Non-accidental burns in a neurodevelopmentally vulnerable child: A case of institutional child abuse

Abstract

Paediatric burns may result from accidental or non-accidental mechanisms, with diagnostic challenges arising when histories suggest dubious accidental causes. We report an 8-year-old boy, placed in a local temple due to longstanding behavioural difficulties, who sustained burns reportedly from hot water spillage. Examination revealed deep burns affecting the left face and neck, lower back, buttocks, perineum and posterior thighs. The distribution and severity were inconsistent with the reported explanation, raising suspicion of non-accidental injury. Multiple facial angiofibromas prompted multidisciplinary assessment, leading to a new diagnosis of tuberous sclerosis, a neurocutaneous disorder associated with cognitive and behavioural impairment. Child protection investigations later identified evidence of abuse within this institutional setting. This case highlights the importance of recognising burn patterns suggestive of non-accidental injury, particularly in children with previously undiagnosed neurodevelopmental disorders, and the critical role of multidisciplinary evaluation and safeguarding in institutional care settings.