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A Practical Guide to the Evaluation of Child Physical Abuse and Neglect pp 85–140Cite as

Skin Injury: Bruises and Burns

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Abstract

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).

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References

  • 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 

  • 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.

    PubMed  CAS  Google Scholar 

  • American Academy of Pediatrics Committee on Child Abuse and Neglect. (2002, September). When inflicted skin injuries constitute child abuse. Pediatrics, 110(3), 644–645.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Ayoub, C, & Pfeiffer, D. (1979). Burns as a manifestation of child abuse and neglect. American Journal of Diseases of Children, 133, 910–914.

    PubMed  CAS  Google Scholar 

  • Baptiste, M. S., & Feck, G. (1980). Preventing tap water burns. American Journal of Public Health, 70, 727–729.

    Article  PubMed  CAS  Google Scholar 

  • 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 

  • Besner, G. E. & Otabor, I. A. (2009). Burns: Surgical perspective. eMedicine. March 10, 2009. http://emedicine.medscape.com/article/934173-media.

  • Carpenter, R. F. (1999, April). The prevalence and distribution of bruising in babies. Archives of Disease in Childhood, 80(4), 363–366.

    Article  PubMed  CAS  Google Scholar 

  • 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 

  • Coffman, K., Boyce, W. T., & Hansen, R. C. (1985). Phytodermatitis simulating child abuse. American Journal of Diseases of Children, 139, 239–240.

    PubMed  CAS  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • Durani, P., Agarwal, R., & Wilson, D. I. (2006). Laxative-induced burns in a child. Journal of Plastic, Reconstructive and Aesthetic Surgery, 59(10), 1129.

    Article  CAS  Google Scholar 

  • Ellerstein, N. S. (1979). Cutaneous manifestations of child abuse and neglect. American Journal of Diseases of Children, 133, 906–909.

    PubMed  CAS  Google Scholar 

  • 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 

  • 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 

  • Faller-Marquardt, M., Pollak, S., & Schmidt, U. (2008, April 7). Cigarette burns in forensic medicine. Forensic Science International, 176(2–3), 200–208.

    Article  PubMed  Google Scholar 

  • Feldman, K. W. (1983). Help needed on hot water burns. Pediatrics, 71, 145–146.

    PubMed  CAS  Google Scholar 

  • 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 

  • Fleisher, G. R., & Ludwig, S. (1993). Textbook of pediatric emergency medicine (3rd ed.). Baltimore: Williams & Wilkins

    Google Scholar 

  • Gedalia, A. (2004, June). Henoch-Schönlein purpura. Current Rheumatology Reports, 6(3), 195–202.

    Article  PubMed  Google Scholar 

  • Gillespie, R. W. (1965). The battered child syndrome: Thermal and caustic manifestations. Journal of Trauma, 5, 523–533.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • Hicks, R. A., & Stolfi, A. (2007, May). Skeletal surveys in children with burns caused by child abuse. Pediatric Emergency Care, 23(5), 308–313.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Hill, P. F., Pickford, M., & Parkhouse, N. (1997, October). Phytophotodermatitis mimicking child abuse. Journal of the Royal Society of Medicine, 90(10), 560–561.

    PubMed  CAS  Google Scholar 

  • Jackson, D. M. (1953). The diagnosis of the depth of burning. British Journal of Surgery, 40, 588.

    Article  PubMed  CAS  Google Scholar 

  • Johnson, C. F. (1990). Inflicted injury versus accidental injury. Pediatric Clinics of North America, 37, 791–814.

    PubMed  CAS  Google Scholar 

  • Johnson, C. F., & Coury, D. L. (1988). Bruising and hemophilia: Accident or child abuse? Child Abuse & Neglect, 12, 409–415.

    Article  CAS  Google Scholar 

  • Johnson, C. F., & Showers, J. (1985). Injury variables in child abuse. Child Abuse & Neglect, 9, 207–215.

    Article  CAS  Google Scholar 

  • Keen, J. H., Lendrulm, J., & Wolman, B. (1975). Inflicted burns and scalds in children. British Medical Journal, 4, 268–269.

    Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Kessler, D. B., & Hyden, P. (1991). Physical, sexual, and emotional abuse of children. CIBA Foundation Symposium, 43(2), 1–32.

    CAS  Google Scholar 

  • 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 

  • Kos, L., & Shwayder, T. (2006, July–August). Cutaneous manifestations of child abuse. Pediatric Dermatology, 23(4), 311–320.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Lenoski, E. F., & Hunter, K. A. (1977). Specific patterns of inflicted burn injuries. Journal of Trauma, 17, 842–846.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Meagher, D. P. (1990). Burns. In J. G. Raffensperger (Ed.), Swenson’s pediatric surgery (5th ed., pp. 317–337). Norwalk, CT: Appleton & Lange.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • Pascoe, J. M., Hildebrandt, H. M., Tarrier, A., & Murphy, M. (1979). Patterns of skin injury in nonaccidental and accidental injury. Pediatrics, 64, 245–247.

    PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Porzionato, A., & Aprile, A. (2007). Staphylococcal scalded skin syndrome mimicking child abuse by burning. Forensic Science International, 168(1), e1–e4.

    Article  PubMed  Google Scholar 

  • Purdue, G. F., Hunt, J. L., & Prescott, P. R. (1988). Child abuse by burning—An index of suspicion. Journal of Trauma, 28, 221–224.

    Article  PubMed  CAS  Google Scholar 

  • Rapaport, S. I. (1983). Preoperative hemostatic evaluation: Which tests, if any? Blood, 61, 229–231.

    PubMed  CAS  Google Scholar 

  • Reece, R. M., & Ludwig, S. (2001, January). Child abuse: Medical diagnosis and management (2nd ed.). Philadelphia, PA: Lippincott Williams and Wilkins.

    Google Scholar 

  • Reinhardt, M. A., & Ruhs, H. 1985). Moxibustion. Another traumatic folk remedy. Clinical Pediatrics (Phila), 24(1), 58–59.

    Article  Google Scholar 

  • 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 

  • 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 

  • Saulsbury, F. T., & Hayden, G. F. (1985). Skin conditions simulating child abuse. Pediatric Emergency Care, 1, 147–150.

    Article  PubMed  CAS  Google Scholar 

  • Schwartz, A. J., & Ricci, L. R. (1996). How accurately can bruises be aged in abused children? Literature review and synthesis. Pediatrics, 97, 254–256.

    PubMed  CAS  Google Scholar 

  • Showers, J., & Garrison, K. M. (1988). Burn abuse: A four-year study. Journal of Trauma, 28, 1581–1583.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Stone, N. H., Rinaldo, L., Humphrey, C. R., & Brown, R. H. (1970). Surgical Clinics of North America, 50, 1419–1424.

    PubMed  CAS  Google Scholar 

  • Stratman, E., & Melski, J. (2002). Scald Abuse. JAMA, 138(3), 318–320.

    Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Sussman, S. H. (1968). Skin manifestations of the Battered Child Syndrome. Journal of Pediatrics, 72, 99–101.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    CAS  Google Scholar 

  • 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 

  • Wilson, E. F. (1977). Estimation of the age of cutaneous contusions in child abuse. Pediatrics, 60, 750–752.

    PubMed  CAS  Google Scholar 

  • Wissow, L. S.(1990a). Child advocacy for the clinician: An approach to child abuse and neglect. Baltimore: Williams & Wilkins.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA

    Erin E. Endom MD (Assistant Professor)

  2. Baylor College of Medicine, Texas Children’s Health Plan, Inc., Suite 34L, Houston, Texas, 77021, USA

    Angelo P. Giardino MD, PhD, MPH

Authors
  1. Erin E. Endom MD
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  2. Angelo P. Giardino MD, PhD, MPH
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Editor information

Editors and Affiliations

  1. Texas Children's Health Plan, Inc., Holcombe Blvd. 2450, Houston, 77021, Texas, USA

    Angelo P. Giardino

  2. Texas Children’s Hospital, Children's Assessment Center, Baylor College of Medicine, Fannin St. 6621, Houston, 77030-2399, Texas, USA

    Michelle A. Lyn

  3. School of Nursing at Houston, Department of Integrative Care, University of Texas, Bertner 6901, Houston, 77030, Texas, USA

    Eileen R. Giardino

Appendix

Appendix

figure ba

Bruising to buttock and upper thigh. Similar injury taken from a different angle.

figure bbfigure bb

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figure bd

(continued)

figure cfigure cfigure c

Child with bruising on the ear—note erythema and swelling.

figure kfigure kfigure kfigure k

Cuts abdomen/maybe healing burns to abdomen based on the pattern of the most lateral mark or a combination of both burns and cuts.

Great close-up Photo 1.

figure dfigure dfigure dfigure d

Circumscribed burns to right hand with denuded skin.

Photos 3–8 Circumscribed burns to right hand with denuded skin on both dorsal and palmar surfaces.

figure dafigure dafigure dafigure da

(continued)

figure dbfigure dbfigure dbfigure db

(continued)

figure efigure efigure e

Burns on plantar surface of left foot.

Child with burns to plantar surface of both feet.

The same injury from different angles.

figure eafigure eafigure eafigure ea

(continued)

figure eb

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figure ffigure f

Circumscribed burning may be confused with infections such as impetigo.

figure gfigure gfigure gfigure g

(continued)

figure gafigure gafigure gafigure ga

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figure gbfigure gbfigure gbfigure gb

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figure gcfigure gcfigure gc

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figure gdfigure gdfigure gd

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Photo 3.5
figure ai

Photo taken at a closer distance of injury in 7i.

Full size image
Photo 3.5
figure aj

Photo of burns of lower abdomen

Full size image

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Endom, E.E., Giardino, A.P. (2010). Skin Injury: Bruises and Burns. In: Giardino, A., Lyn, M., Giardino, E. (eds) A Practical Guide to the Evaluation of Child Physical Abuse and Neglect. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0702-8_3

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