Young, scarred children and their mothers--a short-term investigation into the practical, psychological and social implications of thermal injury to the preschool child. Part I: Implications for the mother

Evaluating effects of burn injury characteristics on quality of life in pediatric burn patients and caregivers

OBJECTIVES

The purpose of this study was to evaluate pediatric burn patients' and caregivers' quality of life (QoL), while identifying clinical characteristics correlated with psychological stress.

METHODS

Pediatric burn patients at an ABA-verified institution from November 2019-January 2021 were included. Caregivers of patients 0-4 years completed the Infant's Dermatology QoL Index (IDQOL). Patients> 4-16 years completed the Children's Dermatology Life Quality Index (CDLQI). The Short Post-Traumatic Stress Disorder Rating Interview (SPRINT) measured caregivers' stress. Generalized linear mixed models evaluated associations between assessment scores and burn characteristics.

RESULTS

Overall, 27.3% (39/143) of IDQOL and 53.1.% (41/96) of CDLQI scores indicated that patients' burns caused moderate to extremely large effects on QoL. In caregivers, 4.5% (7/159) scored> 14 on the SPRINT, warranting further PTSD evaluation. For the IDQOL, each additional 1% TBSA burn was associated with a 2.75-point increase (p = 0.05), and patients sustaining 2nd degree deep partial thickness burns scored an average of 3.3 points higher compared to 2nd degree superficial partial thickness burns (P < 0.01). CLDQI and SPRINT scores demonstrated a similar pattern.

CONCLUSIONS

QoL is impacted in a substantial proportion of pediatric burn patients. Larger TBSA and increased burn depths cause significantly more psychological stress in children, and caregivers may require more extensive psychological evaluation.

Impact of Parental Acute Psychological Distress on Young Child Pain-Related Behavior Through Differences in Parenting Behavior During Pediatric Burn Wound Care

Pediatric burn injuries and subsequent wound care can be painful and distressing for children and their parents. This study tested parenting behavior as a mediator for the relationship between parental acute psychological distress and child behavior during burn wound care. Eighty-seven parents of children (1-6-years-old) self-reported accident-related posttraumatic stress symptoms (PTSS), pre-procedural anxiety, general anxiety/depression symptoms, and guilt before the first dressing change. Parent-child behavior was observed during the first dressing change. Mediation analyses identified three indirect effects. Parental PTSS predicted more child distress, mediated through parental distress-promoting behavior. Parental guilt predicted more child distress, mediated through parental distress-promoting behavior. Parental general anxiety/depression symptoms predicted less child coping, mediated through less parental coping-promoting behavior. Parents with accident-related psychological distress have difficulty supporting their child through subsequent medical care. Nature of parental symptomology differentially influenced behavior. Increased acute psychological support for parents may reduce young child procedural pain-related distress.

Parents' memories and appraisals after paediatric burn injury: a qualitative study

Background: It is well established that a paediatric burn injury can lead to parental post-traumatic stress symptoms. The content of parents' memories and appraisals may reveal the traumatic experiences that need attention. Objective: To inform clinical practice, the aim of this study was to qualitatively examine parents' (intrusive) memories and appraisals, and associated emotions, concerning the injury, the hospitalisation, and its consequences. Method: Approximately three to six months after the burn event, semi-structured interviews were conducted with parents of 18 children (0-16 years old) that had been hospitalised for a burn injury. Thematic analysis was carried out to obtain themes. Results: A central element in parents' memories and appraisals was a sense of external or internal threat. Intrusive memories were predominantly related to the accident and first aid (i.e. threat of the injury), whereas parents' memories about the child's suffering were emotional but not experienced as intrusive. Later appraisals of the burn injury and its consequences included negative appraisals of the child's increased vulnerability, responsibility of self or other, the child's prolonged suffering and (risk of) permanent change, as well as appraisals of positive outcome and recovery. Emotions commonly reported in the context of memories and appraisals were fear, sadness, guilt, and relief. Conclusions: This study offers insight into the traumatic nature of paediatric burn injury from the parent's perspective and provides directions for the delivery of trauma-informed (after)care.

Parent-perceived isolation and barriers to psychosocial support: a qualitative study to investigate how peer support might help parents of burn-injured children

INTRODUCTION

Burn injuries can be traumatic and distressing for the affected child and family, with a prolonged period of recovery. This research explores parents' experiences of support following their child's injury and their thoughts on peer support specifically.

METHODS

Thirteen semi-structured interviews were conducted with parents/caregivers, a mean of three years after their child's injury, either face-to-face or remotely. Responses were analysed using thematic analysis.

RESULTS

Analysis produced four themes and 11 sub-themes. These described parents' experiences of loss, change, isolation and access to psychosocial support. This paper focuses on themes of isolation and parents' access to psychosocial support.

DISCUSSION

Findings indicate that parents access psychosocial support following their child's injury and often find it helpful; however, there is a prevailing sense of isolation. Parents often seek information online and find that this is lacking. Many parents reported that peer support would be valuable to them, particularly the sharing of experiential knowledge.

CONCLUSION

An online resource may be beneficial for parents, but further research is needed to confirm the exploratory data gained to date, ensuring that any resource developed would meet the identified needs of parents.

"This is not just a little accident": a qualitative understanding of paediatric burns from the perspective of parents

PURPOSE

To describe the experiences of parents of children admitted to hospital for a burn.

METHODS

In-depth interviews were conducted with 21 parents (14 mothers and seven fathers) of children who had sustained a burn requiring hospitalisation. Face-to-face interviews were conducted six months post-burn, in rural, remote and metropolitan areas. The interview guide explored the overall experience of parents and included probing questions exploring the perceptions, thoughts and feelings of participants. Interviews were digitally recorded and transcribed verbatim. Transcripts were analysed according to the seven-step Coliazzi method. Relationships between themes were explored to identify core concepts.

RESULTS

Analysis of interview transcripts revealed three phases that describe the parents' journey: experiencing the accident, the in-patient phase and the return to community. Within these phases, themes were identified. Themes represented subthemes of stressors, behavioural and emotional responses and coping factors.

CONCLUSION

Findings from this research will allow health professionals to optimise a holistic clinical service from a consumer's perspective at all stages of the burn journey. These research conclusions could be used for the development of protocols to underpin a comprehensive information and social support management plan for families that would complement and support the surgical, medical and therapeutic treatment plan, providing direction for comprehensive service delivery. Implications for Rehabilitation Health professionals should optimise a holistic clinical service from a consumer's perspective taking into consideration all stages of the burn journey. Therapeutic supports are required to target each phase of the burn journey and address changes in coping strategies and behavioural responses. There is a need for the development of protocols to underpin a comprehensive information and social support management plan for families that will complement and support the surgical and medical treatment plan.

Brief report: mothers' long-term posttraumatic stress symptoms following a burn event of their child

OBJECTIVE

This prospective longitudinal study examines the course of posttraumatic stress symptoms (PTSS) in mothers of children with burns between 1 and 11 years after the burn event and the role of burn severity and feelings of guilt on this course.

METHOD

Self-reported PTSS of 48 mothers were measured with the Impact of Event Scale. Guilt feelings were assessed during an in-depth interview 2 years after the burn event. Eleven years after the burn event, mothers marked their child's scars at the present time on a drawing.

RESULTS

Over a period of 10 years, maternal PTSS decreased. Multiple regression analysis showed that the interaction between guilt and burn severity predicted the course of PTSS.

CONCLUSIONS

Although PTSS substantially decreases through the years, a subset of mothers, in particular mothers who feel guilty about the burn event and whose children have more extensive permanent scarring seem at risk for longer term PTSS.

Psychological rehabilitation of pediatric burn patients

Pediatric burns are devastating injuries, physically and emotionally; however, with progressive medical treatment even with the most severe burns, more burn patients are surviving. This leads to the introduction of a new area of medicine including the psychologic rehabilitation requiring the attention of reconstructive surgeons. Successful psychologic rehabilitation depends on a coordinated interdisciplinary burn care team, family, and the school environment, as well as the child.

Physical and mental health problems in parents of adolescents with burns--a controlled, longitudinal study

OBJECTIVE

Caregiving has been described in the literature as a risk factor for ill health in the carer. This controlled, prospective study examines the course of physical and mental health problems in parents of adolescent survivors of a mass burn incident.

METHODS

Health information was extracted from electronic medical records. Continuous data were available for 1 year before and 4 years after the fire. Cohorts comprised 273 parents of survivors with burns, 199 parents of survivors without burns, and 1756 controls. Post-fire increases in health problems were compared by means of logistic regression.

RESULTS

Parents of burn victims were more likely to present mental health problems during the first 2 years after the incident, when compared to the baseline. Moreover, they were more likely to present cardiovascular health problems in every year following the disaster, compared to the baseline. Increases observed in mental and cardiovascular health problems were significantly larger in parents of burn victims compared to controls. Risk factors for presenting mental health problems were female gender of the parent and a large burn size in the child. Lower socioeconomic status and female gender of the parent predicted cardiovascular health problems.

CONCLUSION

Evidence gained in longitudinal studies informs on which health problems are most likely to develop in parental caregivers. In the interest of both parent and child, a family-oriented approach is proposed.

The psychological sequelae on mothers of thermally injured children and adolescents: future directions: Part 3

Part 3 of this study focused on maternal psychopathology and relationship with their children in three groups, assessed in Parts 1 and 2. Evidence of greater psychopathology in the mothers of burned children was supported by findings of both interview and self-report data, which indicated more symptoms of worry, depression, tension, anxiety, lack of energy, lower self confidence with other people and guilt, compared with mothers of Fracture Clinic and Normal Controls. Marital and social functioning and adverse life events did not differentiate groups, with the exception of a significantly higher divorce rate in the parents of burned children, following thermal injury.

The psychological effects of sex, age at burn, stage of adolescence, intelligence, position and degree of burn in thermally injured adolescents: Part 2

A total of 44 thermally injured children (22 boys and 22 girls), currently aged 11-16 years old, who had been injured 3-14 years previously, stratified by age, sex, degree of burn (1-9%, 10-19%, 20%+) and position of burn (those whose burns included the face and those not burned facially) were selected from a sample pool of 394 previously hospitalized cases. Extent of psychological disturbance experienced by thermally injured adolescents and their mothers indicated that significant effects were evident regarding the sex of the child, age at the time of burn, stage of adolescence, intelligence and by the position and degree of burn.

Posttraumatic Stress Symptoms in Parents of Children with Acute Burns

OBJECTIVE

To develop a model of risk factors for posttraumatic stress disorder (PTSD) symptoms in parents of children with burns.

METHODS

Immediately following the burn and 3 months later, parents reported on their children's and their own psychological functioning and traumatic stress responses.

RESULTS

Approximately 47% of the parents reported experiencing significant posttraumatic stress symptoms 3 months after the burn. Our model indicates three independent pathways to PTSD symptoms (i.e., parent-child conflict, parents' dissociation, and children's PTSD symptoms). Additionally, parents' anxiety predicted increased parent-child conflict, conflict with extended family and size of the burn predicted parents' dissociation, and size of the burn and children's dissociation predicted children's PTSD symptoms.

CONCLUSIONS

This study suggests that many parents of children with burns suffer from posttraumatic stress symptoms. Interventions that target factors such as family conflict, children's symptoms, and parents' acute anxiety and dissociation may diminish the risk for PTSD.

Maternal and child psychological sequelae in paediatric burn injuries

It is a commonly held belief that many children suffer psychological sequelae following burn injury. This six month controlled, prospective, follow up study was designed to investigate psychological sequelae in children and their mothers following paediatric burn injury. The study employed a sample of 40 children with burn injuries, and their mothers with three control groups, each of 40 children and their mothers: an acutely ill group, a fracture group and a non ill/injured group. Measures at initial contact and 6 month follow up included the Child Behaviour Checklist and the Hospital Anxiety and Depression Scale. The results demonstrated higher initial maternal anxiety scores in the burn, compared to the fracture and non ill/injured groups, which remained comparatively high 6 months later even though they decreased over time. Children with burn injuries, of the type included in this study, did not appear to develop significant psychological or behavioural sequelae. Following paediatric burn injury mothers appear to be at higher risk than children for developing psychological sequelae, which may have longer term implications for the child's outcome such as affecting compliance with treatment.

Long-term psychosocial sequelae of paediatric burns

Ninety-one patients burn-injured in their childhood were assessed by mailed interview and clinical re-examination in 1994. On average, the patients had sustained injuries to 11.9 per cent (SD = 8.8) of their TBSA (maximum 50 per cent), the injuries were mainly scalds (90.1 per cent). Nineteen patients (20.9 per cent) remembered the event and 23 (25.3 per cent) remembered their hospitalisation. The hospitalisation vignettes were significantly associated with painful memories among children older than 3 yr (Fisher's exact test P = 0.04). Seventeen patients (18.7 per cent) had recollections of pain during hospitalisation. They had been confined for an average of 30.9 days. Twenty-one patients (23.1 per cent) had a fear of hot water and fire, and 39 (42.9 per cent) were cautious. The median age at the time of admission was 1.7 yr. The re-examined patients had good school marks and their rate of educational qualifications did not differ from the Finnish national average. No less than one fifth (20.8 per cent, N = 11) had some difficulties with contact with the opposite gender in their adolescence but only one had difficulties later. Fifty-five patients (mostly female, chi 2 = 13.06, DF = 2, P < 0.01) expressed annoyance at their scars, but no more than one third (N = 17) kept them covered continuously. Only five (5.5 per cent) with visible scars had no memories or special psychosocial sequelae. Almost everyone burn-injured in childhood will have some memories of burn care as an adult. However, the negative psychosocial sequale are modest after the typical paediatric burns, scalds, in early childhood.