Gill, P. & Falder, S. Paediatrics and Child Health | Published online: 21 April 2017
Image shows skin cells from a scald
Burns are a common form of trauma in children, resulting most frequently from scalds but also contact, flame, electrical and chemical sources. Burn patients have a wide spectrum of injury severity and diverse outcome, ranging from superficial burns with no lasting physical signs to deep, large body surface area burns which are profoundly life-changing, affecting all physiological systems. Size, site and depth are important factors affecting treatment and outcome.
There are important anatomical, physiological and psychosocial differences between adults and children. Their body proportions are different, they have thinner skin, smaller airways, reduced blood volume and high levels of distress. They are vulnerable to non-accidental injury.
Children require formal fluid resuscitation and maintenance fluids for burns more than 10% total body surface area. Complications include infection, toxic shock syndrome, adverse scarring and psychological sequelae. This paper discusses how correct assessment and management in the acute stage can reduce later morbidity and mortality.
New research (yet to be published) has looked at family coping and distress during a dressing change following a burn injury in kids | The Conversation
The 18-month study observed 92 families during their young child’s (one to six years) first burn dressing change at a Brisbane hospital.
Parents who reported they were more anxious or distressed were less able to support their child during the procedure. This decreased the child’s ability to cope and increased the child’s distress, which was measured by their ability to be distracted by toys and conversation, compared to crying or screaming during the dressing change.
Ratings of child anxiety and pain during the dressing change were also greater for children of parents who were less able to support their child during the dressing change.
Read the full blog post by Erin Brown & Justin Kenardy here
Emond, A. et al. Archives of Disease in Childhood. Published Online: 13 November 2016
Image shows skin cells from the blistered area of a scald.
Objective: To investigate child developmental and behavioural characteristics and risk of burns and scalds.
Design: Data on burns in children up to 11 years from 12 966 participants in the Avon Longitudinal Study of Parents and Children were linked to developmental profiles measured before the burn injury.
Measures: Preinjury profiles of the children derived from maternal questionnaires completed in pregnancy, and at 6, 18, 42, 47 and 54 months. Injury data collected by questionnaire at 6, 15 and 24 months and 3.5, 4.5, 5.5, 6.5, 8.5 and 11 years of age.
Results: Incidence: Burn rates were as follows: birth–2 years 71.9/1000/year; 2–4.5 years 42.2/1000/year; 5–11 years 14.3/1000/year. Boys <2 years were more likely to sustain burns, and girls had more burns between age 5 and 11 years. Medical attention was sought for 11% of burn injuries. Development: Up to age 2 years, burns were more likely in children with the most advanced gross motor developmental scores and the slowest fine motor development. Children with coordination problems at 4.5 years of age had increased risk of burns between 5 and 11 years. No associations were observed with cognitive skills. Behaviour: At 3.5 years, the Strengths and Difficulties Questionnaire scores and reported frequent temper tantrums predicted subsequent burns in primary school age. After adjustment for confounders, burns in the preschool period were related to gender and motor development, and in school-aged children, to frequent temper tantrums, hyperactivity and coordination difficulties.
Conclusion: Child factors associated with increased risk of burns were male gender in infancy and female gender at school age, advanced gross motor development, coordination difficulties, hyperactivity and problems with emotional regulation.
Johnson, E.L. et al. Emergency Medicine Journal. 2016;33:465-470
Objective: An evidence based clinical decision rule (CDR) was developed from a systematic review and epidemiological study to identify burns due to child maltreatment (abuse or neglect). Prior to an implementation evaluation, we aim to explore clinicians’ views of the CDR, the likelihood that it would influence their management and factors regarding its acceptability.
Methods: A semistructured questionnaire exploring demographics, views of the CDR and data collection pro forma, ability to recognise maltreatment and likelihood of following CDR recommended child protection (CP) action, was administered to 55 doctors and nurses in eight emergency departments and two burns units. Recognition of maltreatment was assessed via four fictitious case vignettes.
Analysis@ Fisher’s exact test and variability measured by coefficient of unalikeability.
Results: The majority of participants found the CDR and data collection pro forma useful (45/55, 81.8%). Only five clinicians said that they would not take the action recommended by the CDR (5/54, 9.3%). Lower grade doctors were more likely to follow the CDR recommendations (p=0.04) than any other grade, while senior doctors would consider it within their decision making. Factors influencing uptake include: brief training, background to CDR development and details of appropriate actions.
Conclusions: It is apparent that clinicians are willing to use a CDR to assist in identifying burns due to child maltreatment. However, it is clear that an implementation evaluation must encompass the influential variables identified to maximise uptake.