Iron contact burns and the path to the diagnosis of child abuse

Burns are a common injury in both abused and non-abused children, and the accurate diagnosis of abusive burns is important to ensure protection. In the particular case of a three year old child with a second degree burn on her face and neck caused by an alleged contact with a hot iron, the correct analysis of the injury and the dynamics of what was reported as a domestic accident allowed the recognition of a different scenario and a diagnosis of child abuse due to the pressure of the flat part of the iron on the skin, thus uniformly involving the cheek and the upper part of the neck. The involvement of parts of the body placed on different anatomical planes (thus indicating pressure and not mere contact) should be considered as a further element of differential diagnosis. This demonstrates and underlines the importance of a thorough multidisciplinary assessment for this type of injury which is described as an accidental event but rarely as an outcome of child abuse.