L. Murphy

Parental Well-Being and Behavioral Adjustment of Pediatric Survivors of Burns

Parents of pediatric patients with burns often perceive their children as troubled and having an increased number of problem behaviors. This study examines the relationship between these problem behaviors and the parents own emotional well-being. Mothers of 38 burned children completed three standardized questionnaires: Child Behavior Checklist, Parental Stress Index, and the Eight State Questionnaire. The population was further divided into troubled and untroubled by a Child Behavior Checklist total problem T score of 60. Parents were not significantly different from reference populations on most of the scales. However, the Parental Stress Index results revealed that parents who report their children as troubled are themselves stressed, not only by their childrens behaviors but in areas unrelated to their children. In addition, these mothers report often feeling depressed and guilty on the Eight State Questionnaire. This study emphasizes the need for psychological assessment of both parents and children.

Physical and psychologic rehabilitation outcomes for pediatric patients who suffer 80% or more TBSA, 70% or more third degree burns

Advances in medical management have dramatically decreased the mortality of children with massive burn injuries, which raises many questions about the expected quality of life for these young survivors. In this article, we address this issue by examining the functional and psychological adaptation of 41 young survivors with 88% mean total body surface area (TBSA) burns and 85% mean third degree TBSA burns. Patient scores were compared with normative data on standardized psychological measures of adjustment and on performance of age appropriate activities of daily living (ADL) skills. Thirty-three of the 41 patients (80%) were independent in basic ADL skills. Eighty-six percent of the patients who were aged 10 years and older were independent in advanced ADL skills. Patients with amputated fingers were significantly more dependent in ADL skills than those without amputations (P < .05). Mean psychosocial adjustment scores were within normal limits and were not significantly related to functional independence in ADL skills.

Competence and physical impairment of pediatric survivors of burns of more than 80% total body surface area

Children who survive massive burn injuries are challenged by the physical sequelae of their injuries as they return to normal daily routines. The purpose of this study was to assess the impact of physical impairment on the competence of such children as they pursued their lives. It was hypothesized that children who survive burn injuries of more than 80% total body surface area would be less competent than their unburned peers, and that competence would decrease with increased physical impairment. Competence for the 19 patients was assessed by parental report using the Child Behavior Checklist and by the patients self-report on the Youth Self-Report. Physical impairment scores were calculated from range of motion measurements of upper and lower extremities according to AMA guidelines. Competence scores for the sample were within normal ranges. Physical impairment was significantly related to competence only in the area of activity on both the Child Behavior Checklist and the Youth Self-Report.

Evaluating the psychosocial adjustment of 2- and 3-year-old pediatric burn survivors.

Very little information has been published about 2- and 3-year-old children who have experienced major burns. This study used a standardized instrument to measure the behavioral adjustment of these young burn survivors, and the results were compared with those of a nonclinical normative sample. Thirty-three pediatric burn survivors with 50%+/-28% total body surface area burns were evaluated 1.2+/-0.7 years postburn. Parental observations were assessed with the use of the Child Behavior Checklist for 2- and 3-Year-Olds, a 99-item standardized checklist designed to identify behavior problems. Forty of the questions are specific to 2- and 3-year-olds, and the scores of male and female children are not differentiated. The raw scores of the children with burns were statistically compared with the reported normative sample for this version of the Child Behavior Checklist. Pediatric burn survivors in this sample exhibited significantly more internalizing behaviors than the children in the normative group. Parents reported children who had been burned to be more depressed and to have more somatic complaints and sleep problems. Determining the relationship of behavior problems to posttrauma sequelae and preburn environmental factors would assist with the establishment of appropriate psychosocial interventions.

Inconsistencies in psychosocial assessment of children after severe burns

Health care providers usually except children with severe burns to have psychosocial problems due to the severity of the injuries and resulting deformities. To test the validity of that expectation, 72 children (43 boys, 29 girls) who had suffered severe burns were assessed at least 1 year after burn injury for behavior problems and competence, by use of the 1991 Achenbach questionnaires: Child Behavior Checklist (CBCL), Youth Self-Report, and Teacher Report Form. The scores on each questionnaire then were compared by use of paired t tests. Also, the scores of the patient population were compared with those of the nonreferred reference populations provided by Achenbach. Compared with the Teacher Report Form and Youth Self-Report, the CBCL revealed a statistically significant (p < 0.05) greater number of behavior problems and lower level of competence for all age groups and both sexes. Item analysis revealed in most instances excess endorsement of specific items on all scales for the patient population compared with their respective reference populations, but more items were endorsed on the CBCL. These results could be explained by increased parental sensitivity to problem behavior or decreased competence of their children after severe burns. Further studies are needed to understand the discrepancies between the CBCL and the other scales.