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Q: Child abuse ( Answered,   1 Comment )
Subject: Child abuse
Category: Health
Asked by: brewton-ga
List Price: $25.00
Posted: 11 Jun 2004 14:15 PDT
Expires: 11 Jul 2004 14:15 PDT
Question ID: 359854
I am looking for an illustration of a child being lowered into a
bathtub to show how an immersion burn injury with "sparing" is caused
by child abusers.
I have seen one on the web, but I cannot find it again. The child
curls his or her feet to "spare" the body from inury.
Subject: Re: Child abuse
Answered By: czh-ga on 13 Jun 2004 04:27 PDT
Hello brewton-ga,

I?ve found several valuable resources that discuss the various methods
of child abuse, including burning by immersion and the associated
phenomenon of sparing. Some of these documents are extremely graphic
even though they don?t contain any illustrations. Several of these
articles are guidelines for helping social workers and medical
professionals distinguish between intentional and unintentional burn
injuries and they contain illustrations. I don?t know if I?ve found
the exact image you had seen before but I believe the ones I?ve
collected will help you illustrate the sparing you describe.

This was a difficult project because some of the descriptions and
images are horrific. I hope that you will find them useful and that
your project is dedicated to preventing and/or alleviating the harm
caused to young children.

Wishing you well for your work.

~ czh ~
Medical Evaluation of Physical Abuse ? Children?s Hospital, San Diego

Burns ? Pages 54 ? 80
Forced Immersion ? Pages 75 ? 79

***** This is a 94-page PPT presentation with some horrific
illustrations. I?m not sure that any of them illustrate ?sparing? as
effectively as you hope but the immersion photos are very graphic.

Recognition and Management of Child Abuse

Donut Sign: Sparing of the bottom of the buttocks occurs when the
child is forcefully held in a tub of hot water. The spared area of
skin, not burned because it was in contact with the bottom of the tub,
looks like a donut hole surrounded by a donut of scalded skin. This
clinical finding is clear evidence that the child did not climb into
the tub of scalding water voluntarily.

Zebra Sign: Skin at the bottom of skin folds in the groin, knees or
other areas may not be burned when the surrounding body part is
immersed in hot water. This may result in linear areas of normal skin
resembling the stripes of a zebra within larger areas of scalded skin.

Stocking and Glove: This variant of the immersion burn involves the
hands or feet. The entire hand or foot is burned circumferentially,
again with a clearly defined upper limit of demarcation. The care
provider will generally claim that the child burned himself
accidentally by putting his hand in some water, not realizing it was
hot. (Figure 4) Children, however, have good protective reflexes, and
do not voluntarily immerse their hands or feet in scalding hot water.

Figure 4. This child was said to have immersed his hand in scalding
hot water. Note the clearly defined upper limit of demarcation of the
burn and the fact that, although the entire hand was immersed, only
the dorsum has blistered.

***** This is a small, black and white illustration.

US Department of Justice -- National Criminal Justice Reference Service

Burn Injuries in Child Abuse

Immersion Burns ? Pages 8 - 9

When a child?s hand is forced into hot water, the child will make a
fist, thus ?sparing? the palm and discounting the statement that the
child reached into the pan of hot water for something. A child whose
body is immersed in hot water will attempt to fold up, and there will
be sparing in creases in the abdomen. Curling up the toes when the
foot is forced into hot liquid will spare part of the soles of the
feet or the area between the toes. The area where the child was held
by the perpetrator will also be spared. These flexing actions prevent
burning within the body?s creases, causing a striped configuration of
burned and unburned zones, or a ?zebra? pattern.

Deliberate immersion burns can often be recognized by one of the
following characteristic patterns: (see page 9)

***** This is a 24-page pamphlet. It does not have any illustrations
but the descriptions are very graphic.

Child Abuse & Neglect: Physical Abuse

Burn patterns that may suggest physical maltreatment include the following:
 -- Patterned burns 
 -- Classic forced immersion burn pattern with sharp stocking and
glove demarcation and sparing of flexed protected areas
 -- Splash/spill burn patterns not consistent with history or developmental level 
 -- Cigarette burns
Caption: Picture 16. Child abuse & neglect: physical abuse. Burn from
being held down on hot cement. Image courtesy of Lawrence R. Ricci,

CHILD ABUSE: Investigation
PPT Presentation

***** See Burns ? Slides 29 ? 44
Slide 35 ? Immersion burn illustration
Slide 36 ? Illustration of sparing
Slide 37 ? Immersion burn on hand
Slides 43 - 44 ? Immersion burn on legs

Child Abuse and Neglect Investigation 
Basic Training - Recruit Academy

Child Abuse ? First Degree ? illustrations (see Scalding) 


burns areas of sparing
scalding with sparing
burns with sparing
forced immersion burn pattern

Request for Answer Clarification by brewton-ga on 14 Jun 2004 07:32 PDT
Thanks, but I already found most of these or sites similar to them. 
The illustrations are not what I am looking for.
The specific immersion illustration I am looking for is a drawing
showing a child being lowered into water, the child's legs are pulled
up to the buttocks, the feet are curled up to "spare" the feet from
burn.  The burn pattern shows that the sides and bottoms of the feet
are spared.  If the child's legs and feet were completely lowered into
the water, the sides and bottoms of the feet would be burned.  It also
shows that the buttocks and genitals are burned, but the thighs are
not burned because they are not lowered into the water.  The
illustration also shows that the burn on the calfs is at an angle, not
horizontal across the calfs.

Clarification of Answer by czh-ga on 14 Jun 2004 09:43 PDT
Hello again brewton-ga,

I?m sorry that none of the information I found meets your needs. It
was not clear from your original question that you were looking for
the one and only specific example of sparing that you describe in your

Can you please tell me more about where you had found the
illustration? Can you remember what organization or publication might
have been the source? I?ve spent a lot of time finding the
illustrations I provided in my answer and I don?t think I?ll be able
to find anything else without further details from you about the
possible sources for the drawing you?re describing. I look forward to
your clarification.

~ czh ~

Clarification of Answer by czh-ga on 14 Jun 2004 10:00 PDT
Hello again brewton-ga,

I believe the last link I gave in my original answer is the
illustration you?re looking for. It?s under Child Abuse First Degree,
about half way down the document. The illustration on the top right
shows a child being lowered into water with legs pulled up and the
feet curled. The effects of the sparing are also illustrated.

Please take another look at this drawing. Thanks.
Child abuse First Degree

~ czh ~

Request for Answer Clarification by brewton-ga on 14 Jun 2004 11:28 PDT
Thank you for the clarification and I am pleased with what you found.
  However, the reason I hired you is that I cannot find that site
again.  My searches have used the same key words.  I may have added
water also or bathtub just to see what else came up.  The illustration
was a simple black and white drawing like the illustrations in
instruction manuals.  It shows exactly what happened to little Justin.
 If I can't find it again, I will have to hire someone to draw it for
me to show how the burn pattern matches this immersion and that he did
not climb into the tub.

Clarification of Answer by czh-ga on 14 Jun 2004 12:21 PDT
Hello brewton-ga,

Thank you for the clarification. I?m sorry that the illustration of
burning by immersion and the associated sparing is not the specific
picture you?re looking for.

Thank you for the detail that the illustration you remember was a
black and white line drawing. I?m confused about your statement that,
?It shows exactly what happened to little Justin.? Does this mean that
the illustration was for a specific case involving a child named
Justin? Or, are you involved in some way with the case of a child
named Justin and you need to illustrate the injuries suffered by this

Again, it would help if you could tell me ANYTHING about where or how
you previously found the illustration you?re searching for. What kind
of website was it ? educational institution, professional or consumer
advice, case documentation, etc.? Any additional details you can
remember might be helpful. Thanks.

~ czh ~

Request for Answer Clarification by brewton-ga on 14 Jun 2004 13:42 PDT
Dear czh:
I am an attorney who represents a foster child (age 1 1/2) who
suffered an immersion burn by his foster parents.

I know the whole subject is gross.  I was much happier not knowing
that adults do this to kids on a regular basis.

When I first started the case, the question was whether it was an
accident or intentional.  Stupidly, in one of my early searches, I
found the illustration which shows exactly what happened.

Generally, my searches have been in the area of educational/medical to
identify what is and what is not child abuse.  As you have read, if it
is accidental there will be a splash pattern.  If it is immersion,
there will be a clear burn line.  Justin's are angled on his calf and
on his bottom and penis.  I couldn't figure this out until I saw the
illustration showing an immersion with the legs tucked under.

As stated, this illustration was important becauses I have photographs
of his injuries(that will make you cry) which match the illustration.

At any rate, I moved on to other searches, and thought I could find
the illustration again.  Now, I can't.  Thus, I turned to a
professional searcher.

If you can't find anything more, thanks for your help.  I'll get
someone to draw it or I'll get a doll and use the "blue dye"
demonstration to show that the dyed area matches the burn pattern on
the child.

Thanks again.

Clarification of Answer by czh-ga on 14 Jun 2004 15:06 PDT
Dear brewton-ga,

Thank you for the further clarification. I hate to report that I
haven?t been able to find the drawing your looking for. Like you, I
was shocked by the gruesome pictures that I got in response to my

I understand how frustrating it is to not be able to find something
that you recall very clearly. I have been through this myself and
occasionally have been able to find the resource by going through the
history of my searches. The possibility of doing this depends on how
long ago you conducted your successful search and how often you empty
your history/cache files. If it?s not too long ago I suggest that you
open your History window and browse through the links listed there. If
you?re very lucky you will be able to find the link.

I?m sorry that even with multiple hours of searching I haven?t been
able to find the picture you need. I hope that little Justin has
recovered from his injuries. I wish you success with your case.

~ czh ~
Subject: Re: Child abuse
From: vik1981-ga on 13 Jun 2004 17:02 PDT
Medical Evaluation of Physical Abuse ? Children?s Hospital, San Diego

I thought this slideshow was an excellent resource that gave a broad
overview of the topic at hand. However, the photos were somewhat
ruined in conversion to pdf I believe.

A very thorough answer answer czh!

The last link: Child Abuse I think is exactly what brewton wanted.
? First Degree ? illustrations (see Scalding)

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