Non-accidental burns in a neurodevelopmentally vulnerable child: A case of institutional child abuse

Area of Science:

• Pediatrics
• Child Abuse
• Medical Diagnostics

Background:

• Paediatric burns can stem from accidental or non-accidental causes, posing diagnostic difficulties when explanations are questionable.
• Children with behavioural issues may be vulnerable, requiring careful evaluation of burn injuries.

Purpose of the Study:

• To highlight the diagnostic challenges in suspected non-accidental paediatric burns.
• To emphasize the importance of recognizing burn patterns indicative of abuse.
• To underscore the role of multidisciplinary assessment in identifying underlying conditions and ensuring child protection.

Main Methods:

• Case report of an 8-year-old boy with deep burns.
• Clinical examination to assess burn distribution and severity.
• Multidisciplinary team evaluation, including genetic assessment for neurocutaneous disorders.
• Child protection investigation.

Main Results:

• Burn pattern was inconsistent with the reported hot water spillage explanation, suggesting non-accidental injury.
• Facial angiofibromas led to a diagnosis of tuberous sclerosis, explaining behavioural difficulties.
• Child protection services confirmed evidence of abuse in the institutional setting.

Conclusions:

• Burn pattern recognition is crucial for identifying non-accidental paediatric injuries.
• Undiagnosed neurodevelopmental disorders, like tuberous sclerosis, can be associated with increased risk.
• Multidisciplinary evaluation and robust safeguarding are essential in institutional care to protect children.