An 18-month-old with a second-degree glove distribution burn in the emergency department prompts consideration of possible child abuse. Which history would most strongly suggest abuse?

An 18-month-old with a second-degree glove distribution burn in the emergency department prompts consideration of possible child abuse. Which history would most strongly suggest abuse?

• A. Staphylococcal scalded skin syndrome
• B. Immersion injury caused by child abuse
• C. Possible contact with a caustic material
• D. Accidental burn from an iron

Answer: (B)

Immersion burns that create a glove-like, symmetrical pattern on both hands are a classic red flag for non-accidental injury. In a child this age, hands are typically burned only if someone forces the child into hot water, producing a uniform depth burn with a clear water-line demarcation at the wrists and minimal splash marks on the rest of the body. A history that describes forced immersion or an implausible or inconsistent explanation for how both hands were burned would strongly suggest abuse. By contrast, chemical burns tend to have irregular margins, accidental iron burns are usually localized and linear, and a presentation of SSSS would involve widespread skin involvement with systemic symptoms, not a discrete glove pattern.

Immersion burns that create a glove-like, symmetrical pattern on both hands are a classic red flag for non-accidental injury. In a child this age, hands are typically burned only if someone forces the child into hot water, producing a uniform depth burn with a clear water-line demarcation at the wrists and minimal splash marks on the rest of the body. A history that describes forced immersion or an implausible or inconsistent explanation for how both hands were burned would strongly suggest abuse. By contrast, chemical burns tend to have irregular margins, accidental iron burns are usually localized and linear, and a presentation of SSSS would involve widespread skin involvement with systemic symptoms, not a discrete glove pattern.