The Medical Investigation of Burn Related Child Abuse

 

Burn injuries to a child often result in criminal prosecutions or petitions to terminate parental rights by Department of Human Services officials such as a CPS investigator.  Sometimes, parents are facing both kinds of legal problems at the same time.  They can also result in custody battles when the biological parents are not together.  However, the investigations of suspected burn related child abuse often has three components:

• Investigation by police or sheriff officials
• Investigation by child abuse investigators (CPS)
• Investigation by hospital officials ( burn injury doctors and child abuse pediatricians from the hospital's child protection team)

Medical doctors, nurses and hospital social workers are trained to evaluate parents when they suspect abuse by scalding, immersion or contact.  The social history of the family is extremely important to that investigation.  Although there is no universally accepted list of "red flags," here are some of the things that they are looking for that will cause additional concern and suspicion:

 

Stress on the family unit.  This could be financial stress, emotional instability, relationship difficulties, employment issues, isolation or even a general sense of a parent being overwhelmed with the home environment.

 

Negative history.  A family's history is closely examined for prior difficulties.  This could be a history of prior criminal behavior, domestic violence, parents who were abused as children, prior psychological treatments, substance abuse involving prescription or illegal drugs or alcohol, and prior contacts with CPS.  CPS contacts will be considered whether or not there were any negative findings.

 

Family relationships.  Historically, almost half of burns believed to be intentionally cause by caregivers have been attributed to the mother.  The second largest group of  offending caregivers is boyfriends, and the third is fathers.  Together, these three groups account for approximately 75% of child abuse abuse by burning.

 

Case History.  For the most part, the treatment of burn injuries is going to be dictated by the severity of the burn, the depth of the burn, the percentage of the body that is burned and the presence or absence of additional injuries or medical conditions which require immediate medical attention.  There is a reason that doctors, nurses, social worker, police and CPS workers are asking you repeatedly to tell them what happened.  That is because parents are intensely evaluated based on two criteria:

 

(1) Does the history of events being provided seem to explain the injuries?

 

(2) Does the history change? In other words, is it consistent? If the story seems to change with the repeated telling of events, or when the story is questioned, the level of suspicion and accusation can rise. 

 

Age of the Child.  Abuse burns most often involve young children.  The most involved age group are toddlers, or children between the age of two and four.

 

Type of Burns.  The frequency of a particular type of burn being considered abuse does not really shed any light on whether any one particular burn was caused by accident or is intentionally inflicted.  However, the statistics may fuel additional suspicion in your case. Therefore, it is important to consider some facts which will be on the mind of the medical staff and other investigators:

 

Scalding with a hot liquid is the single most common type of intentionally inflicted burn in pediatric abuse cases.

 

Among the scalding cases, hot water immersion is by far the most common mechanism of injury.

 

A significant number of burn victims where the medical providers and investigators conclude that the child is abused have a history of abuse or neglect previously documented by CPS.

 

It is generally believed that boys are intentionally burned more often than girls.

 

In addition to the case history and social investigation, doctors will evaluate the medical injuries.  The pattern of burns is very important to the medical conclusion about the cause.  There are some burn injuries that are generally considered more diagnostic of abuse than others.  The pattern of burn is extremely important to the conclusion of whether the burn is intentional abuse, neglect or pure accident.  Although there are too many specific pattern of burn scenarios to discuss here, there are some commonly sited examples that illustrate the importance of burn patterns:

 

Many objects will leave a particular pattern of injury on the skin when they are heated and come into contact with it.  For example, there have been numerous reported cases of pattern injuries which followed the expected shape of a cigarette, a curling iron, a clothes iron, a butane lighter, a fork etc.

 

The pattern of a scalding injury often goes a long way toward telling the story of what happened.  Scalding injuries often leave fairly clean lines where the scalding begins and ends.  This becomes a mechanical analysis as the doctors will simply ask what position the body would have had to be in if you line up all of the linear borders of the injury.  The analysis of the immersion pattern often involves an analysis of areas of the child's body that was spared (unburned) from the burn.  Thus, a child burned from the feet to the waist line, with the buttocks being spared would appear to be a case where the child sat down in a bathtub and the temperature of the tub was less than the water temperature.

 

Doctors advance different theories about a child's reaction to being scalded or upon immersion in a hot liquid.  Some believe that the child would try to move around to avoid the injury, while others believe that a child would essentially "freeze up" or become immobile.