More Than Skin Deep - Children, Families, Community

This is the first of the two modules and will provide you with strategies to help you support your child, yourself, and siblings and other family members while your child is in hospital.

 It will take 45 minutes to complete and includes information, podcasts and videos. 

Key messages:

• Stress following a burn injury.
• The burn experience – 0-5 years, 6-12 years, 13-18 years.
• Providing reassurance.
• The 4S’s – Communicating with your child.
• Helping your child through dressing changes.
• Dressing changes and other procedures.
• How to support your child for surgery.
• How to get information.
• Support from the social worker.
• Seeking practical help.
• Your child’s network.
• Supporting siblings and other family members.
• Knowing it's OK to ask for help.

Information sheet

The burn experience   

Children can react differently to burn injuries. Some of this will depend on their developmental stage. Here are some changes that you may notice in your child.

0-5 years

After the burn injury, they may:

• relive the accident through play, drawings, or conversation
• become more fussy or clingy or even distant and fearful
• experience more tantrums than normal
• revert to a previous developmental stage
• develop new fears that don’t have anything to do with the accident that caused the burn injury e.g. afraid of the dark, don’t want to be left alone.

Age 6-12 years

• After the burn injury, they may:
• relive the accident through nightmares or upsetting thoughts that ‘pop’ into their heads
• want to avoid talking about the accident
• become aggressive, disobedient, or withdraw from their family and friends
• be more anxious about their safety and ask lots of questions about their ongoing safety.

Age 13-18 years

After the burn injury they may:

• re-experience the accident by talking about it a lot or not want to talk about it at all
• be on edge and have difficulty concentrating and sleeping
• have mood swings and worry that their reactions aren’t normal
• not want to do things they used to enjoy and their school performance may change
• want to avoid social events and have relationship troubles with friends and family.

The important thing to remember if you notice changes in your child's behaviour is that support is available. Talk to the burns team, and they will refer you to the best person to help you and your child.

Seeking help

The hospital experience may be very new and even confronting for you. Identifying who can help you while your child is in hospital is important.

1. For information and help about your child’s medical situation, talk to the nursing staff, an occupational therapist or physiotherapist, or your child’s surgeon.
2. For support and advice about how you, your family or your child are coping talk to the hospital’s social worker, psychologist, or Aboriginal liaison officer.
3. Remember to ask for and accept help from partners, family, friends, and the community.

Connections

Work to find ways to connect your child with their siblings and other family members, their friends, their school, and people from other groups they are usually involved in, such as sports groups or other recreational activity groups, while they are in hospital. SMS, video chats and video messages, cards and hospital visits can help your child to feel supported and connected.

Ths is a difficult time for everyone, so, remember that accidents happen. Try not to feel guilty or blame others if you can help it. You can’t change what has happened. Think about what needs to be done next and how to manage things so you can move forward.

Remember that its ‘OK’ to ask for help and teach your child that they can do the same.

More Than Skin Deep | Supporting your child in hospital information sheet - PDF Download CLICK HERE  

This is the second of the two modules and will help you to understand the importance of the care and treatments provided in the outpatient clinic, how you can get the most out of the care provided in the clinics from the team, and how to support your child as they move back into life at home, school, and the wider community.

It will take 30 minutes to complete and includes information, podcasts and videos. 

Key messages:

• What to expect when your child goes home.
• Scar management at home.
• Surgical scar management.
• The role of physiotherapy.
• The importance of your child being physically active and having a good quality of life.
• The role of research.
• Why research? A personal perspective.
• Connecting to your child’s emotions.
• Back to school.
• Talking with your child.
• Helping siblings cope and looking after yourself.

Information sheet

Outpatient care

Outpatient care is a very important part of burn recovery. The outpatient clinic is where we keep a close eye on the progress and decide which treatments for burn scar management are right for your child.

If your child still has a burn wound, or requires dressings after surgery, we can often attend to these in clinic. We will continue to see to dressings until the burn is healed, or until a decision for an operation is made. After the burn wound is healed, we see you at six weeks to check for early signs of scarring.

If your child has a scar, we will develop a follow up plan that is right for your child. This plan will vary from patient to patient, so it is important to remember that what is right for one child, might not suit another. Sometimes children respond differently to treatments, and therefore plans may change as they are reassessed. Keep this in mind.

Care and treatment will continue for as long as required. You will meet different members of the burns team in clinic, including nurses, doctors, occupational therapists, physiotherapists, clinical photographers, and researchers. They are all there to help.

Tips to help your child cope after hospital

• Establish a routine.
• Set normal limits.
• Allow your child to talk about their feelings
• and worries if they want to.
• Encourage your child to spend time with friends.
• Start planning for reintegration back into school, sport and community activities as soon as practical.
• Set up meetings, have open conversations, and develop an agreed plan of action.
• Be patient, provide reassurance, and give everyone time to adjust.

Scar management

The Occupational Therapist (OT) in the outpatient clinic will help to educate you and your child about how best to manage your child’s scars.

1. If your child needs a compression garment, the OT will measure and prescribe one. The garments work by applying mechanical pressure over the affected area of the body. They counteract the thickening of the scar tissue reducing blood circulation to the area which reduces the likelihood of scarring. The garments also provide an additional layer of protection to reduce the risk of further damage and the fabric used has been specifically designed to reduce itch.
2. Your OT may also prescribe silicone gels and patches. Gels and patches soften and flatten raised scars, reduce redness and discoloration, relieve itching and discomfort, and prevent abnormal and excessive scar formation.
3. The OT will also help to educate you around the importance of massaging and moisturising the scar and ensuring the scar is always protected from the sun. By massaging the scar, you are helping to break down the collagen that has formed during the repair phase of the burn, you are hydrating the skin, and reducing the impact of scarring.
4. The OT can work with you and your child to create a desensitisation program to reduce the impact of a hypersensitive scar which may feel numb, tingly or painful.
5. The OT may also refer your child to a number of specialist services.

It is very important that you attend all follow-up appointments at clinic. These appointments are scheduled regularly to enable the team to provide your child with quality care so that the best outcomes for your child can be achieved.

Healing on the outside and inside

When you come into the burns clinic, we take the opportunity to check in with your child. We are looking to see how they are going emotionally, socially, and depending on their age, how preschool or school is going. The 5-minute quality of life form that we use, called the PedsQL, gives us a snapshot of the recovery process, and provides us with the opportunity to follow up and explore any challenges that your child might be experiencing. These forms are routinely collected and are part of our standard clinical practice.

Caring for yourself and other family members

Siblings and other family members can feel big emotions when someone in the family has had a burn. These emotions need to be heard and acknowledged. They also need information about what is happening that is suitable for their age and understanding. This can reduce any anxiety they may be feeling about the situation.

Caring for yourself is an important part of caring for your child and the family. It is important for you to seek help when you need and accept help when offered. Caring for others at the expense of caring for yourself is not healthy in the long-term, and it is important to recognise and respond to your own needs to prevent emotional burnout.

Try to make self-care a priority. Eat healthily, get plenty of sleep, and get some regular exercise. Nurture your relationships and find a trusted person to confide in. Talk to your GP and seek professional psychological help if you need. Be realistic about what you can achieve and try not to do it all.

The importance of research

You might be asked if you and your child are willing to give samples, such as a small amount of hair or blood, or a urine or stool sample. A hair sample gives a good indication of stress through the measurement of cortisol levels, and if we collect hair at the time of burn, and then a few months later, we can see how stress levels have changed for you and your child. If your child needs to have an operation, we might ask for a blood sample when they are asleep. From these samples we can measure their immune responses to the burn. When we combine the information from these samples with clinical data from a large number of patients, we hope to see the differences that are important in determining their recovery. We can then use this to guide our clinical care to be the best for each individual.

Research studies will likely be offered to you and your child, but they are always voluntary, and if you choose not to take part, that is perfectly fine. You will always receive the best care from our team regardless of whether or not you choose to be involved in the research.

Help and support

It’s important to know and think about the best places for you to seek help and support when your child comes home. The following are some options.

Medical support from:

1. the outpatient clinic and burns team
2. your family doctor.

Other support from:

1.  organisations eg Ngala
2. your friends and family
3. other people in the community eg school, church group, sporting club.

Remember:

• Don’t be afraid to ask for help.
• Don’t be afraid to accept help.
• Outpatient appointments are important for your child’s recovery.
• Remember to bring your questions
• and write down the answers.

More Than Skin Deep | Supporting your child at home information sheet - PDF Download CLICK HERE  

This resource has been developed to assist those supporting a child or young person who is recovering from a burn and is suitable for teachers, coaches, friends, and community members.

It will provide insight into the challenges they may be facing and help to build a greater understanding of the support strategies that can be used when working with a child or young person recovering from a burn.

It will take 20 minutes to complete and includes information, podcasts and videos.