The saddest burn cases are those where an abuser inflicts the burns intentionally. The victim is typically one who is defenseless such as a child under the age of ten or an adult that is unable to fend off such attacks. Most victims of such cruelty are unable to speak for themselves and therefore rescue personnel must be able to identify these abuse burn victims. This identification may not be obvious, and it should not be assumed that those in charge of the care of the individual are the one doing the abuse. Rescuers must be able to identify accidental burns from intentional ones. Tools for determining the difference between burn causes (accidental/intentional) may include a burn evidence worksheet and a recreation of the burn incidence based on the statement of those present at the time of the burn occurring or those found in the care of the individual. Knowing the difference can give a burn victim the help they need without causing additional harm.
Burn injuries can occur in different ways including spilling or splashing of hot liquids, immersion burns, and also contact burns.
Burn injuries caused by spilling or splashing hot liquids. With all burn injuries location of burn and pattern of the burn is not the only critical piece of information that should be considered when determining if the burn is intentional or accidental.
There are usually more than one reason why an intentional liquid burn may have occurred including anger and punishment for the child playing too close to a hot liquid.
Burn injuries caused by immersion can result from the child falling into or being placed into a tub or container of hot liquid. Waterlines are important evidence as well as any evidence that the child may have thrashed around while in the liquid. Most forced immersions are done with the child being held in place in which thrashing is usually not possible. If the child was intentionally immersed there may be evidence of soft tissue bruising to support this happening.
Toilet training and the occurrence of repeated soiling of clothing often trigger intentional immersion burns.
Burn injuries caused by contact with heat such as flames or heated solid objects are not as common as immersion or spilling/splashing but when they do occur they can be identified because of the well-defined appearance and the depth of the injury as compared to accidental contact burns. This difference is due to the fact that if the burn was accidental the victim will instinctively pull away from the heat, thus minimizing the depth and causing a lack of a pattern to the burn. An accidental burn can be second-degree in nature so the degree of the burn is not necessarily evidence.
There are several skin conditions that can mimic burns and this should be taken into account when investigating possible burn abuse such as cutaneous infections of the skin such as severe diaper rash, or hypersensitivity reactions to citrus fruits and then having the skin exposed to sunlight. Certain skin preparations such as topical antiseptics can also cause what may look like burn patterns. Accurate exposure history should allow investigators to help in distinguishing these skin conditions from burns as well as any medical records that verify these skin conditions.