Pediatric Burns
Epidemiology
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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
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Thermal
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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., 20% are household scalds
bathing, spills)
95% occur indoors
60% occur outdoors
Most play is indoors
Increased experimentation
Increased responsibilities for
outdoor chores
Key Concepts
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TBSA = % of Total Body Surface Area
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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
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Based on depth of burn injuries
1st degree: damage to epidermis
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2nd degree: damage to dermis
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Heals in ~2-5 days with peeling; minimal scarring
Partial thickness
Heals in ~ 1-3 weeks with no grafting
3rd degree: damage to multiple layers including
subcutaneous tissue
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Full thickness
Heals in ~3-5 weeks; requires grafting
Layers of Skin
Degrees of Burns
Medical Management:
Emergency Phase
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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
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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
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Surgical procedures
Physical therapy
Nutritional concerns
Pressure garments
Psychological Issues:
Injury Occurrence
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Child abuse
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Child neglect
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Scalds from immersion in hot water
Neglect vs accident?
Socioeconomic status
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Substandard housing
Lack of basic resources (e.g., outlet covers)
Higher rates of child/parent psyc disorder
Psychological Issues:
Acute Phase
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Pain Management
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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
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PTSD symptoms (e.g., sleep disturbance)
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Normalize
Enhance safety
Encourage telling of narrative
Exposure to trauma-related cues
Nutritional intake
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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
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Adherence to treatment procedures
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PT/OT exercises
Pressure garment use
Wound care (cleansing, debriding)
Skin care (lotions, sunscreens)
Body image considerations
Disruptive behavior
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Behavioral interventions
Re-establish routines
Psychological Issues:
Rehabilitation Phase
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Psychological adjustment
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Negative peer and social reactions
Body image concerns
Coping with losses
School re-entry
Prevention!
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Modify devices
Education
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Safe-proof the home
Increase awareness
Psychological Issues: Reading
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Landolt et al., 2002
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Quality of Life in burn victims