Genitalia burn: accident or violence? Concerns that transcend injury treatment

OBJECTIVE: To describe a case of genital burn which raised the suspicion of maltreatment (sexual abuse and neglect by lack of supervision).CASE DESCRIPTION: An infant was taken to the Emergency Room of a pediatric hospital with an extensive burn in the vulva and perineum. The mother claimed the burn had been caused by a sodium-hydroxide-based product. However, the injury severity led to the suspicion of sexual abuse, which was then ruled out by a multidisciplinary team, based on the consistent report by the mother. Besides, the lesion type matched those caused by the chemical agent involved in the accident and the family context was evaluated and considered adequate. The patient had a favorable outcome and was discharged after four days of hospitalization. Outpatient follow-up during six months after the accident enabled the team to rule out neglect by lack of supervision.COMMENTS: Accidents and violence are frequent causes of physical injuries in children, and the differential diagnosis between them can be a challenge for healthcare workers, especially in rare clinical conditions involving patients who cannot speak for themselves. The involvement of a multidisciplinary trained team helps to have an adequate approach, ensuring child protection and developing a bond with the family; the latter is essential for a continued patient follow-up.研究目的：报告1例疑似虐待（包括性虐待及监管缺失型忽视）的生殖器烧伤病例。 病例资料：1名婴儿因外阴及会阴部大面积烧伤被送至儿科医院急诊室。患儿母亲称烧伤由氢氧化钠类产品所致，但损伤严重程度引发了性虐待的怀疑。经多学科团队评估，结合母亲的一致性陈述，最终排除了性虐待可能。此外，病变类型与此次事故中涉及的化学制剂所致损伤相符，且经评估家庭环境符合正常养育标准。患儿预后良好，住院4天后出院。事故后6个月的门诊随访证实不存在监管缺失型忽视。 讨论：意外伤害与暴力伤害是儿童躯体损伤的常见诱因，二者的鉴别诊断对医护人员而言颇具挑战，尤其针对无法自主表述的罕见临床病例。由经过专业培训的多学科团队参与评估，有助于制定恰当的诊疗方案，保障儿童权益，并与家属建立信任纽带——后者对于持续随访患者至关重要。