Reading between the lesions: Recognizing intent in pediatric burn injuries.

Abstract

Burn injuries are common in childhood and may occur in accidental or non-accidental circumstances, making forensic interpretation challenging. Evaluation is difficult when clinical findings, reported history, and contextual evidence are incomplete or discordant. We present three pediatric cases evaluated through a structured forensic approach integrating clinical findings, lesion morphology, reported circumstances, developmental assessment, scene reconstruction, and experimental testing. The first involved a 7-year-old girl with scald burns of the buttocks and right lower limb following the reported rupture of a bag filled with boiling water; analysis supported an accidental mechanism. The second concerned a 9-month-old boy with deep partial-thickness burns of the left hand reportedly caused by accidental contact with a stove hot plate; lesion analysis, scene reconstruction, thermal testing, and developmental assessment were inconsistent with the reported history and supported abuse. The third involved a 13-year-old girl with multiple rounded burn-like skin lesions in different stages of healing; extensive clinical investigations did not identify a specific dermatologic or systemic cause, while toxicological analysis of lesional skin supported exposure to an aluminum-containing topical product, namely her deodorant. Multidisciplinary assessment indicated a deliberate mechanism, with self-infliction considered the most probable interpretation. These cases show that no single feature is diagnostically decisive in the forensic assessment of pediatric burns. Determination of injury mechanism and intentionality requires multidisciplinary integration of lesion morphology, developmental plausibility, thermal dynamics, toxicological findings, and scene reconstruction. In this case series, this structured approach supported three distinct mechanisms: accidental scald injury, inflicted contact burn, and deliberate self-inflicted burn-like injury.