Inflicted burns and scalds — branching viva

Opening

Examiner: An eighteen-month-old boy is brought to the emergency department with a scald to both feet and lower legs. The burn stops at a sharp, clear line just above both ankles, there are no splash marks, and the depth is uniform. His mother says he pulled a cup of hot tea over himself while standing at a coffee table. How do you frame this? ^[1]

Candidate: I am immediately concerned that this is an inflicted immersion scald. The pattern — symmetrical stocking-glove distribution with a sharp upper margin, uniform depth, and no splash marks — is not consistent with a cup-of-tea spill, which would produce an irregular splash with tapering edges and visible splash marks. I would treat the burn and initiate the safeguarding pathway in parallel from this first contact. ^[1]

Branch 1 — pattern recognition

Examiner: Walk me through the inflicted versus accidental pattern. ^[1]

Candidate: The Maguire 2008 systematic review is the definitive synthesis. An accidental spill scald produces an irregular splash pattern with tapering, dripping edges, variable depth where the liquid ran off, and splash marks on nearby skin. A forced immersion scald produces a symmetrical stocking-glove or glove distribution with a sharp fluid-level margin, uniform depth because the limb was held still, no splash marks, and often flexure-sparing where the skin was folded against itself. This child has every feature of the immersion pattern and none of the spill pattern. ^[1]

Examiner (probe): Why is developmental plausibility important here? ^[1]