Children with burns referred for child abuse evaluation: Burn characteristics and co-existent injuries

Marie Christin Pawlik, Alison Kemp, Sabine Maguire, Diane Nuttall, Kenneth W. Feldman, Daniel M. Lindberg, Jayme Coffman, Deb Bretl, Nancy Harper, Katherine Deye, Antoinette L. Laskey, Harris Tara Harris, Yolanda Duralde, Marcella Donaruma-Kwoh, Daryl Steiner, Ken Feldman, Kimberly Schwartz, Robert A. Shapiro, Mary Greiner, Alice NewtonRachel Berger, Ivone Kim, Kent Hymel, Suzanne Haney, Alicia Pekarsky, Andrea Asnes, Paul McPherson, Neha Mehta, Gwendolyn Gladstone

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Intentional burns represent a serious form of physical abuse that must be identified to protect children from further harm. This study is a retrospectively planned secondary analysis of the Examining Siblings To Recognize Abuse (ExSTRA) network data. Our objective was to describe the characteristics of burns injuries in children referred to Child Abuse Pediatricians (CAPs) in relation to the perceived likelihood of abuse. We furthermore compare the extent of diagnostic investigations undertaken in children referred to CAPs for burn injuries with those referred for other reasons. Within this dataset, 7% (215/2890) of children had burns. Children with burns were older than children with other injuries (median age 20 months vs. 10 months). Physical abuse was perceived as likely in 40.9% (88) and unlikely in 59.1% (127). Scalds accounted for 52.6% (113) and contact burns for 27.6% (60). Several characteristics of the history and burn injury were associated with a significantly higher perceived likelihood of abuse, including children with reported inflicted injury, absent or inadequate explanation, hot water as agent, immersion scald, a bilateral/symmetric burn pattern, total body surface area ≥10%, full thickness burns, and co-existent injuries. The rates of diagnostic testing were significantly lower in children with burns than other injuries, yet the yield of skeletal survey and hepatic transaminases testing were comparable between the two groups. This would imply that children referred to CAPs for burns warrant the same level of comprehensive investigations as those referred for other reasons.

Original languageEnglish (US)
Pages (from-to)52-61
Number of pages10
JournalChild Abuse and Neglect
StatePublished - May 1 2016

Bibliographical note

Funding Information:
We thank Dr. Daniel Farewell and Dr. Laszlo Trefan for their statistical advice. This work is supported by the Healing Foundation – Registered Charity No. 1078666 .

Publisher Copyright:
© 2016 The Authors.


  • Burns
  • Child maltreatment
  • Skeletal survey

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