Which scenario would most strongly raise concern for non-accidental trauma in an infant?

• A. A 4-month-old with a clean medical history
• B. An infant with bilateral circumferential burns from a tub immersion in hot water
• C. An adolescent with a single minor injury
• D. A toddler with a small laceration

Answer: (B)

Patterned injuries that reveal the mechanism are especially concerning in infants. A burn from hot-water immersion that is bilateral and circumferential strongly suggests someone forcibly holding the child in hot liquid, rather than an accidental slip. The telltale signs include a uniform depth around the entire limb, a distinct water-line or crisp margins, and often sparing of the natural skin creases where the body wasn’t fully immersed. The symmetry and consistent burn pattern in an infant are powerful red flags for non-accidental trauma. In contrast, the other scenarios involve injuries or histories that are less suggestive of abuse in an infant, such as a clean history with a single issue in a older child or a minor injury in a toddler.