Pediatric Burns

Epidemiology 1,000,00 pediatric burn injuries each year Preschoolers are >50% of pediatric burns 3rd leading cause of death in youth Due to medical advances, children now routinely survive massive burns But, little research is devoted to the psychological aspects of pediatric burns

Types of Burn Injuries Thermal Radiation Chemical Electrical Scald Flame Radiation Chemical Electrical

Household Burn Risks Kitchen Living Room Bathroom Garage/Outdoors

Developmental Trends Infants and Toddlers Adolescents 75-90% are scald burns (I.e., bathing, spills) 20% are household scalds 95% occur indoors 60% occur outdoors Most play is indoors Increased experimentation Increased responsibilities for outdoor chores

Key Concepts TBSA = % of Total Body Surface Area Using standard charts displaying dorsal (back) and ventral (front) views for the body Heat intensity and duration of skin contact determine the extent and depth of skin damage

Degrees of Burn Injuries Based on depth of burn injuries 1st degree: damage to epidermis Heals in ~2-5 days with peeling; minimal scarring 2nd degree: damage to dermis Partial thickness Heals in ~ 1-3 weeks with no grafting 3rd degree: damage to multiple layers including subcutaneous tissue Full thickness Heals in ~3-5 weeks; requires grafting

Layers of Skin

Degrees of Burns

Medical Management: Emergency Phase Remove source of heat Apply first aid Assess for and treat shock Evaluate breathing (inhalation injury) Use CPR at scene, if necessary Fluid resuscitation – to correct electrolyte imbalance and decreased blood volume

Medical Management: Acute Phase Goal: close the wound Reduce infection risk Remove eschar (dead skin) by debridement Apply topical dressings Use physiological dressings to reduce fluid and heat loss Perform autografting surgery Use tissue-cultured skin as last resort

Medical Management: Rehabilitation Phase Surgical procedures Physical therapy Nutritional concerns Pressure garments

Psychological Issues: Injury Occurrence Child abuse Scalds from immersion in hot water Child neglect Neglect vs accident? Socioeconomic status Substandard housing Lack of basic resources (e.g., outlet covers) Higher rates of child/parent psyc disorder

Psychological Issues: Acute Phase Pain Management Burns are among most painful injuries Patients experience long periods of severe pain Burn wound pain tends to be resistant to pharmacological management Numerous aversive medical procedures

Psychological Issues: Acute Phase PTSD symptoms (e.g., sleep disturbance) Normalize Enhance safety Encourage telling of narrative Exposure to trauma-related cues Nutritional intake Burn patients require high fluid and caloric intake that body needs to repair wound Food refusal and poor dietary intake are common problems Behavioral interventions to increase food intake

Psychological Issues: Acute Phase Adherence to treatment procedures PT/OT exercises Pressure garment use Wound care (cleansing, debriding) Skin care (lotions, sunscreens) Body image considerations Disruptive behavior Behavioral interventions Re-establish routines

Psychological Issues: Rehabilitation Phase Psychological adjustment Negative peer and social reactions Body image concerns Coping with losses School re-entry

Prevention! Modify devices Education Safe-proof the home Increase awareness

Psychological Issues: Reading Landolt et al., 2002 Quality of Life in burn victims