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
 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
 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