Which burn pattern is most strongly associated with abuse?

• A. A single burn on the arm
• B. Bilateral burns to feet, hands, and buttocks
• C. A sunburn on the back
• D. A small scald on the leg

Answer: (B)

Burn patterns that are symmetric and involve multiple distal areas are a strong clue for nonaccidental injury. When burns appear on both feet, both hands, and the buttocks, it suggests the person was restrained and exposed to heat—often from immersion in hot liquid or forced contact with a hot surface. Immersion burns, in particular, tend to produce uniform depth and clear margins with a bilaterally symmetric distribution, reflecting controlled exposure rather than an accidental, single-event burn.

In contrast, accidental burns are usually unilateral, irregular, and tied to a specific incidental contact, and sunburn is from sun exposure and tends to be more generalized rather than a precise, paired pattern on different body parts. A small, isolated burn on a leg fits that pattern less well.

So, the pattern described—burns on both feet, both hands, and buttocks in a symmetric distribution—fits best with abuse because it implies one person intentionally restrained or held the individual during heat exposure, creating a consistent, multi-site, bilateral burn pattern.