LITMIR.BIZ

       Chapter 1

      BURN INJURIES

      Matt Young, MD

      Terra N. Frazier, DO

      Aaron J. Miller, MD, MPA

      Donna Londergan Evans, MD, FAAP

      Children who are burned abusively are marked or branded with the outward manifestation of parental violence, emotional imbalance, impulsivity, educational and cultural deprivation, and poverty. Intentionally burning a child is controlled and premeditated.

      Abusive burns cause both physical and emotional trauma at the time of the incident, and often produce long-term physical and psychological scarring. Individuals who burn children typically are educationally deprived; abuse women (if male); and may be isolated, suspicious, rigid, dependent, or immature. They often display more concern for themselves than the child, frequently show little remorse, and are evasive and contradictory. They generally do not volunteer information, seldom visit the child in the hospital, and rarely ask questions about the child’s condition. By contrast, parents whose child is unintentionally burned usually blame themselves for a lack of supervision and may display a profound sense of guilt.

      Burn injuries can be divided into 6 categories: flame, scald, contact, electrical, chemical, and radiation, eg, sunburn from ultraviolet radiation. Abusive burns generally cluster in the scald and contact categories, although there are reports of other types of burns. Children’s skin is much thinner than adult skin, so serious burning occurs more rapidly and at lower temperatures. Electrical burns can be deceptive since trauma may not always be outwardly apparent. Electricity follows the path of least resistance, and skin is a natural resistor to electrical flow. Nerves, muscles, and blood vessels, however, are good conductors and, therefore, are more susceptible to electrical trauma. Electrical flash burns are caused when the current is shorted, producing a very brief, high-intensity fireball that causes thermal injury. Flash burns char the superficial layers of skin but usually do not cause destruction of deep tissues.

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