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as demonstrated by the physician or nurse in the ED. Burns should be
examined by a physician every 2 or 3 days until healing is well underway.
Large burns or burns of the hands, feet, perineum, or overlying joints that
are managed as an outpatient should be referred to a burn specialist and
evaluated in follow-up more frequently. Prophylactic antibiotics are not
recommended.
Minor partial-thickness burns can be expected to have epithelial healing
in 7 to 14 days.

SPECIAL CIRCUMSTANCES
Goals of Treatment
Certain types of burns require special attention. Clinicians should remain
alert to historical and/or physical examination findings which suggest
inflicted burn injuries, electrical injuries, and/or chemical burns. Each of
these burns warrants additional workup and specific treatment.

Inflicted Burns
Child abuse must be considered in patients with specific patterns of burn
injury. Between 10% and 20% of burns in children are inflicted, accounting
for 10% of child abuse cases. Most inflicted burns are scalds. Forced
submersion of the hands or feet often causes burns that are deep, have a
clear line of immersion, and are symmetric. Scald burns of the buttocks and
thighs in toddlers are frequently the result of forcible submersion in a tub of
hot water. Scald burns usually have scattered splash lesions. In burns from
spilled hot beverages, there is often a pattern of injury spreading downward
from the falling liquid. Inflicted contact burns also have characteristic
patterns. Small, round, deep burns result from cigarettes intentionally
applied to the skin. A deep wound with a geometric pattern and sharply
demarcated borders suggests a contact burn. Deep injuries with distinctive
patterns may also be noted in children held against portable heaters or
burned with irons.

In many children with inflicted burns, the pattern of injury is nonspecific
and a history of abuse is not offered. Physicians should make a judgment
whether the characteristics of a burn correspond with the reported