Family scars after pediatric burns

Abstract

A pediatric burn injury can be a traumatic experience for both the child and its parents. This dissertation was aimed at better understanding the psychological impact of pediatric burns on the family. With the use of both quantitative and qualitative methods, and multiple informants, the perspectives of different family members across various time points postburn were described and analyzed. The first part of the dissertation covered a prospective, longitudinal study of children (8-18 years old) with burns and their parents, with assessments up to 18 months postburn. Within-family associations and predictors of children’s, mothers’ and fathers’ psychological symptoms (such as those of posttraumatic stress) were examined. It was found that despite high levels of traumatic stress in the acute phase, most children and parents appeared to recover in the long term. Nevertheless, there was a considerable group of parents, particularly mothers, that experienced lasting posttraumatic stress reactions. Negative emotions and appraisals were identified as potential risk factors. Moreover, the results provided evidence for a within-family interdependency of psychological reactions. The second part of the dissertation comprised three qualitative studies that provided an in-depth picture of child and parent experiences after burn injury. Specific attention was paid to experiences surrounding child wound care procedures, as well as the content and nature of child and parent (intrusive) memories after discharge. Despite the emotional nature of wound care procedures, most parents preferred to be present during these procedures. Among other advantages, they described experiencing a sense of control resulting from their presence. In addition, later child and parent intrusive memories were predominantly related to the accident, and not to medical treatment such as wound care. Altogether, these results suggest that parents should be offered the opportunity to be present during their child’s wound care. The findings indicate that a family perspective on pediatric burn injury is essential, both in clinical practice and in research. The results call for assessment of both child and parent psychological symptoms. The dissertation includes a discussion of the implications for psychosocial support surrounding wound care procedures, early screening, prevention- and intervention programs, and support for social challenges. Efforts should be made to develop and evaluate these types of support, which may contribute to the recovery of the entire family.