1. Pediatric Burns

2. 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

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

4. Household Burn Risks
Kitchen
Living Room
Bathroom
Garage/Outdoors

5. 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

6. 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

7. 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

8. Layers of Skin

9. Degrees of Burns

10. 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

11. 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

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

13. 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

14. 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

15. 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

16. 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

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

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

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