Burns in young children may be missed sign of abuse

NEW YORK (Reuters Health) - Burns in young children are a potential warning sign of abuse and neglect, but the risk can initially go unrecognized, a UK study finds.

In a follow-up of 145 children who were hospitalized for burns before the age of 3, researchers found that, by age 6, one-third of the children were referred to social services because of concerns for their welfare. Meanwhile, almost 10 percent were placed in protective services because of abuse or neglect.

Yet, at the time of the initial burn injury, just under 3 percent were judged to be "non-accidental."

The implication is that doctors and social services initially missed some burns that were inflicted purposely or resulted from neglect, according to study co-author Dr. Michelle James-Ellison, of Abertawe Bro Morgannwg University NHS Trust in Wales.

It can be difficult even for experienced doctors to determine whether a child's burn is accidental or not, James-Ellison told Reuters Health in an email. She added that is it particularly hard to know when the burn is a product of general neglect -- rather than, for instance, an isolated instance of inadequate supervision.

"Professionals recognize children who are suffering harm from neglect when the pattern of parenting is persistently or recurrently inadequate," James-Ellison said. "Sadly, this may mean that neglect is picked up only after further injury or harm."

The study, published in the Archives of Disease in Childhood, included 145 children younger than 3 who were admitted to the same Welsh burn unit between 1994 and 1997. They were followed until the age of 6, and each was compared with a "control" child of the same age, sex and area of residence who was not admitted for burns.

At the time of the injury, 89 percent of the children were thought to have suffered an accidental burn, while four children -- less than 3 percent -- were believed to have suffered a burn due to abuse or neglect.

During the follow-up period, however, 10 percent of the children were eventually referred to protective services because of abuse or neglect, versus just over 1 percent of children in the control group.

Similarly, one-third of the children with burns were eventually referred to social services as being "in need," compared with 18 percent of the control group.

James-Ellison said that more work is needed to figure out how health professionals and social agencies can better separate cases of accidental burns from those stemming from abuse or neglect.

For now, the researchers write, burns in young children could be seen as an indication that a child's health and well- being need to be monitored over time.

SOURCE: Archives of Disease in Childhood, September 2009.