1. Pediatric Burn Injuries: Why the Best Treatment is Prevention Karen J. Tien, Ph.D. 5/5/14

2. Overview The pediatric injury problem The pediatric injury problem Leading types Leading types Prevention models & strategies Prevention models & strategies Pediatric burn injuries close up: Pediatric burn injuries close up: Problem scope Problem scope Characteristics Characteristics Developmental trends Developmental trends Medical management Medical management Psychological issues & interventions Psychological issues & interventions Case vignettes Case vignettes Resources Resources

3. Pediatric Injury Morbidity, Mortality, & Cost Morbidity in U.S. Morbidity in U.S. 20 million + nonfatal injuries/ year 20 million + nonfatal injuries/ year 300,000 + hospital admits/ year 300,000 + hospital admits/ year 50,000 permanent disabilities in 0-14 year olds/ year 50,000 permanent disabilities in 0-14 year olds/ year Psychological impact Psychological impact Mortality in U.S. 16,000 deaths/ year #1 cause of death Exceed all other causes combined Cost in U.S. $347 billion/ year

4. Leading Types of Child Injuries InfantsToddlers School-aged Children Adolescents Suffocation F MVC F Fall Drowning F Fire/burn (often scald) Fire/burn F (often scald) Fire/ burn F DrowningFallFall Poisoning Bicycle/ pedestrian F = injuries that account for the most injury-related fatalities for a particular age group.

5. A Model of Child Injury

6. Injury Prevention Strategies Active vs. passive Active vs. passive Behavioral Behavioral Environmental Environmental Legislative Legislative

7. Say Yes to Helmets!

8. Pediatric Burns: Extent of the Problem Morbidity in U.S. Morbidity in U.S. 120,000 ER visits/ year 120,000 ER visits/ year 100,000 scald burns/year 100,000 scald burns/year 40,000 hospitalizations/year 40,000 hospitalizations/year Mean hospital stay: 17 days (moderate-severe burn) Mean hospital stay: 17 days (moderate-severe burn) 10,000 permanent disabilities/year 10,000 permanent disabilities/year Mortality in U.S. 3 rd leading cause of unintentional death 1461-2500 deaths/year Cost in U.S. 1985: $3.5 billion; 101,000 life years lost 2007: $1.3 billion for scalds in 0-4 year olds Mean hospital stay: $42,500 (moderate-severe burn)

9. Characteristics of Burn Injuries Types Types Thermal, chemical, electrical, radiation Thermal, chemical, electrical, radiation Degrees Degrees 1st, 2nd, & 3rd 1st, 2nd, & 3rd Other markers Other markers % total body surface area (TBSA) % total body surface area (TBSA) Intensity Intensity Duration Duration

10. Developmental Trends with Burns Infants & Toddlers School-agedChildrenAdolescents 75-90% scalds Mostly thermal from matches, lighters, cooking tools 20% scalds; more from experimentation with hazards 95% indoors 60% outdoors

11. A Parent-Supervised Bath!

12. Photo 1: Scald Burn

13. Photo 2: Contact Burn

14. Burn Medical Management: Emergency Phase Emergency phase Emergency phase Remove heat source Remove heat source Apply first aid Apply first aid Evaluate & treat shock Evaluate & treat shock Assess respiration (e.g., inhalation injury) Assess respiration (e.g., inhalation injury) Apply CPR as needed Apply CPR as needed Begin fluid resuscitation Begin fluid resuscitation

15. Burn Medical Management: Acute Phase Aims Aims Close the wound Close the wound Prevent infection (e.g., sepsis ) Prevent infection (e.g., sepsis ) Procedures IV insertions Escharotomy Debridement Dressing changes Autografting Physiological dressings

16. Burn Medical Management: Rehabilitation Phase Surgical procedures Surgical procedures Ongoing grafts Ongoing grafts Releases Releases Regimens Regimens Increased caloric intake Increased caloric intake Physical therapy Physical therapy Pressure garments Pressure garments Follow-up medical visits Follow-up medical visits Reconstructive operations Reconstructive operations

17. Video

18. Psychological Outcomes of Pediatric Burn Injuries Research is mixed Research is mixed Acute psychological distress for most kids & families Acute psychological distress for most kids & families Long-term psychological difficulties for substantial subset of youth & families Long-term psychological difficulties for substantial subset of youth & families What differentiates children with good adjustment from those with poor adjustment? What differentiates children with good adjustment from those with poor adjustment?

19. Psychological Considerations I Abuse Abuse Neglect Neglect Family/ home chaos Family/ home chaos Prevention Prevention

20. Burn Safety Knowledge Quiz 1. What is the best first response to a burn injury?  Remove heat source, remove clothing if over burn, apply cool water, seek medical attention 2. What is the highest temperature that one should set his/her hot water tank at to be below scalding for young children?  120 degrees F 3. What is the best thing to do if one’s frying pan (with grease/ oil inside) catches on fire?  Cover it with a lid

21. Psychological Considerations II Mental status Mental status Pain/ distress Pain/ distress Procedural Procedural Healing-related Healing-related Anticipatory anxiety Anticipatory anxiety Stress Stress Trauma reaction Trauma reaction

22. Psychological Considerations III Intense itching Intense itching Disruption in routines Disruption in routines Developmental regression Developmental regression Nonadherence to procedures/ regimens Nonadherence to procedures/ regimens Disruptive behavior Disruptive behavior

23. Psychological Considerations IV Guilt Guilt Grief over losses Grief over losses Family, friends, pets, possessions, home Family, friends, pets, possessions, home Body image concerns Body image concerns Loss of function Loss of function

24. Psychological Considerations V Relationship difficulties Relationship difficulties Depression Depression School & society re-entry School & society re-entry

25. Psychological Considerations VI Sleep disorders Sleep disorders Death/ dying Death/ dying

26. Family Protective Factors Cohesiveness Cohesiveness Organization Organization Effective communication Effective communication Conflict resolution skills Conflict resolution skills Social support Social support Financial resources Financial resources Active coping style Active coping style Achievement orientation Achievement orientation

27. Delivery of Psychological Services through a Burn Trauma Center Where Where Burn Unit (inpatient) Burn Unit (inpatient) Burn Clinic (outpatient) Burn Clinic (outpatient) Interdisciplinary case conferences Interdisciplinary case conferences Burn Camp Burn Camp Who Patients Families Staff

28. Case Vignettes for Discussion

29. Recap: Why Is the Best Treatment Prevention? Burn injuries contribute significantly to childhood mortality & morbidity Burn injuries contribute significantly to childhood mortality & morbidity Treatment often is extremely painful Treatment often is extremely painful Double trauma Double trauma Acute distress for child & family Acute distress for child & family Long-term physical & psychosocial difficulties for a substantial subset of pediatric burns Long-term physical & psychosocial difficulties for a substantial subset of pediatric burns Exorbitant financial costs Exorbitant financial costs

30. Burn Prevention Resources The American Burn Association The American Burn Association www.ameriburn.org www.ameriburn.org The Burn Institute The Burn Institute www.burninstitute.org www.burninstitute.org www.burninstitute.org Safe Kids Worldwide Safe Kids Worldwide www.safekids.org www.safekids.org The American Academy of Pediatrics The American Academy of Pediatrics www.healthychildren.org/English/Safety- prevention/pages/default.aspx www.healthychildren.org/English/Safety- prevention/pages/default.aspx The CDC The CDC www.cdc.gov/safechild www.cdc.gov/safechild

31. Thumbs Up for Safety!

32. Alternate Burn Video (Back-Up)