, 20, 302–310.PubMedCrossRefGoogle Scholar
  15. Davis, H. W., & Carrasco, M. (1992). Child abuse and neglect. In B. J. Zitelli & H. W. Davis (Eds.), Atlas of pediatric physical diagnosis (2nd ed., pp. 6.1–6.30). London: Wolfe.Google Scholar
  16. Durani, P., Agarwal, R., & Wilson, D. I. (2006). Laxative-induced burns in a child. Journal of Plastic, Reconstructive and Aesthetic Surgery, 59(10), 1129.CrossRefGoogle Scholar
  17. Ellerstein, N. S. (1979). Cutaneous manifestations of child abuse and neglect. American Journal of Diseases of Children, 133, 906–909.PubMedGoogle Scholar
  18. Ellerstein, N. S. (1981). Dermatologic manifestations of child abuse and neglect. In N. S. Ellerstein (Ed.), Child abuse and neglect: A medical reference. New York: Wiley.Google Scholar
  19. Erdman, T. C., Feldman, K. W., Rivara, F. P., Heimbach, D. M., & Wall, H. A. (1991). Tap water burn prevention: The effect of legislation. Pediatrics, 88, 572–577.Google Scholar
  20. Faller-Marquardt, M., Pollak, S., & Schmidt, U. (2008, April 7). Cigarette burns in forensic medicine. Forensic Science International, 176(2–3), 200–208.PubMedCrossRefGoogle Scholar
  21. Feldman, K. W. (1983). Help needed on hot water burns. Pediatrics, 71, 145–146.PubMedGoogle Scholar
  22. Feldman, K. W. (1987). Child abuse by burning. In R. E. Helfer & R. S. Kempe (Eds.), The battered child (4th ed., pp. 197–213). Chicago: University of Chicago Press.Google Scholar
  23. Fleisher, G. R., & Ludwig, S. (1993). Textbook of pediatric emergency medicine (3rd ed.). Baltimore: Williams & WilkinsGoogle Scholar
  24. Gedalia, A. (2004, June). Henoch-Schönlein purpura. Current Rheumatology Reports, 6(3), 195–202.PubMedCrossRefGoogle Scholar
  25. Gillespie, R. W. (1965). The battered child syndrome: Thermal and caustic manifestations. Journal of Trauma, 5, 523–533.PubMedCrossRefGoogle Scholar
  26. Hammond, J., Perez-Stable, A., & Ward, G. (1991). Predictive value of historical and physical characteristics for the diagnosis of child abuse. Southern Medical Journal, 84, 166–168.PubMedCrossRefGoogle Scholar
  27. Hathaway, W. E., Hay, W. W., Groothuis, J. R., & Paisley, J. W. (1993). Current p pediatric diagnosis and treatment. Norwalk, Ct. Appleton & Lange.Google Scholar
  28. Heider, T. R., Priolo, D., Hultman, C. S., Peck, M. D., & Cairns, B. A. (2002, September–October). Eczema mimicking child abuse: a case of mistaken identity. Journal of Burn Care and Rehabilitation, 23(5):357–359.PubMedCrossRefGoogle Scholar
  29. Hicks, R. A., & Stolfi, A. (2007, May). Skeletal surveys in children with burns caused by child abuse. Pediatric Emergency Care, 23(5), 308–313.PubMedCrossRefGoogle Scholar
  30. Hight, D. W., Bakalar, H. R., & Lloyd, J. R. (1979). Inflicted burn in children: Recognition and treatment. Journal of the American Medical Association, 242, 517–520.PubMedCrossRefGoogle Scholar
  31. Hill, P. F., Pickford, M., & Parkhouse, N. (1997, October). Phytophotodermatitis mimicking child abuse. Journal of the Royal Society of Medicine, 90(10), 560–561.PubMedGoogle Scholar
  32. Jackson, D. M. (1953). The diagnosis of the depth of burning. British Journal of Surgery, 40, 588.PubMedCrossRefGoogle Scholar
  33. Johnson, C. F. (1990). Inflicted injury versus accidental injury. Pediatric Clinics of North America, 37, 791–814.PubMedGoogle Scholar
  34. Johnson, C. F., & Coury, D. L. (1988). Bruising and hemophilia: Accident or child abuse? Child Abuse & Neglect, 12, 409–415.CrossRefGoogle Scholar
  35. Johnson, C. F., & Showers, J. (1985). Injury variables in child abuse. Child Abuse & Neglect, 9, 207–215.CrossRefGoogle Scholar
  36. Keen, J. H., Lendrulm, J., & Wolman, B. (1975). Inflicted burns and scalds in children. British Medical Journal, 4, 268–269.Google Scholar
  37. Kemp, A., Maguire, S. A., Sibert, J., Frost, R., Adams, C., & Mann, M. (2006, November). Can we identify abusive bites in children? Archives of Disease in Childhood, 91(11), 951.PubMedCrossRefGoogle Scholar
  38. Kessler, D. B., & Hyden, P. (1991). Physical, sexual, and emotional abuse of children. CIBA Foundation Symposium, 43(2), 1–32.Google Scholar
  39. Kornberg, A. E. (1992). Skin and soft tissue injuries. In S. Ludwig & A. E. Kornberg (Eds.), Child abuse: A medical reference (2nd ed., pp. 91–104). New York: Churchill Livingstone.Google Scholar
  40. Kos, L., & Shwayder, T. (2006, July–August). Cutaneous manifestations of child abuse. Pediatric Dermatology, 23(4), 311–320.PubMedCrossRefGoogle Scholar
  41. Langlois, N. E. I., & Gresham, G. A. (1991). The aging of bruises: A review and study of the color changes with time. Forensic Science International, 50, 227–238.PubMedCrossRefGoogle Scholar
  42. Lenoski, E. F., & Hunter, K. A. (1977). Specific patterns of inflicted burn injuries. Journal of Trauma, 17, 842–846.PubMedCrossRefGoogle Scholar
  43. Leventhal, J. M., Griffin, D., Duncan, K. O., Starling, S., Christian, C. W., & Kutz, T. (2001, January). Laxative-induced dermatitis of the buttocks incorrectly suspected to be abusive burns. Pediatrics, 107(1), 178–179.PubMedCrossRefGoogle Scholar
  44. Look, K. M., & Look, R. M. (1997, January). Skin scraping, cupping, and moxibustion that may mimic child abuse. Journal of Forensic Sciences, 42(1), 103–105.PubMedGoogle Scholar
  45. Maguire, S., Mann, M. K., Sibert, J., & Kemp, A. (2005, February). Are there patterns of bruising in childhood which are diagnostic or suggestive of abuse? A systematic review. Archives of Disease in Childhood, 90(2), 182–186.PubMedCrossRefGoogle Scholar
  46. Meagher, D. P. (1990). Burns. In J. G. Raffensperger (Ed.), Swensons pediatric surgery (5th ed., pp. 317–337). Norwalk, CT: Appleton & Lange.Google Scholar
  47. Mill, J., Wallis, B., Cuttle, L., Mott, J., Oakley, A., & Kimble, R. (2008, August). Phytophotodermatitis: case reports of children presenting with blistering after preparing lime juice. Burns, 34(5), 731–733.PubMedCrossRefGoogle Scholar
  48. Moritz, A. R., & Henriques, F. C. (1947). Studies of thermal injury: The relative importance of time and surface temperature in the causation of cutaneous burns. American Journal of Pathology, 23, 695–720.PubMedGoogle Scholar
  49. Nields, H., Kessler, S. C., Boisot, S., & Evans, R. (1998, March). Streptococcal toxic shock syndrome presenting as suspected child abuse. American Journal of Forensic Medicine and Pathology, 19(1), 93–97.PubMedCrossRefGoogle Scholar
  50. Nielsen, A., Knoblauch, N. T., Dobos, G. J., Michalsen, A., & Kaptchuk, T. J. (2007, September–October). The effect of Gua Sha treatment on the microcirculation of surface tissue: A pilot study in healthy subjects. Explore (NY), 3(5), 456–466.CrossRefGoogle Scholar
  51. Ojo, P., Palmer, J., Garvey, R., Atweh, N., & Fidler, P. (2007, March). Pattern of burns in child abuse. American Surgery, 73(3), 253–255.Google Scholar
  52. O’Neill, J., Meacham, W., Griffin, P. P., & Sawyers, J. L. (1973). Patterns of injury in the battered child syndrome. Journal of Trauma, 13, 332–339.PubMedCrossRefGoogle Scholar
  53. O’Neill, J. A. (1979). Burns in children. In C. P. Artz, J. A. Moncrief, & B. A. Pruitt (Eds.), Burns: A team approach (pp. 341–350). Philadelphia, PA: W. B. Saunders.Google Scholar
  54. Pascoe, J. M., Hildebrandt, H. M., Tarrier, A., & Murphy, M. (1979). Patterns of skin injury in nonaccidental and accidental injury. Pediatrics, 64, 245–247.PubMedGoogle Scholar
  55. Peck, M. D., & Priolo-Kapel, D. (2002, November). Child abuse by burning: A review of the literature and an algorithm for medical investigations. Journal of Trauma, 53(5), 1013–1022.PubMedCrossRefGoogle Scholar
  56. Porzionato, A., & Aprile, A. (2007). Staphylococcal scalded skin syndrome mimicking child abuse by burning. Forensic Science International, 168(1), e1–e4.PubMedCrossRefGoogle Scholar
  57. Purdue, G. F., Hunt, J. L., & Prescott, P. R. (1988). Child abuse by burning—An index of suspicion. Journal of Trauma, 28, 221–224.PubMedCrossRefGoogle Scholar
  58. Rapaport, S. I. (1983). Preoperative hemostatic evaluation: Which tests, if any? Blood, 61, 229–231.PubMedGoogle Scholar
  59. Reece, R. M., & Ludwig, S. (2001, January). Child abuse: Medical diagnosis and management (2nd ed.). Philadelphia, PA: Lippincott Williams and Wilkins.Google Scholar
  60. Reinhardt, M. A., & Ruhs, H. 1985). Moxibustion. Another traumatic folk remedy. Clinical Pediatrics (Phila), 24(1), 58–59.CrossRefGoogle Scholar
  61. Richardson, A. C. (1994). Cutaneous manifestations of abuse. In R. M. Reece (Ed.), Child abuse: Medical diagnosis and management (pp. 167–184). Philadelphia, PA: Lea & Febiger.Google Scholar
  62. Robson, M. C., & Heggers, J. P. (1988). Pathophysiology of the burn wound. In H. F. Carvajal & D. H. Parks (Eds.), Burns in children: Pediatric burn management (pp. 27–32). Chicago: Year Book.Google Scholar
  63. Saulsbury, F. T., & Hayden, G. F. (1985). Skin conditions simulating child abuse. Pediatric Emergency Care, 1, 147–150.PubMedCrossRefGoogle Scholar
  64. Schwartz, A. J., & Ricci, L. R. (1996). How accurately can bruises be aged in abused children? Literature review and synthesis. Pediatrics, 97, 254–256.PubMedGoogle Scholar
  65. Showers, J., & Garrison, K. M. (1988). Burn abuse: A four-year study. Journal of Trauma, 28, 1581–1583.PubMedCrossRefGoogle Scholar
  66. Singer, A. J., Brebbia, J., Soroff, H. H. (2007, July). Management of local burn wounds in the ED. American Journal of Emergency Medicine, 25(6), 666–671.PubMedCrossRefGoogle Scholar
  67. Spiller, H. A., Winter, M. L., Weber, J. A., Krenzelok, E. P., Anderson, D. L., & Ryan, M. L. (2003, May). Skin breakdown and blisters from senna-containing laxatives in young children. Annual Pharmacology, 37(5), 636–639.CrossRefGoogle Scholar
  68. Stone, N. H., Rinaldo, L., Humphrey, C. R., & Brown, R. H. (1970). Surgical Clinics of North America, 50, 1419–1424.PubMedGoogle Scholar
  69. Stratman, E., & Melski, J. (2002). Scald Abuse. JAMA, 138(3), 318–320.Google Scholar
  70. Surrell, J. A., Alexander, R. C., Cohle, S. D., Lovell, F. R. Jr., & Wehrenberg, R. A. (1987, August). Effects of microwave radiation on living tissues. Journal of Trauma, 27(8), 935–939.PubMedCrossRefGoogle Scholar
  71. Sussman, S. H. (1968). Skin manifestations of the Battered Child Syndrome. Journal of Pediatrics, 72, 99–101.PubMedCrossRefGoogle Scholar
  72. Sweet, D., Lorente, M., Lorente, J. A., Valenzuela, A., & Villanueva, E. (1997, March). An improved method to recover saliva from human skin: The double swab technique. Journal of Forensic Science, 42(2), 320–322.Google Scholar
  73. Vogeley, E., Pierce, M. C., & Bertocci, G. (2002, March). Experience with wood lamp illumination and digital photography in the documentation of bruises on human skin. Archives of Pediatrics & Adolescent Medicine, 156(3), 265–268.Google Scholar
  74. Wilson, E. F. (1977). Estimation of the age of cutaneous contusions in child abuse. Pediatrics, 60, 750–752.PubMedGoogle Scholar
  75. Wissow, L. S.(1990a). Child advocacy for the clinician: An approach to child abuse and neglect. Baltimore: Williams & Wilkins.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Erin E. Endom
    • 1
  • Angelo P. Giardino
    • 2
  1. 1.Department of PediatricsBaylor College of MedicineHoustonUSA
  2. 2.Baylor College of MedicineTexas Children’s Health Plan, Inc.HoustonUSA

Personalised recommendations