Burns: systematic review

Child Protection Evidence is a resource for clinicians across the UK and internationally to inform clinical practice, child protection procedures and professional and expert opinion in the legal system.


Scald burns are the most common burn type in children who have been abused and the most common causative agent is tap water. Abusive scalds tend to be distributed on the buttocks, perineum, and lower extremities, with clear upper limits and scald symmetry especially when present on the lower extremities. In non-scald abusive burns contact burns are the most common. These burns tend to be distributed on the back, shoulders, and buttocks, with clearly demarcated edges often matching the object used.

The following systematic review evaluates the scientific literature on abusive and non-abusive burns in children published up until October 2021.

The review aimed to answer four questions:

    • What are the clinical and social features that distinguish intentional and accidental scalds in children?
    • What are the features of intentional non-scald burns?
    • What conditions mimic intentional burns?
    • How do you identify a burn due to neglect?

This update includes four new studies with evidence added to all current clinical questions. One study profiled burn injuries associated with Child and Family service involvement, whilst another investigated the differences in presentation for noninflicted, negligent and inflicted burns. The characteristics of accidental versus abusive paediatric burn injuries in an urban burn centre over a 14-year period were described in a retrospective study, and a systematic review discussed the incidence and characteristics of non-accidental burns in children.

Key findings:

    • One study reported that apart from abusive head trauma, intentional burns are the most likely injury to cause death or long-term morbidity
    • The prevalence of abusive burns is estimated to be 5.3% – 14% of children admitted to burns units highest for those aged 0 – 1 years
    • Scalds are the most common intentional burn injury. These injuries may occur as a consequence of running water, resulting in burns to the lower limbs with a symmetrical distribution. Contact burns are the second most common intentional burn injury
    • Features in the history that are associated with intentional scalds include inconsistent history
    • A single comparative study noted a great proportion of occult injuries in those with intentional scalds
Disclaimer: This is a summary of the systematic review findings from our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

Original reviews and content © Cardiff University, funded by NSPCC

Updates and new material by RCPCH August 2022

While the format of each review has been revised to fit the style of the College and amalgamated into a comprehensive document, the content remains unchanged until reviewed and new evidence is identified and added to the evidence-base. Updated content will be indicated on individual review pages.

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