With a water temperature of 145 degrees or greater, an almost instantaneous full-thickness burn will occur. With a water temperature of 130 degrees, it takes approximately 30-45 seconds. Contact burns from a hot metal object or cigarette are another type of burn seen with child abuse. Head injuries are the most common cause of death from child abuse. In 1946, Dr. John Caffey reported six children who had chronic subdural hematomas in association with multiple fractures of the peripheral skeleton.
Abdominal injury is the second most common cause of death among battered children.
Ruptures of the spleen, liver or bowel caused by a punch or kick can result in the above with no visible bruises or marks on the abdomen in over half the cases. Rupture of the bladder may also occur. A child who presents with multiple fractures at multiple sites and in various stages of healing should be considered abused until proven otherwise. Epiphyseal-metaphyseal injury is virtually diagnostic of physical abuse in an infant, since an infant cannot generate enough force to fracture a bone at the epiphysis. Fractures secondary to abuse are more commonly seen in children less than 3 years of age.