Expert Commentary

The characteristics of burns among children referred for child abuse evaluations: New research

2016 study published in Child Abuse & Neglect that looks at the characteristics of burns among children to determine the likelihood that the burns are the result of child abuse.


Burns are one of the leading causes of accidental injury among children. Every day, U.S. emergency rooms treat more than 300 children under the age of 19 for burn-related injuries, according to the U.S. Centers for Disease Control and Prevention. But while touching a scorching pot on the stove or spilling hot liquid can cause burns that are common childhood injuries, burns also can indicate abuse in the home.

Being able to differentiate between an accidental burn and a deliberate one is sometimes difficult. But it is critically important for medical professionals and child protection workers to be able to recognize such signs of abuse, especially when a child is too young to communicate. The U.S. Department of Justice has reported that the majority of children who suffer intentional burns are under the age of 2.

Researchers have tried to identify features that distinguish deliberate burns from accidental burns, including scalds. There are not, however, many published studies that attempt to describe the burns of children who have been referred to child protection workers for an investigation into possible maltreatment. A group of scholars from the United Kingdom reviewed 20 small studies – primarily case studies — involving a total of 73 children to try to identify patterns and similarities. Their 2014 published study, “Contact, Cigarette and Flame Burns in Physical Abuse: A Systematic Review,” found, among other things, that most non-scald burns were from household items such as cigarettes and irons and appeared in multiple places on children’s bodies.

More recently, another research team sought more information about the characteristics of intentional burns. That team — six researchers from three medical schools — examined data on U.S. children aged 10 years old and younger who had been referred to one of 20 identified child protection teams between January 2010 and April 2011. Data was collected on a total of 215 children through the Examining Siblings To Recognize Abuse (ExSTRA) network. The resulting study, titled “Children with Burns Referred for Child Abuse Evaluation: Burn Characteristics and Co-existent Injuries,” was published in May 2016 in the journal Child Abuse & Neglect. 

Among the key findings:

  • The median age of children with burns who were referred to child protection workers was 20 months. Nearly 56 percent were boys.
  • The vast majority had public insurance. Almost two-thirds were racial or ethnic minorities.
  • For about 86 percent of these children, burns were the primary reason for their referrals. Burns were secondary injuries for about 14 percent.
  • The most common burn types were scalds (52.6 percent) and contact burns (27.6 percent). The most common causative agent was hot water.
  • Burns that did not have adequate explanations – or any explanation at all — and burns that followed a history of other burns were significantly more likely to be associated with abuse than one-time burns or burns with an adequate explanation. Physical abuse was deemed likely in 70 percent of cases for which there was no explanation and in 62.5 percent of cases with an additional burn history.
  • Burns from hot water, burns sustained from being immersed in hot liquid and burns from unknown sources were more likely to be associated with abuse. In contrast, burns that were not likely to be associated with abuse were burns from hot food and beverages or a radiator or burns that resulted from touching hot objects.
  • Bilateral burns, burns of the skin’s full thickness and burns that covered 10 percent or more of a child’s body were significantly more likely to be associated with abuse.
  • Burns that coincided with other injuries were significantly more likely to be associated with abuse. Researchers deemed physical abuse likely in 88.2 percent of cases in which a bone fracture accompanied a burn.
  • About 55 percent of children with burns who were referred to child protection workers underwent a skeletal survey — a series of X-rays of all the bones in the body. The skeletal survey identified a new injury in 16 percent of those children. Skeletal surveys found new injuries in 25 percent of youngsters aged 36 months to 60 months and in 23 percent of babies 6 months old and younger.

Related research: A 2014 study published in Pediatrics, “Income Inequality and Child Maltreatment in the United States,” considers the link between income inequality and child abuse. A 2013 study published in JAMA Pediatrics, “Violence, Crime, and Abuse Exposure in a National Sample of Children and Youth: An Update,” offers data on trends related to child abuse and childhood violence. A 2013 study in the International Journal of Public Health, “The Current Prevalence of Child Sexual Abuse Worldwide: A Systematic Review and Meta-analysis,” suggests that an estimated 9 percent of girls and 3 percent of boys worldwide are the victims of forced sexual intercourse.


Keywords: maltreatment, cigarette burns, burn pattern, children protective services, CPS, physical abuse, trauma

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