“I just get scared it’s going to happen again”: A qualitative study of the psychosocial impact of pediatric burns from the child’s perspective

doi:10.21203/rs.3.rs-2482695/v1

Download PDF

Research Article

“I just get scared it’s going to happen again”: A qualitative study of the psychosocial impact of pediatric burns from the child’s perspective

https://doi.org/10.21203/rs.3.rs-2482695/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 05 Jun, 2023

Read the published version in BMC Pediatrics →

You are reading this latest preprint version

Background

Advances in medicine have improved the chances of survival following burn injuries, however, psychosocial outcomes have not seen the same improvement, and burn injuries can be distressing for both the child or young person, negatively affecting their wellbeing. Pediatric burn patients are at a higher risk of developing psychopathology compared to the general population. In order to promote resilience and prevent psychopathology post-burn injury for pediatric burn patients, it is crucial to understand the experience of children and young people after a burn. This study aimed to understand the psychosocial impact that a pediatric burn has as perceived by the pediatric burn patient.

Methods

Seven pediatric burn patients were interviewed from the Perth Metropolitan area on average 3.1 years after their injury. All participants had been admitted to hospital for their acute injury and stayed for a median length of 2 days in hospital. Interviews with pediatric patients took place online, and the patients were asked about their mental health, coping strategies, changes to lifestyle and supports following their burn injury. The interviews were transcribed and then thematically analysed using an inductive approach.

Results

Three overarching themes emerged from the interviews: burn-specific impact on the child or young person (including appearance concerns, family factors, and lifestyle factors), the psychological impact (including positive and negative impact on mental health), and factors supporting the recovery journey (including coping strategies and support services). The participants in our study highlighted issues they faced during recovery, the positive and negative impacts of the injury and recovery process and provided suggestions for future opportunities to bolster resilience and promote growth for pediatric burn patients who may face similar challenges in the future.

Conclusion

Factors that improve the mental health and wellbeing of pediatric burn patients should be promoted, such as mental health and social supports, the promotion of adaptive coping mechanisms, and meeting the needs of the family unit as a whole. Ultimately, the implementation of trauma-focused, family centred interventions is crucial for the psychosocial recovery of pediatric burn survivors.

burn

pediatric

mental health

psychosocial

Medical trauma is the psychological and physiological response to pain, injury, illness, medical procedures and treatments (1). Burn injuries are a common medical trauma impacting children and young people. In Australia and New Zealand, children and young people under the age of 15 made up a third (30.9%) of hospital admissions relating to burns between 2009–2021 (2). Advances in medicine have improved the chances of survival following larger burn injuries and thus patients might live with greater impacts of burn injury and more scarring (3). In addition, better scar treatments have improved the physical health outcomes of those who have experienced a burn injury (4). However, psychosocial outcomes have not seen the same improvement, and burn injuries can be distressing for both the child or young person, negatively affecting their wellbeing (5).

Children and young people who have experienced a burn injury (hereafter ‘pediatric burn patient’) are at a higher risk of developing psychopathology compared to the general population (5, 6). Studies show pediatric burn patients are at risk of developing posttraumatic stress symptoms or Posttraumatic Stress Disorder (PTSD) within the first month after the burn injury (7–9). Long-term psychological issues are also reported, with children and young people who have experienced a burn reported to experience elevated anxiety, depression, sleep disturbances, social functioning, and quality of life (5).

These statistics are not surprising given the complexity of burn aftercare, which often involves multiple invasive and painful treatments and procedures to improve function and lessen scarring (10). Frequent hospital visits are also often reported to be a source of distress for pediatric burn patients, as it serves as a reminder of the injury (11). The scarring following a burn can also be a source of distress for pediatric patients, particularly if the scar is visible (12–14).

Although pediatric burn patients face challenges post-burn, it is also clear that this population can experience resilience following their injury (15). A recent review showed factors like social support, having purpose, and personality variables like extroversion, can contribute to resilience following a burn (15). In order to promote resilience and prevent psychopathology post-burn injury for pediatric burn patients, it is crucial to understand the experience of children and young people after a burn. Further, community involvement in research is essential to ensure lived experience is considered when designing and implementing interventions and treatments (16). To design trauma-informed, person-centred treatments for burn injuries, health professionals and researchers must understand the experience of the injury from the perspective of the child or young person themselves. Therefore, this study aimed to understand the psychosocial impact that a pediatric burn has as perceived by the pediatric burn patient.

2.1 Participants

This study is part of a larger research project called The Wellbeing Project. The current study reports on interviews with pediatric burn patient aged 12 years and older who were admitted with an acute burn injury to the Perth Children’s Hospital outpatient burns treatment clinic in Western Australia. Only patients aged 12 years and older were eligible to participate in this study, given the emotional maturity required to discuss potentially distressing events such as their burn injury. Parents were also invited to participate in interviews about their experiences, however the results of those interviews are not reported in this study but rather in an earlier publication (17). Participants were excluded from the study if their burn was intentional or if they did not consent to take part in the study.

2.2 Ethics approval and consent to participate

Ethics approval was obtained from the WA Child and Adolescent Health Service Human Research Ethics Committee (RGS4669), and informed written consent was provided by all participants including consent from legal guardians/parents and young people themselves. Participants were able to voluntarily withdraw from the study at any time without consequence or reason at any stage. All methods in this study were carried out in accordance with relevant guidelines and regulations specified by the Human Research Ethics Committee.

2.3 Procedure

The staff from the burn treatment clinic provided the research team with the contact details of caregivers of eligible participants. Caregivers were contacted via telephone or email to invite their child to participate, and those interested were provided with further information about the study. If their child was willing to participate, they were asked to return a written consent form and a demographic form which enquired about the patient’s age, gender, residential suburb and whether they were diagnosed with any mental health conditions before or after the burn injury. Burn characteristics were obtained from the patient’s medical file provided by the clinic staff.

In total, 47 children/young people who had sustained a burn injury were eligible to participate in the interviews. Due to project delays, the research team could not contact 18 (38%) children/young people. Furthermore, one young person was uncontactable, 19 (40%) declined, and two (<1%) children/young people agreed to participate but did not return consent forms.

Interviews were conducted online as semi-structured interviews between February and May 2022, using Microsoft Teams. All interviews were carried out by a provisionally registered psychologist and PhD candidate (EJ), except for one interview conducted by a registered general psychologist due to staffing changes. All interviews were digitally recorded and lasted 43 minutes on average (mean) (range: 30-70 minutes). The interview guide (see Appendix 1) consisted of open-ended questions about general topics initially to build rapport, then participants were asked to describe their mental health since experiencing the burn injury, coping strategies, changes to their lifestyle, and sources of support.

2.4 Data Analysis

All interview recordings were imported into the online transcription service Otter (18) and manually checked by one of the research team members to ensure accuracy (PDGB, NW and EJ). The transcripts were de-identified, and participant names were replaced with pseudonyms to ensure confidentiality. Interviews were then analysed using NVivo (19), which assisted in the coding process. Each interview was independently coded by at least two authors (PDGB, NW and EJ). Furthermore, three authors (PDGB, NW and EJ) thematically analysed the interviews using an inductive approach (20), which involved creating themes and sub-themes based on participants common experiences. As part of the coding procedure, these codes were then checked and refined by four authors (PDGB, NW, EJ, and AW). Two authors (AW, NW) documented reflective and emerging ideas concerning the final themes and critical quotes during this iterative process.

A total of seven participants (five females and two males) aged between 12-18 years (mean 13.85, SD 2.27) were interviewed, the majority lived in the Perth Metropolitan area (n=6, 86%; see Table 1). Participants were aged between 4-14 years at the time of the burn injury, and interviews were conducted on average 3.10 years after the burn injury. All participants had been admitted to the hospital for their acute burn injury with a median length of stay of 2 days. All participants had surgery for wound closure, and three participants had laser treatment for scar management, one of whom had also received serial reconstructive surgery and releases for the hand scar she sustained at a young age. Injuries were from flame, scald (i.e., liquid from the kettle, tap, saucepan, or food) or contact burn (i.e., a solid hot object such as BBQ, iron, or hot ash). Total burn surface area (TBSA) ranged from one to seven per cent. No participants reported being diagnosed with mental health conditions before or after their burn injury. However, two participants reported that their mental health had worsened since the burn ("increased general anxiety", "increased anxiety/fear of the accident").

3.1 Themes

Three overarching categories were identified during data analysis: burn-specific impact on the child or young person, the psychological impact of the burn injury on the child or young person, and factors supporting the recovery journey (see Table 2). Within these categories, key themes and sub-themes were generated. All direct quotes are presented in quotation marks and the following pseudonyms have been used to protect participant confidentiality: participant ID (#XX), gender (M/F), age at injury (X yo) in years, and time since injury (XXTSI).

3.2 Burn-specific impact on the child or young person

Appearance concerns: scarring is common after a burn injury and participants described being self-conscious about how their scar would be perceived by others. One participant described her worries about having to explain her scar:

“…what if I have to hold someone's hand or something, and they don't want to, and just knowing that you're with kids that aren't going to really understand what happened and make comments” (#31, F, 13yo, 13.42TSI)

One participant explained that the pressure garment, used during the healing process of a burn, was protective when they wore it. However, once the garment came off, this was a source of distress as the scar became visible to others:

“I had to stop wearing my garment, for me it was also hard to look at… I was kind of thinking ahead and saying …What if they [other people] judge me?” (#10, F, 12yo, 0.72TSI)

A common experience for participants was the worry about how others would perceive them after the burn injury. Three participants described worrying about how their peers would view their scars. For example, one participant stated:

“… the worry of having my burn on my hand and thinking that it looked scary, and being worried about how that would be received by my peers” (#31, F, 18yo, 13.42TSI)

Family factors: participants were very cognisant of the guilt that their caregivers or family members felt about the burn injury. Three participants explained that they wished their caregivers were offered support to deal with the feelings of shame and guilt brought on by the burn injury. One participant who experienced a burn injury while staying at his grandparent’s house stated:

“I had to convince my parents and grandad it wasn't their fault. It was a bit frustrating because there was no way they could have affected the injury, my grandad felt really bad because he didn't tell me that sparks could set cotton on fire” (#53, M, 16yo, 2.17TSI)

Another participant acknowledged that their mother’s anxiety influenced their own mental health:

“Her getting that kind of anxiety from that. And then that also kind of translating to me as well” (#31, F, 18yo, 13.42TSI)

Lifestyle factors: participants often talked about how the burn injury caused disruption to their lifestyle and routine, such as missing out on sports or schooling, which in turn impacted their wellbeing. Some participants talked about how it took them a while to heal enough to be able to physically play sports. Others talked about how they were anxious to start playing sport again in case they injured themselves:

“And whether it be even just mental, like being scared that something's gonna hit my hand too hard. It's a fear of mine, I guess. But I still do netball casually, but I can't do serious netball anymore.” (#31, F, 18yo, 13.42TSI)

All participants talked about missing school because of their injury. One participant summed up their experience:

“…when I used to have all my appointments all the time, I'd always miss out on school” (#22, F, 12yo, 2.17TSI)

3.3 Psychological impact of the burn injury on the child or young person

Negative impact on mental health: many participants reflected on the hardships they faced after the burn injury, and how the injury itself had a negative impact on their mental health. Anxiety was the most commonly reported issue among participants. Participants talked about catastrophising thoughts (i.e., a cognitive distortion where the person thinks the worst outcome will happen), fear of fires or burn injuries occurring again, and feelings of generalised anxiety following their injury. One participant stated:

“Because I was exposed to that kind of stuff … making me yeah, just kind of anxious about the world around me and aware of quite heavy stuff when I couldn't really process it in a healthy way” (#31, F, 18yo, 13.42TSI)

Posttraumatic stress was also a clear theme, with participants describing symptoms of hypervigilance, repetitive thoughts about the injury, hallucinations, and in one case, nightmares. One participant described intrusive thoughts about the accident:

“I just have that memory… and then I just get a bit more scared that's going to happen again” (#10, F, 12yo, 0.72TSI)

One participant described the low mood they experienced after their injury:

“And then when I'm feeling emotional about it, which is rarer these days… But sometimes you still will just…feel emotional about something that caused you pain and caused your family pain” (#31, F, 18yo, 13.42TSI)

Positive impact of the burn injury on the child or young person: one participant spoke about the resilience they now feel after experiencing a burn injury:

“I guess when I was younger and then now it's like when I'm feeling stressed, I can acknowledge that I'm feeling stressed and that's a form of anxiety and it's gonna be pass, and it's because of this.” (#31, F, 18yo, 13.42TSI)

3.4 Factors supporting the recovery journey

Coping strategies: participants spoke about strategies they use to cope and what helped during the acute phase of the healing journey. Acceptance and taking a holistic approach were common amongst participants. A few participants mentioned how they now use mindfulness to cope:

“I think that before I started seeing this psychologist, I actually didn't deal with stress or anxiety very well, because I didn't really have the skills to do it. But I think now breathing exercises and stuff like that work.” (#31, F, 18yo, 13.42TSI)

Leaning on others and social support were another common sub-theme that helped participants cope:

“I think my close friends are a huge support for me in a whole bunch of different ways. But even in stuff related to my burn, whether it be needing an operation… my friends already supported me through that.” (#31, F, 18yo, 13.42TSI)

I mean, whenever I'm with my friends, I'm like, quite happy.” (#22, F, 12yo, 2.17TSI)

And some participants spoke about the need to positively reframe the injury:

“I would of like to be able to tell [my story] in a more positive way. Because most of the time, your brain always thinks about the negatives, not the positives.” (#4, F, 13yo, 0.7TSI)

Support services: two sub-themes emerged within support services, the hospital setting and counselling services. One participant mentioned it would have been helpful for the hospital to provide options for parents and families to engage in supports:

“a more holistic understanding of different options. And for my parents as well, knowing there were options for them as well to get support and for my mum especially, definitely to have more emotional support and [being able to] process her feelings about it.” (#31, F, 18yo, 13.42TSI)

A few participants talked about accessing counselling during their healing journey, however one participant mentioned they would have liked to have been put in contact with a psychologist earlier on in their recovery journey:

“And then having the understanding [of] how to reach out for help. And also that it's the stigma around it as well. I think that it definitely should not have taken me this long to get a psychologist just because it's just the most normal thing ever. It should be the most normal thing ever” (#31, F, 18yo, 13.42TSI)

This study aimed to understand the psychosocial impact experienced by pediatric patients following a burn injury. Our study demonstrated that a burn injury impacts many areas of patient’s lives. Our analysis categorised themes as burn-specific impacts (including appearance concerns, family factors, and lifestyle factors), the psychological impact (including positive and negative impact on mental health), and factors supporting the recovery journey (including coping strategies and support services). The participants in our study highlighted issues they faced during recovery, the positive and negative impacts of the injury and recovery process and provided suggestions for future opportunities to bolster resilience and promote growth for pediatric burn patients who may face similar challenges in the future.

Participants in our study reported on factors that impacted their wellbeing that were specifically outcomes characteristic of a burn injury. One of these factors was appearance concerns, as burn injuries are associated with scarring and having to wear pressure garments during the recovery journey. Participants talked about their burn being a source of anxiety in terms of how they would be perceived by others when they wore a pressure garment and also when the garment was off, and their scar would be seen by others. This theme is consistent with previous research demonstrating that body image concerns in young people contribute to social anxiety, which is likely due to critical periods of social development occurring during adolescence (21,22). Often appearance concerns are compounded by lack of education in schools around burn injuries, and certainly in our sample participants were concerned about their peers’ perceptions of them.

Disruption to schooling and other lifestyle factors had a big impact on our participants. Many talked about missing school being a cause of anxiety, as well as missing out on sporting activities. Both sports and schooling can be sources of social support for children and young people, and further, can improve psychological wellbeing (23). It is not surprising then, that the participants in our study found missing out on both school and sports to be detrimental to their wellbeing.

Recognising caregiver guilt, which often added to the child or young person’s mental health issues, were a consistent theme for the participants in our study. The participants were aware that their caregivers often felt responsible or blamed themselves for the burn injury, and the participants reported that they felt like their caregivers needed more support. This is in line with previous findings that demonstrate caregivers feel guilt relating to their child’s burn injury (Wickens et al., Under Review), which leads to negative mental health issues if left untreated such as anxiety, symptoms of PTSD (such as intrusive thoughts and hypervigilance), and depression (24–27).

In line with previous research, the participants in our study reported heightened anxiety, fear, and posttraumatic stress following their burn injury (5). The majority (71%) of our participants reported that their mental health was significantly worse after their injury, and of those who reported worse mental health, all stated that they experienced anxiety. This aligns with research showing that children who experience a burn injury are four times more likely to experience anxiety (5). Worryingly, some participants described symptoms of PTSD, such as nightmares, flashbacks, repetitive thoughts relating to the accident, and hypervigilance. One study has shown that in a sample of toddlers who experienced a burn injury, up to 11.7% met the full criteria for PTSD and 15.3% showed subsyndromal PTSD symptoms (8). Many of these symptoms reported by the participants in our study were related to the essential procedures that are required for physical recovery (e.g., wound dressings and laser treatments). Again, this is consistent with previous studies on children who have experienced burns, whereby children experience intrusive thoughts related to not only the burn injury itself, but the painful procedures they have to endure during recovery (10).

Interestingly, participants in our study described how they now foster a sense of resilience, in other words they can now acknowledge their negative emotions and process them in a way that allows them to move on. The participants also described helpful coping mechanisms that they have adopted, such as mindfulness, acceptance, and leaning on social support. Indeed, a recent systematic review on the factors that contribute to psychosocial recovery after burn found that social support is the most important factor to promote both resilience after burn for all ages, and posttraumatic growth after burn in adults (15). Further, another study found that relaxation techniques are useful in relieving procedural anxiety during burn recovery (28). Trauma-focused therapies often use mindfulness strategies as a therapeutic technique and thus, trauma-focused therapies should be integrated into the recovery process of burn injuries.

Finally, participants were very enthusiastic about mental health support following a burn injury and were very open about seeking help themselves. All participants who sought mental health support described it as being a positive experience that helped them cope immensely. Many participants however, remarked that mental health support should be a part of routine care for patients who experience a burn injury. Further, due to the negative impact that caregivers often feel following their child’s burn (24,29), evidenced in this study by participants recognising guilt and anxiety felt by their caregivers as well as other family members, a trauma-centred approach for the family unit would be beneficial for children and caregivers who experience a burn. Such interventions or treatments should include resilience building, healthy coping mechanisms and facilitating the expression and regulation of emotions.

This study aligns with previous research on the impact of pediatric burn injuries and provides evidence that a burn injury impacts many facets of wellbeing however, there are limitations to this study. The generalisability of this study may be impacted by both the relatively small sample size (although we did reach data saturation with this sample), as well as the fact that this sample is from a single metropolitan area in a Western society. Future studies should endeavour to investigate experiences of children and young people from rural and remote areas. Another limitation was the variability in time since the burn injury, which may place the child or young person at risk of recall bias. Although we must consider this study within the context of these limitations, we nonetheless present a deeper understanding of the experiences of pediatric burn survivors.

This study has shown that children and young people who experience a burn face many hardships, which should be acknowledged by clinical care teams in the recovery journey. Factors that improve the mental health and wellbeing of children and young people who sustain a burn injury should be promoted, such as mental health and social supports, the promotion of adaptive coping mechanisms, and meeting the needs of the family as a whole. Ultimately, the implementation of trauma-focused, family centred interventions is crucial for the psychosocial recovery of pediatric burn survivors.

Ethics approval and consent to participate: Ethics approval was obtained from the WA Child and Adolescent Health Service Human Research Ethics Committee (RGS4669), and informed written consent was obtained from legal guardians/parents and young people themselves.

Consent for publication: Not applicable. All data is de-identified.

Availability of data and materials: The datasets generated during and analysed during the current study are not publicly available due to the sensitivity of participant data but are available from the corresponding author on reasonable request. Every request will be reviewed by the institutional review board at the Telethon Kids Institute; the researcher will need to sign a data access agreement with the Telethon Kids Institute after approval.

Competing interests: None.

Funding: This work was supported by a Channel 7 Telethon Trust grant.

Author’s contributions: A.W. and N.W. wrote the manuscript and prepared figures, all authors reviewed the manuscript. E.J. collected interview data, E.J., PDGB., and N.W. transcribed the data. E.J., PDGB., A.W. and N.W. thematically analysed the data. All authors contributed to ethics approval and consent.

Acknowledgements: The authors would like to thank all the participating caregivers for their time and willingness to share their experiences. We would also like to thank Indijah Bullman for assistance with the data collection and the staff at the Perth Children’s Hospital outpatient burns clinic for their support throughout this project.

Kazak AE, Kassam-Adams N, Schneider S, Zelikovsky N, Alderfer MA, Rourke M. An Integrative Model of Pediatric Medical Traumatic Stress. J Pediatr Psychol. 2006 May;31(1):343–55.
Department of Epidemiology and Preventative Medicine. Burns Registry of Australia and New Zealand Annual Report. Melbourne, Australia: Monash University; 2020.
Peck MD. Epidemiology of burns throughout the world. Part I: Distribution and risk factors. Burns. 2011 Nov;37(7):1087–100.
Wang Y, Beekman J, Hew J, Jackson S, Issler-Fisher AC, Parungao R, et al. Burn injury: Challenges and advances in burn wound healing, infection, pain and scarring. Adv Drug Deliv Rev. 2018 Jan;123:3–17.
Woolard A, Hill NTM, McQueen M, Martin L, Milroy H, Wood FM, et al. The psychological impact of pediatric burn injuries: a systematic review. BMC Public Health. 2021;21:1–27.
Duke JM, Randall SM, Vetrichevvel TP, McGarry S, Boyd JH, Rea S et al. Long-term mental health outcomes after unintentional burns sustained during childhood: a retrospective cohort study. Burns Trauma. 2018 Dec 1;6:s41038-018-0134-z.
Haag AC, Landolt MA. Young Children’s Acute Stress After a Burn Injury: Disentangling the Role of Injury Severity and Parental Acute Stress. J Pediatr Psychol. 2017 Sep;42(8):861–70.
Graf A, Schiestl C, Landolt MA. Posttraumatic Stress and Behavior Problems in Infants and Toddlers With Burns. J Pediatr Psychol. 2011 Sep 1;36(8):923–31.
De Young AC, Paterson RS, Brown EA, Egberts MR, Le Brocque RM, Kenardy JA, et al. Topical Review: Medical Trauma During Early Childhood. J Pediatr Psychol. 2021 Aug;11(7):739–46.
Egberts MR, Geenen R, de Jong AE, Hofland HW, Van Loey NE. The aftermath of burn injury from the child’s perspective: a qualitative study. J Health Psychol. 2020;25(13–14):2464–74.
McGarry S, Elliott C, McDonald A, Valentine J, Wood F, Girdler S. Pediatric burns: From the voice of the child. Burns. 2014 Jun;40(4):606–15.
Bakker A, Maertens KJP, Van Son MJM, Van Loey NEE. Psychological consequences of pediatric burns from a child and family perspective: A review of the empirical literature. Clin Psychol Rev. 2013 Apr;33(3):361–71.
Rimmer RB, Foster KN, Bay RC, Floros J, Rutter C, Bosch J. The reported effects of bullying on burn-surviving children. J Burn Care Res. 2007;28(3):484–9.
Stubbs TK, James LE, Daugherty MB, Epperson K, Barajaz KA, Blakeney P, et al. Psychosocial impact of childhood face burns: A multicenter, prospective, longitudinal study of 390 children and adolescents. Burns. 2011 May;37(3):387–94.
Woolard A, Bullman I, Allahham A, Long T, Milroy H, Wood F et al. Resilience and Posttraumatic Growth after Burn: A Review of Barriers, Enablers, and Interventions to Improve Psychological Recovery.Eur Burn J. 2022 Feb9;3(1):89–121.
Molloy EJ, Mader S, Modi N, Gale C. Parent, child and public involvement in child health research: core value not just an optional extra. Pediatr Res. 2019 Jan;85(1):2–3.
Wickens N, van Janse E, Belinelo P, Milroy H, Martin L, Wood F et al. “It’s a big trauma for the family”: Insight into the psychological trauma of pediatric burns from the perspective of caregivers.Rev. 2023
Liang S, Fu Y. Otter Ai. California, United States; 2016.
NVivo QSR.International Pty Ltd
Thomas DR. A General Inductive Approach for Analyzing Qualitative Evaluation Data. Am J Eval. 2006 Jun;27(1):237–46.
Riobueno-Naylor A, Williamson H, Canenguez K, Kogosov A, Drexler A, Sadeq F et al. Appearance concerns, psychosocial outcomes, and the feasibility of implementing an online intervention for adolescents receiving outpatient burn care.J Burn Care Res Off Publ Am Burn Assoc. 2020;((Riobueno-Naylor, Canenguez, Kogosov, Drexler, Sadeq, DePamphilis, Stoddard, Lydon, Murphy, Sheridan) Shriners Hospitals for Children-Boston, Boston MA, United States).
Blakemore SJ. Adolescence and mental health - The Lancet. The Lancet. 2019;393:2030–1.
Eime RM, Young JA, Harvey JT, Charity MJ, Payne WR. A systematic review of the psychological and social benefits of participation in sport for children and adolescents: informing development of a conceptual model of health through sport. Int J Behav Nutr Phys Act. 2013;10(1):98.
McGarry S, Girdler S, McDonald A, Valentine J, Wood F, Elliott C. Pediatric medical trauma: The impact on parents of burn survivors. Burns. 2013;39(6):1114–21.
Egberts MR, van de Schoot R, Geenen R, Van Loey. N.E.E. Parents’ posttraumatic stress after burns in their school-aged child: A prospective study. Health Psychol. 2017;36(5):419–28.
Egberts MR, Engelhard IM, Schoot RVD, Bakker A, Geenen R, van der Heijden PGM et al. Mothers’ emotions after pediatric burn injury: Longitudinal associations with posttraumatic stress and depressive symptoms 18 months postburn. J Affect Disord. 2020;263((Egberts, Van Loey) Association of Dutch Burn Centres, Beverwijk, Netherlands):463–71.
Hawkins L, Centifanti LCM, Holman N, Taylor P. Parental Adjustment following Pediatric Burn Injury: The Role of Guilt, Shame, and Self-Compassion. J Pediatr Psychol. 2019;44(2):229–37.
Cohen JA, Mannarino AP. Trauma-focused Cognitive Behavior Therapy for Traumatized Children and Families. Child Adolesc Psychiatr Clin N Am. 2015 Jul 1;24(3):557–70.
Lehna C. Sibling Experiences after a Major Childhood Burn Injury.Pediatr Nurs.36(5):8.

Table 1: Participant demographics and burn characteristics

Characteristics of paediatric burn (N = 7)
	*Median*	*Range*
Age at burn injury (years)	12.5	4.83-14.33
Time since burn (years)	1.92	0.33-13.42
Total length of hospital stay (days)	2	0.5-15
TBSA (%)	1.65	1-7
Type of burn	n	%
Contact	2	14
Scald	4	57
Flame	1	29

Table 2: Interview categories, themes, and sub-themes

Categories	Themes	Sub-themes
Burn-specific impact on the child or young person	Appearance concerns	Scarring Garments coming off Response from other people
	Family factors	Family guilt around the injury Vicarious anxiety
	Lifestyle factors	Missing out/not being able to do the same activities Disrupted routine
Psychological impact of the burn injury on the child or young person	Negative impacts on mental health	Anxiety Fear Posttraumatic stress
	Positive impacts on mental health	Resilience
Factors supporting the recovery journey	Coping strategies	Acceptance Holistic approach Mindfulness Social support
Factors supporting the recovery journey	Support services	Hospital settings Counselling

No competing interests reported.

Appendix1.docx

Download PDF

Journal Publication

published 05 Jun, 2023

Read the published version in BMC Pediatrics →

Editorial decision: Major revision
23 Mar, 2023
Reviews received at journal
27 Feb, 2023
Reviewers agreed at journal
09 Feb, 2023
Reviewers invited by journal
19 Jan, 2023
Editor assigned by journal
19 Jan, 2023
Editor invited by journal
19 Jan, 2023
Submission checks completed at journal
19 Jan, 2023
First submitted to journal
16 Jan, 2023

You are reading this latest preprint version

“I just get scared it’s going to happen again”: A qualitative study of the psychosocial impact of pediatric burns from the child’s perspective

Status:

Journal Publication

Version 1

Abstract

Background

Methods

Results

Conclusion

1. Introduction

2. Method

3. Results

4. Discussion

5. Strengths And Limitations

6. Conclusions

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

Journal Publication

Version 1