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Skin Injury: Bruises and Burns

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A Practical Guide to the Evaluation of Child Physical Abuse and Neglect

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Abstract

Careful examination of the child’s skin is an essential component of the abuse evaluation. Injuries to the skin are common findings in maltreated children and may include (a) contusions (bruises), abrasions, and lacerations; (b) burns from scalding, direct contact with flame or hot objects, and electricity; (c) frostbite (O’Neill et al., J Trauma 13: 332–339, 1973); and (d) scars resulting from these injuries (Richardson, Cutaneous manifestations of abuse. In: Reece RM (ed) Child abuse: medical diagnosis and management. Lea & Febiger, Philadelphia, pp 167–184, 1994). In one study examining the injuries of 616 children suspected of having been abused, at least 80% of the 775 primary injuries involved the skin, including (a) bruises/ecchymoses/hematomas (56%), (b) erythema/marks (9%), (c) burns (8%), and (d) abrasions/scratches (7%) (Johnson and Showers, Child Abuse Negl 9, 207–215, 1985). Ellerstein (J Dis Child 133, 906–909, 1979, Dermatologic manifestations of child abuse and neglect. In: Ellerstein NS (ed), Child abuse and neglect: a medical reference. Wiley, New York, 1981) noted the importance of cutaneous findings in maltreated children, because the recognition of these easily observed injuries by the child’s relatives, neighbors, and schoolteachers may trigger contact with the healthcare provider. Healthcare providers evaluating children with suspicious skin findings need to consider physical abuse and/or neglect as a potential etiology and pursue a thorough evaluation.

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Author information

Authors and Affiliations

  1. Texas Children’s Hospital, Houston, TX, USA

    Erin E. Endom

  2. Department Pediatrics, University of Utah Health, Salt Lake City, UT, USA

    Angelo P. Giardino

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  1. Erin E. Endom
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  2. Angelo P. Giardino
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Correspondence to Erin E. Endom .

Editor information

Editors and Affiliations

  1. Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA

    Angelo P. Giardino

  2. Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    Michelle A. Lyn

  3. Department of Integrative Care, School of Nursing at Houston, University of Texas, Houston, TX, USA

    Eileen R. Giardino

Appendix

Appendix

Series 1

Bruising of the buttocks and upper high (Photos 3.9a, b, c and 3.9d) .

Photo 3.9
figure 22

a, b, and c Photos taken at different distances showing bruises on the left thigh and buttock

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Photo 3.9d
figure 23

Photo of bruises on the thigh taken from a different angle

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Series 2

Child with bruising of ears (Photos 3.10a, 3.10b, and 3.10c) .

Photo 3.10a
figure 24

Photo of patient’s right ear from a distance

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Photo 3.10b
figure 25

Photo of the right ear exposed from behind

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Photo 3.10c
figure 26

Photo of the left ear exposed from behind

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Series 3

Lacerations/abrasions to the abdomen (Photos 3.11a, 3.11b, 3.11c, and 3.11d) .

Photo 3.11a
figure 27

Photo taken at a distance showing the lacerations/abrasions on the patient’s abdomen

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Photo 3.11b
figure 28

Photo of patient in 3.11a at a closer distance

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Photo 3.11c
figure 29

Photo of 3.11a taken at a different angle to capture a side view of the laceration/abrasion

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Photo 3.11d
figure 30

Photo of patient 3.11a with injury to the right upper thigh

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Series 4

Burns of the right hand with denuded skin and lower torso. Please take note of the various angles of the photos (Photos 3.12a, 3.12b, 3.12c, 3.12d, 3.12e and 3.12f).

Photo 3.12a
figure 31

Photo taken from the side angle of the right hand with denuded skin

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Photo 3.12b
figure 32

Photo of the dorsum of the burned right hand

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Photo 3.12c
figure 33

Photo of the burned right palm with denuded skin

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Photo 3.12d
figure 34

Photo of patient in 3.12c at closer view

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Photo 3.12e
figure 35

Photo taken from the side angle of burned right hand

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Photo 3.12f
figure 36

Photo of patient in 3.12e showing burned right thigh

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Series 5

Child with burns on the surfaces of both feet and the left hand (Photos 3.13a, 3.13b, 3.13c, 3.13d, 3.13e, 3.13f, 3.13g, and 3.13h) .

Photo 3.13a
figure 37

Photo of burns on the dorsum of the burned left foot

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Photo 3.13b
figure 38

Photo of the left foot with burns on the plantar surface

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Photo 3.13c
figure 39

Photo taken at a different angle of the burns on the left foot

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Photo 3.13d
figure 40

Photo taken at a different angle of the left foot showing the burns on plantar surface

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Photo 3.13e
figure 41

Photo of burns on dorsal surface of the right foot

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Photo 3.13f
figure 42

Photo taken at a different angle of the burns on dorsal surface of the right foot

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Photo 3.13g
figure 43

Photo of the burns on plantar surface of the right foot

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Photo 3.13h
figure 44

Photo of the same patient in Photo 3.13a with a burned left hand

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Series 6

Circumscribed burns which may be confused with infections such as impetigo (Photos 3.14a, and 3.14b).

Photo 3.14a
figure 45

Circumscribed burns which may be confused with infections such as impetigo

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Photo 3.14b
figure 46

Photo from a distance of circumscribed burns

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Series 7

Child with burns to the body including the face, shoulders, and chest (Photos 3.15a, 3.15b, 3.15c, 3.15d, 3.15e, 3.15f, 3.15g, 3.15h, 3.15i, 3.15j, and 3.15k) .

Photo 3.15a
figure 47

Photo of burns on the left shoulder

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Photo 3.15b
figure 48

Photo taken from a closer distance of burns on the left shoulder

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Photo 3.15c
figure 49

Photo of burns on child’s right upper back

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Photo 3.15d
figure 50

Photo of burns on child’s right upper back taken at a closer distance

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Photo 3.15e
figure 51

Photo taken at a different angle and distance of burns on child’s right upper back

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Photo 3.15f
figure 52

Photo of burns on child’s left upper back and neck

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Photo 3.15g
figure 53

Photo of patient with burns to the body including the face, shoulders, chest, and right hip area

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Photo 3.15h
figure 54

Photo of the burn on the right hip taken at a closer angle

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Photo 3.15i
figure 55

Photo taken from a different view of burn of the right hip

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Photo 3.15j
figure 56

Photo taken at a closer distance of injury in Photo 3.15i

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Photo 3.15k
figure 57

Photo of burns of the lower abdomen

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Endom, E.E., Giardino, A.P. (2019). Skin Injury: Bruises and Burns. In: Giardino, A., Lyn, M., Giardino, E. (eds) A Practical Guide to the Evaluation of Child Physical Abuse and Neglect. Springer, Cham. https://doi.org/10.1007/978-3-030-00635-8_3

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