Sock burns on both feet of a child most strongly suggest which of the following concerns?

• A. Maltreatment
• B. Accidental burn
• C. Infection
• D. Frostbite

Answer: (A)

Burns that create a stocking-like pattern across both feet point most strongly to non-accidental injury from forced immersion in hot liquid. When a child is held and submerged, the area that was submerged takes on a uniform depth with a clear boundary where the liquid level was, often producing identical, symmetrical burns on both feet. This symmetry and the well-defined pattern are unusual for an accidental spill, which tends to be irregular, with splash marks or uneven depth, and more likely to involve one limb than both feet. Frostbite presents differently, usually related to cold exposure with color and sensation changes rather than a precise, uniform “sock” burn. Infections don’t create this type of burn pattern either. Because this presentation is a red flag for maltreatment, it’s important to follow mandated reporting protocols and pursue a thorough assessment for additional injuries while ensuring the child’s safety.