We launch into this informative discussion right out of the gate describing the different types of burns. Lets jump in:
The Different Types of Burns
There are four main types of burns that are often seen in child abuse cases: scald, contact, electrical, and chemical. These burns can range in severity from first-degree to third-degree, with fourth-degree being the most severe.
Superficial burns
Superficial burns are the least serious type of burn. They damage only the outer layer of your skin (the epidermis). Most often, they can be treated at home. Superficial burns may cause redness, pain, and swelling. Minor superficial burns usually heal in 3 to 6 days without scarring.
Superficial partial-thickness burns
Superficial partial-thickness burns affect the outer layer of skin and the layer below it (the dermis). These burns are also called first-degree or second-degree burns. Superficial partial-thickness burns are usually less painful than full-thickness burns because some of the nerve endings in the dermis are still intact. They often heal in 7 to 21 days with little or no Scarring .
Deep partial-thickness burns
Deep partial-thickness burns damage the outer layer of skin and all layers below it, getting into the fatty tissue beneath the skin. These Burns are also called second-degree or third-degree Burns . Deep partial thickness Burns can be very painful because all of the nerve endings in the area may be damaged. They often take 4 weeks or longer to heal and may result in permanent Scarring .
Partial-thickness burns
Partial-thickness burns injure the epidermis and dermis, the two outermost layers of skin. Sometimes called a “second-degree” burn, these wounds cause pain, redness, swelling and blistering. Initially, the burn may appear white or red. When partial-thickness burns heal they often result in scarring.
Examples: Blisters caused by heat from a stove burner, sunburns
Full-thickness burns
Full-thickness burns are the most severe burns. They go through all three layers of skin, and can cause severe damage to the muscles, tendons, and bones underneath. Full-thickness burns often require skin grafts to heal properly.
The Different Causes of Burns
Burns are one of the more common ways that child abuse is discovered. Many times, the burns are caused by scalding liquids, such as hot water or soup. Others are caused by contact with hot surfaces, such as irons, stovetops, or cigarette lighters.
Scalding
Burns from scalding liquids are the most common type of burns in young children. Scalding can happen quickly, and the hot liquid can cause severe damage to the skin. In most cases, scalding happens when a child is accidentally splashed with hot water or coffee. However, it can also happen if a child is left in a hot bathtub or if hot food or drinks are spilled on them.
Scalding injuries can be very serious, and they often require hospital treatment. In some cases, scalding can lead to permanent scarring or disfigurement. If you suspect that your child has been injured by scalding, its important to seek medical attention immediately.
Contact with fire
There are many different ways that a person can sustain a burn injury. The type of burn depends on how the tissue was damaged and how deep the damage goes. Some common causes of burns include contact with fire, chemicals, electricity, hot liquids and steam.
Contact with fire is the most common cause of burns in child abuse cases. Children sustaining Burns from contact with fire typically have injuries on their hands, arms, legs and feet. The depth of these burns can vary from superficial to full thickness. Superficial burns damage the top layer of skin (epidermis) and are often called first-degree or partial-thickness burns. These burns are usually red in color, painful and heal within 7-10 days without scarring. Full thickness or third-degree burns go through all the layers of skin and often damage the underlying fat, muscle and bone. These burns are white or black in color, painless (due to nerve damage) and require skin grafts for healing.
Other less common causes of burns seen in child abuse cases include scalds (burns from hot liquids), electrical burns and chemical Burns. Scalds typically affect areas where there is a lot of loose skin like the buttocks, genitalia, groin and abdomen. Electrical injuries usually occur when a child comes into contact with an electrical current either by biting on an electrical cord or touching exposed electrical wiring. These injuries can cause deep tissue damage and may be associated with internal organ injury or cardiac arrest. Chemical burns can occur when a child comes into contact with strong acids or bases such as cleaners, pool chemicals or battery acid
Chemical
Burns can be caused by many different things, but they are most often categorized by how the burn was caused. The three main types of burns are thermal, electrical, and chemical.
- Thermal: Thermal burns are the most common type of burn. They are caused by contact with something hot, like fire, boiling water, or steam.
- Electrical: Electrical burns are caused by contact with electricity. These can be high-voltage or low-voltage injuries.
- Chemical: Chemical burns happen when the skin comes into contact with an acidic or alkaline substance. This type of burn can also happen if the chemical vapors are inhaled.
The Different Patterns of Burns
There are four general patterns of burns that are often used to help identify child abuse: scalds, contact burns, immersion burns, and flame burns. These patterns can be helpful in identifying abuse, but it is important to remember that any burn on a child could be the result of abuse.
Linear
Linear burns are caused by a leader (hot object) trailing along the surface of the skin. A linear burn is often the result of an electrical injury or being hit with something hot (such as a poker). The leader can be irregular in shape, but the resulting injury will be a line. These burns are also commonly seen in child abuse cases where an adult has used cigarettes to intentionally burn a child.
Stocking
One of the most common patterns of burns in child abuse cases is called stocking or glove. These burns occur when a hand or foot is dipped in hot water or held against a hot surface. The result is a severe burn that covers a large area of the extremity but spare the area between the digits (fingers or toes). In some cases, the term glove may be used to refer to any stocking burn, while in other cases it is used specifically to describe burns that spare the area between the thumb and first digit.
Glove
A glove burn is a clinical finding in burns where the hand is held in a clenched position inside a glove or other tightly fitting garment, and then exposed to fire. The result is deep, full-thickness burns of the palm and fingers, with corresponding extension of burns onto the back of the hand. The injury is frequently associated with crush injuries where the victim falls while their hand is held in this position.
The Different Stages of Burns
There are four different stages of burns. The first stage is superficial or first-degree burns. This is when the damage is only to the first layer of skin, the epidermis. The second stage is partial-thickness or second-degree burns. This is when the damage extends to the second layer of skin, the dermis. The third stage is full-thickness or third-degree burns. This is when all layers of the skin are damaged. Finally, the fourth stage is when there is damage to the underlying tissues, including muscles, bones, and nerves.
First-degree burns
Burns are classified according to their severity: first-, second-, and third-degree. First-degree burns affecting only the epidermis, the outermost layer of skin. The burn site is red, painful, dry, and with no blisters. Like a bad sunburn, first-degree burns usually heal within 3 to 5 days without scarring.
Second-degree burns
Second-degree burns are more serious than first-degree burns. They damage the outer layer of skin and the layer of skin below that. Second-degree burns are also called partial thickness burns. They can be very painful. You might see blisters and your skin will be red and swollen.
Second-degree burns can happen in several ways, including:
- touching something that is too hot, such as a stove
- being in hot water for too long
- chemicals, such as acid
- being outside in severe cold weather without proper clothing
Most second-degree burns will heal in two to three weeks without scarring.
Third-degree burns
Third-degree burns are the most serious type of burn. They cause damage to all layers of the skin. Third-degree burns can also damage nerves, muscles, and bone.
If you have a third-degree burn, you will need to see a doctor right away. You may need to stay in the hospital for treatment.
Treatment for a third-degree burn may include:
- Debridement (the medical removal of dead or damaged tissue)
- Skin grafts
- Surgery
- Antibiotics
- Pain medication
Investigating Child Abuse Cases Involving Burns
Criminal investigations into child abuse cases can be harrowing. But when the investigation uncovers that the child victim has suffered burns, the case takes on a whole new level of complexity. This section will explore how to investigate child abuse cases involving burns.
Interview the child
In order to investigate possible child abuse cases that involve burns, it is important to interview the child. This will help to get a better understanding of what happened and whether or not abuse may have occurred.
When interviewing the child, be sure to:
- Create a safe and supportive environment in which the child feels comfortable talking.
- Build rapport with the child.
- Use developmentally appropriate language.
- Be patient and allow the child to take breaks as needed.
- Avoid leading questions.
- Listen carefully to what the child says.
Interview the caregiver
In every case of possible child abuse involving burns, it is essential to interview the primary caregiver to get their side of the story. It is important to note that interviews with caregivers should be conducted as soon after the event as possible, as memory recall can be unreliable over time.
Caregivers should be asked about:
- The circumstances leading up to the burn injury
- What happened immediately after the injury occurred
- Their current understanding of the child’s prognosis
- Any other relevant information that may help shed light on the circumstances leading up to the injury
Review the medical records
Once you have been assigned a child abuse case involving burns, it is important to review the medical records thoroughly. This will help you understand the extent of the burns and make sure that you are aware of any potential complications.
You should also take note of any other injuries that the child has. It is not uncommon for children who have been abused to have multiple injuries, both old and new. This can be helpful information when trying to determine if the burns are accidental or intentional.
If possible, you should also try to speak to the treating physician about the case. They may be able to provide additional information about the burns and how they were sustained.
As with any type of criminal investigation, it is important to consider all possible scenarios when investigating child abuse cases involving burns. It is also important to consult with medical experts to ensure that all evidence is properly evaluated.
Conduct a scene investigation
Conduct a scene investigation whenever there is reason to believe that a child has been abused by having been burned.See the attached protocol for specific guidance. trained personnel should be consulted as soon as possible to assist with the investigation and collection of evidence.
In general, the following steps should be taken:
- Secure the scene and preserve all evidence.
- Identify and interview all witnesses.
- Collect and document all physical evidence.
- Document the scene thoroughly, including photographs and/or video footage.
- Consult with medical personnel to determine the nature and extent of the victim’s injuries.
- Consult with other experts as necessary (e.g., fire investigators, electrical engineers, etc.).
- Accompany the victim to medical appointments and/or interviews with law enforcement or child protective services, as appropriate, to provide support and ensure that their rights are respected throughout the process.
