Paeds · child-safety-and-social-paediatrics
Inflicted burns and scalds
Also known as Non-accidental burns · Inflicted thermal injury · Burns due to child maltreatment · NAI burns · Scald abuse
Fellowship guide to inflicted burns and scalds: pattern-based recognition of non-accidental thermal injury (immersion stocking-glove scalds, sharp demarcation, contact burns on hidden sites), the BuRN-Tool decision rule, co-existing injury assessment, the mandatory safeguarding pathway, and primary prevention with the SafeTea programme.
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Target exams
Red flags
- A stocking-glove or sock-like scald with a sharp upper margin and no splash marks is an immersion burn until proven otherwise — the story of 'pulling over a cup' does not fit
- Delayed presentation of any burn in a child, or a history that changes between informants, demands a strategy discussion, not a dressing and discharge
- Multiple burn sites of different depths or ages, or co-existing unexplained bruises and fractures, indicate repeated inflicted injury — examine the child head to skin
- A pre-mobile infant with any burn other than a trivial superficial scald is a red flag — infants cannot spill hot water on themselves or reach radiators
- A cigarette-type circular burn, a contact burn on the dorsum of the hand, or a burn on the perineum or posterior trunk should trigger safeguarding referral regardless of the history
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Child protection and safeguarding
- Acute clinical care and the critically ill child
- Current 2026 PREP curriculum — Learning goal 5: Clinical assessment – essential general paediatrics
- Current 2026 PREP curriculum — Learning goal 11: Recognise and manage the acutely ill child
- Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment
- Child protection competencies and mandatory reporting
- Clinical Applications
- Child protection scenarios
- Long Cases
- Short Cases
- Communication scenarios
- 1. Working with children and young people: Safeguarding and child protection
- 4. Professional skills and knowledge: Patient management
- Level 2: Recognises and responds to suspected child maltreatment including inflicted injury
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Clinical
- History
- Communication
- Child protection scenario and inflicted injury recognition
- General Pediatrics Content Outline — Domain 1: Abuse and Neglect
- General Pediatrics Content Outline — Domain 4: Emergency Medicine
- General Pediatrics EPA: Recognise and report suspected child maltreatment
- Patient Care 1: History and Physical Examination
- Patient Care 4: Clinical Reasoning
- Medical Knowledge 1: Clinical Knowledge
- Systems-Based Practice: mandatory reporting and multidisciplinary safeguarding
- Medical Expert
- Collaborator
- Pediatrics: Core EPA — Recognise and respond to child maltreatment
- Health Advocate: injury prevention and advocacy
Overview & Definition
Picture the eighteen-month-old brought in with a scald to both feet and lower legs that stops abruptly at a sharp line just above the ankles, like a sock pulled tight. The story is that he pulled a cup of tea over himself while standing at the coffee table. That pattern — symmetrical, sharply demarcated, no splash marks — does not fit the story, and it is an inflicted immersion scald until proven otherwise. [1]
Inflicted burns and scalds are thermal injuries caused deliberately or through wilful neglect by a carer, and they account for a meaningful and under-recognised fraction of all childhood burn presentations. They span the spectrum from a deliberate scald immersion to a contact burn from a hot implement held against the skin, to neglect allowing a child sustained access to a hazard. The unifying feature is that the injury pattern, its distribution on the body, or the history is not consistent with the stated mechanism and the developmental capability of the child. [11]
The conceptual anchor for the trainee is that the burn itself is rarely the whole story. Inflicted burns are a sentinel: a child who has been burned deliberately often has other unexplained injuries, a background of neglect, and is at high risk of further harm if returned to an unsafe environment. Your job at first contact is to recognise the pattern, document it forensically, and set the safeguarding pathway in motion — treating the burn well but never losing sight of the child behind it. [3] [6]
References13ShowHide
- [1]Maguire S, Moynihan S, Mann M, et al. A systematic review of the features that indicate intentional scalds in children. Burns, 2008.PMID 18538478
- [2]Kemp AM, Hollén L, Emond AM, et al. Raising suspicion of maltreatment from burns: Derivation and validation of the BuRN-Tool. Burns, 2018.PMID 28918905
- [3]Pawlik MC, Kemp A, Maguire S, et al. Children with burns referred for child abuse evaluation: Burn characteristics and co-existent injuries. Child Abuse Negl, 2016.PMID 27088728
- [4]Johnson EL, Maguire S, Hollén LI, et al. Agents, mechanisms and clinical features of non-scald burns in children: A prospective UK study. Burns, 2017.PMID 28645715
- [5]Chester DL, Jose RM, Aldlyami E, et al. Non-accidental burns in children--are we neglecting neglect? Burns, 2006.PMID 16448766
- [6]Peck MD, Priolo-Kapel D Child abuse by burning: a review of the literature and an algorithm for medical investigations. J Trauma, 2002.PMID 12435962
- [7]Hettiaratchy S, Dziewulski P ABC of burns: pathophysiology and types of burns. BMJ, 2004.PMID 15191982
- [8]Johnson EL, Hollén LI, Kemp AM, et al. Exploring the acceptability of a clinical decision rule to identify paediatric burns due to child abuse or neglect. Emerg Med J, 2016.PMID 27068866
- [9]Cowley LE, Bennett CV, Brown I, et al. Mixed-methods process evaluation of SafeTea: a multimedia campaign to prevent hot drink scalds in young children and promote burn first aid. Inj Prev, 2021.PMID 33093127
- [10]Bennett CV, Hollén L, Quinn-Scoggins HD, et al. Feasibility of Safe-Tea: a parent-targeted intervention to prevent hot drink scalds in preschool children. Inj Prev, 2020.PMID 30765457
- [11]Gasteratos K, McCarthy M, Chatziathanasiou D, et al. A Systematic Review of Pediatric Nonaccidental Burns: Protecting the Children Through Knowledge, Vigilance, and Prevention. Ann Plast Surg, 2023.PMID 37157138
- [12]Titus MO, Baxter AL, Starling SP Accidental scald burns in sinks. Pediatrics, 2003.PMID 12563095
- [13]Popowicz P, Regan A, Hotwagner DT Burn Fluid Resuscitation. StatPearls, 2026.PMID 30480960