Caregivers' perspective of school reintegration in children survivors of burns

Abstract

Introduction: Pediatric burns are an important reason of treatment and hospitalization. Children victims of burns may interrupt or even abandon school activities. The process of school reintegration of this population has become a point of attention. Aim: To analyze the caregivers’ perspective of the school reintegration of children survivors of burns. Method: It is an ethnographic study based on Interpretative Anthropology. After the ethical committee approval, data were collected in a burn unit at a university hospital located in the interior state of São Paulo, Brazil, and at children’s home and schools, during 22 months. Caregivers of school-aged children survivors of burns were invited to participate in this study. We defined school-age children victim of burn as a child from six to twelve years-old, enrolled or not in a school at the moment of the burn, and caregiver as the family member who takes care of the children most of the time. The triangulated strategies for data collection were participant observation, in-depth interviews, and field notes. Data were analyzed using inductive thematic analysis and the hermeneutic circle. Results and Discussion: A total of fourteen caregivers participated; eleven mothers, two grandmothers and one father. Eleven were married or living with a partner, one was divorced and another was widower. The ages ranged from 24 to 60 years old. One caregiver was illiterate, six had incomplete elementary school, one had incomplete high school, and one was attending College. The family income per month ranged from R$ 622.00 to R$5000.00. The number of person living in the house ranged from three to nine. Codes were identified and organized in three units of meanings: 1) “Back to school”; 2) “To be normal”; and 3) “To talk about the problem”. Some caregivers had feelings (like guilt, anxiety, and fear), behaviors, and attitudes that postpone the return to school of these children. The caregivers’ level of education influenced the way they were able to deal with the new school demands, such as discrimination. There were distinguished characteristics of the public and private school systems that must be faced during this return. Some caregivers reported that burns in visible locations, like the face, the neck and the harms, negatively influenced the school reintegration. Children with burns located in body regions that could be hidden didn’t have much difficulty to return to school. Most of the caregivers said that the children were normal or needed to be normal, but sometimes they emphasized that children were different than their peers, and even ugly. But if someone made any comment about the child appearance, caregivers advocated for their children with protected attitudes, like giving offensive answers to others or ignoring the comment. Most of them reported that they need to talk about the accident, burn injury and everything related with it when the children return to the school, not just the class of the children, but with all people at the school. This can help the children deal better with the scars and their new appearance. Conclusion: The results of this study contribute to the planning of the school return of other children experiencing the same process. Acknowledging school team interactions with health care professionals and caregivers has the potential to facilitate the reintegration of the child in this context.