A 16-month-old boy was brought unresponsive to the hospital. His mother reported that soon after she put him to sleep, she found him ‘stiff as a board’ and unable to be awakened. Later, the mother added that the child fell from a single step and injured his head. The mother also stated that 2 days prior to admission, she was in the bathtub with the child when he accidentally turned on the hot water and burned his face. She did not seek medical care at that time. https://s3-euw1-ap-pe-df-pch-content-public-u.s3.eu-west-1.amazonaws.com/9780429170423/236ca68c-f283-4df8-88b2-3b8ff49bccc9/content/fig5a.jpg" xmlns:xlink="https://www.w3.org/1999/xlink"/> https://s3-euw1-ap-pe-df-pch-content-public-u.s3.eu-west-1.amazonaws.com/9780429170423/236ca68c-f283-4df8-88b2-3b8ff49bccc9/content/fig5b.jpg" xmlns:xlink="https://www.w3.org/1999/xlink"/>

What do the images show?

What tests and imaging are important to further evaluate the aetiology of this injury?

This child has an 8% burn on his scalp with a finger-like pattern on the left side of his face (Image 5a). The burn is well demarcated over his forehead and the top of his head as shown in Image 5b. This pattern is compatible with a head-first, scalp-down sink immersion burn. 1 The handprint on the left side of the face matched the baby’s hand.

Given the likelihood of inflicted trauma, full imaging of the axial skeleton using a skeletal survey was indicated as well as head imaging especially considering his neurologic status. His skeletal survey showed a proximal humeral fracture with no explanation. His head MRI scan showed subdural haemorrhages and hypoxic-ischaemic brain injury. His funduscopic exam showed retinal haemorrhages. This child succumbed to his head injuries. It is important to evaluate patients with suspected abuse for other types of abuse as there may be many different kinds of abusive injuries in the same patient.