Immersion scald burns and the ability of young children to climb into a bathtub

Introduction. Immersion scald burns in children are often suspicious for neglect or abuse. The history that a child climbed into a tub previously filled with hot water by the parent is common. The child's ability to climb into such a tub is a major factor in determining the reliability of the history. Methods. A standard bathtub was installed in an examination room at a pediatric clinic in a children's hospital. Foam mats were placed in and outside of the tub. Toy boats were placed in the back of the tub. Children were selected if they were between 10 and 18 months of age, born at term, and had no past or present medical condition that could be expected to have affected their fine or gross motor or central nervous system development and had a normal Denver Developmental Screening Test within the past 3 months. The parent placed the child in a standing position with the child holding onto the front of the tub. Parents encouraged the child to climb into the tub and get the toys. The child's efforts were videotaped. Children were allowed 5 minutes to climb, depending on their attention span and tolerance. Results. Of 176 children in the study, 62 (35%) climbed into the tub. One fourth climbed in head first, and the rest climbed in sideways. Conclusions. Our study may have underestimated children's climbing abilities because of the absence of a shower curtain to help with balance and the distracting presence of strangers. The diagnosis of abuse is in part based on a described mechanism being inconsistent with the observed pattern of injury. This has severe repercussions for the child and his or her family. Our study brings into question previously held beliefs that these injuries could only be sustained by direct immersion.