The current study describes the epidemiology and patterns of moderate to severe childhood burn injuries in the Western Cape province in South Africa. Burn injuries sustained by children aged 12 years and younger and registered over January 1999 to December 2000 at the Red Cross Children's Hospital in the Western Cape are analysed (n=1201). Differences in risk distribution between different segments of the population are measured and typical injury patterns are identified. The results show that burn injury incidence is particularly high for toddlers (15.8/10000 child-years/c-y) and infants (14.6/10000 c-y) for boys (7.0/10000 c-y), and for African children (11.4/10000 c-y). Burn injury incidence is highest in winter (1.7/10000 c-y) but only significantly greater than the rate in summer (1.3/10000 c-y). Further, four burn injury patterns are identified, and labeled 'infant scalding', 'toddler scalding', 'injuries among older children with an over-representation of flame-related burns' and 'other causes of burns sustained to the head and neck region'. In sum, the risk of burn injury is higher in younger children. Differences between genders were more pronounced among younger and older age groups. Differences between population groups are more important in magnitude than in nature. The patterns identified can stimulate further research and development into the household product and environmental contributors to childhood burn injury.