Burn Injuries

Abstract

Pediatric burn injuries are often traumatic and painful experiences for children and their families. Pediatric psychologists can play an important role in the care of pediatric patients with burn injuries, both during the acute inpatient hospitalization and in subsequent outpatient follow-up. During an inpatient hospitalization for burn injuries, pediatric psychologists can provide targeted assessments and supportive counseling to patients and their families, as well as brief interventions that target acute adjustment concerns, including teaching of active coping strategies and behavioral management strategies during painful dressing changes. In the outpatient setting, pediatric psychologists can assist with school and social reintegration after burn injury, as well as address long-term concerns such as persistent itching, adherence to burn care tasks (e.g., pressure garments, scar massage), adjustment to and acceptance of new appearance, and teasing/bullying. This chapter provides a summary of pediatric burn injury treatment, the role of pediatric psychologists in burn consultations, and a review of interventions in the inpatient and outpatient burn care settings.

Appendix: When People Stare, Tease, and Ask Questions

When your body is changed by an injury or an illness, social situations often can lead to other people staring or asking questions. At first, the reaction of others can be difficult. However, you can learn new behavioral skills to help you respond to others’ reactions. The good news is that most people learn to accept the changes in their body image. This acceptance takes time, support from others, and a willingness to learn new social survival skills. Here are some tips to help you along the way:

• 1. How to cope with staring

  • Most people stare because they are curious or concerned

  • Only a few people stare because they are rude

    • What todo and say—Some options are:

      • Stand up straight, look directly at the person, and smile. Say something like “How’s it going?” or “Hi, I’m (your name)”

      • Offer a brief response such as “I got burned by fireworks, but I’m fine now” or “I got hurt in a car wreck but I’m doing much better”

    • • Address the staring person directly—“Please do not stare at me.”

      • Use humor or sarcasm—“Do I have something on my face?" Or "I’m having a bad hair day!"

      • Ignore the person who is staring

    • Practice your favorite response or responses

      • In front of a mirror

      • With a parent or close friend

    • Be proactive

      • Give your classmates information before you come to school, so they can be prepared for your new appearance.

      • Be a part of an assembly before returning to school to give your classmates information. You can do a presentation, or you can have your healthcare worker, school nurse, or parent do this.

• 2. How to cope with teasing

  • Unfortunately, many children who have been burned or injured get teased.

  • It is important to have a plan for handling teasing before it starts.

    • What todo—Some options are:

      • Look strong and confident, stand up straight, keep your head up, make eye contact, and use a strong voice when speaking.

      • Use “I” statements such as “I want you to stop staring at me.” Or “I want you to stop calling me names.”

      • Respond with “You might be right” each time someone teases you.

      • Shrug your shoulders and respond with a casual statement such as “Oh well, I don’t care.”

      • Use humor or sarcasm. Examples include: “Thank you for the compliment!” “You are being so nice to me!” 

      • Walk away if the person teasing you becomes dangerous or threatening. Talk to a trusted adult or parent.

    • Whatnotto do:

      • Show the teaser that he/she has upset you by getting mad or crying because that will only increase teasing.

      • Offer to fight the person.

      • Always ignore the teasing (unless the person teasing is dangerous).

      • Tell an adult as a first step. Try to resolve the conflict by yourself if you can.

• 3. How to cope with questions

  • Although people usually ask questions because they are curious or concerned, it may get really annoying when people keep asking you the same questions over and over again or when people you do not know ask you personal questions.

    • What todo and say—Some options are:

      • Take a deep breath before responding.

      • Remind yourself that people are not asking questions to be mean or nosy.

      • Ending your responses with “Thanks for asking” is a nice way to let people know that you do not want to talk about your injury anymore.

      • Practice a short answer for people you do not know. “I got burned while I was trying to cook. Thanks for asking”

      • Practice a long answer for people you want to share a little bit more information with. “I lost my leg in a car accident last summer. I’m still getting used to walking with crutches, but I’m getting really fast. What would you like to know about my situation?”

      • If you feel uncomfortable with someone’s question, you can always say “I really don’t feel like talking about my injury.”

Adapted from Qualye, B.H. (2001) “Tools to handle questions and teasing” and “When people stare” Burn Support News