Pediatric burn survivor psychosocial and family outcomes

Overview¶

A child's burn injures the whole family. The acute wound closes, but the psychosocial work runs for years, and it runs in parallel through the child and through the parents who watched it happen. From a combined child-and-family perspective, the empirical literature shows that child anxiety, traumatic stress reactions, and behavioral problems are considerably prevalent in the first months after the burn event, and that some children go on to long-term problems including anxiety, depression, and difficulties with social functioning ^[1]. The dimension that recurs most consistently is not the burn itself: child peritraumatic anxiety and pain, parental post-trauma psychological reactions, and family functioning are the factors most reliably associated with child outcome ^[1].

That framing matters clinically because it relocates part of the treatment target. The quality of family support has been described in long-term follow-up as the single most important factor influencing a survivor's postburn adjustment ^[10], and in pediatric cohorts good family relationships and younger age at injury were the only significant predictors of good quality of life ^[11]. Parental adjustment and the child's premorbid psychological functioning carry measurable predictive weight in meta-analysis ^[13]. The burn team that screens and supports the parents is, by this evidence, also treating the child.

This page centers the pediatric patient and the family. Where adult-cohort findings are cited, they are used only because they directly inform pediatric care — for example, an adult-cohort adverse-childhood-experiences study that bears on risk screening — and that adult scope is named where it appears. The locked evidence base spans landmark 1980s–1990s pediatric adjustment work through 2026 systematic reviews, so the historical depth here is deeper than on the broader survivor-outcomes parent page.

Epidemiology¶

Pediatric burn injury produces a measurable mental-health signal that begins in the acute phase. Pediatric burn patients often exhibit acute stress disorder symptoms during and shortly after the admission ^[4]. The signal carries into adolescence: in an at-risk adolescent burn-survivor cohort, just over half (52 percent) met criteria for one or more psychiatric disorders and 22 percent had two or more diagnoses, with anxiety disorders the most common at 36 percent ^[55]. In a cohort assessed against DSM-IV criteria, eight children (18.6 percent) met criteria for current post-traumatic stress disorder, and children with PTSD reported impaired overall health-related quality of life with limited physical and emotional functioning ^[3]. These symptoms persist: in a prospective burn cohort, more than half the sample reported recurrent intrusive recollections of the injury at both 1 month and 1 year ^[53], and the authors concluded it is common for patients to carry some post-traumatic symptoms a year out, with early symptoms potentially associated with the development or maintenance of PTSD ^[53]. The empirical literature reviewed from a child-and-family perspective confirms that child anxiety, traumatic stress reactions, and behavioral problems are considerably prevalent in the first months after the burn event ^[1].

The risk pathway is not simply a function of burn size. A prospective pathway model traced PTSD in acutely burned children from the size of the burn and the level of pain, through the child's level of acute separation anxiety, and then to PTSD — placing acute pain and acute dissociation on the causal route to later stress symptoms ^[5]. This is why later sections treat acute pain control as a psychosocial intervention, not only an analgesic one.

The parents are part of the epidemiology. A 2024 systematic review found that post-traumatic stress symptoms within 12 months following a child's burn injury ranged from 6 to 49 percent across studies, with parental PTSD prevalence estimates ranging from 4.4 to 22 percent ^[2]. An earlier multicenter study reported that between 69 and 33 percent of parents reported clinically significant anxiety and between 44 and 22 percent reported clinically significant depression at the inpatient and outpatient stages, respectively ^[16].

Pediatric burn risk is also socially patterned, which shapes who arrives with the heaviest psychosocial load. A systematic review of social complexity found increased pediatric burn incidence in lower-income families, in children with behavioral disorders, with fewer years of parental education, and in children residing in rural settings ^[48]. A 2026 thematic review of pediatric burns in Saudi Arabia described a population predominantly of household scalds in young children, producing long-term disability from scarring, contractures, pain and itch, psychosocial distress, and disrupted schooling ^[9].

Screening and assessment instruments¶

Burn-specific pediatric outcome measures¶

Pediatric burn outcomes require instruments built for children and for proxy reporting. The American Burn Association/Shriners Hospitals for Children Burn Outcomes Questionnaire (BOQ) is a burn-specific quality-of-life instrument for children; the Indian Hindi adaptation has been shown to reliably predict quality of life for children with burns ages 5 to 18 ^[29]. The Brisbane Burn Scar Impact Profile (BBSIP) was developed as a patient-reported, evaluative HRQoL measure for the impact of burn scarring in children and adults, with separate versions including caregiver proxy reports for young children ^[30]. The caregiver-report BBSIP0-8 is a validated proxy measure of burn-scar-specific HRQoL for children under eight in the early post-acute period ^[31].

The School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE5-12) profile organizes pediatric outcomes into three thematic domains: physical functioning (fine and gross motor, pain, skin symptoms, sleep and fatigue, physical resilience); psychological functioning (cognitive, behavioral, emotional, resilience, body image); and family and social functioning (family relationships, parental satisfaction, school, peer relations, community participation) ^[32]. The Burns-Child Adult Medical Procedure Interaction Scale (B-CAMPIS) was developed and validated as a reliable, valid observational measure for assessing coping and distress relationships in young children and their families during procedures ^[33]. A 2026 policy review proposed a minimum national pediatric outcome set spanning scar quality, joint range of motion, age-appropriate pain and itch scales, HRQoL instruments, and school reintegration ^[9].

Screening for child and parental distress¶

Early screening is the recurring recommendation across the family unit. A multicenter family-services study concluded that screening should be a routine part of care, having documented clinically significant parental anxiety and depression ^[16]. For the youngest children, an early risk screener (the PEDS-ES) allows successful early screening of preschool-aged children after a single accidental trauma ^[34]. Risk-factor inventories for PTSD screening in young children incorporate parental variables — preexisting child behavioral problems, parental chronic mental or physical illness, pretraumatic family life events, and parental guilt feelings — making the screen a family-level instrument ^[34].

Adverse-childhood-experience screening has also been studied. In an adult burn cohort, patients with high ACE burdens were less resilient under stress and more likely to screen positive for probable PTSD; the authors suggested ACE screening may help detect burn patients at risk for a more complicated recovery ^[35]. That cohort is adult, but the screening logic applies directly to pediatric risk stratification.

Management¶

Acute pain control as psychosocial prevention¶

Because acute pain sits on the causal pathway to later stress symptoms ^[5], controlling it has psychosocial yield. The mechanism is partly learned: pain, novelty, and altered reinforcement schedules elicit instinctive escape and avoidance behaviors that complicate wound care, and classical conditioning transforms previously neutral stimuli into anxiety-producing, fearful ones ^[57]. A prospective randomized controlled trial found that the incidence of PTSD in children managed with stepwise acute pain management within one month after injury was 3.12 percent (3/96), significantly lower than 14.43 percent (14/97) in the traditional pain-management group ^[36]. Procedural distraction interventions reduce pain and anxiety across a wide range of pediatric ages and are among the best-supported behavioral tools in the acute setting.

Virtual reality is the most consistently studied modality. A 2025 systematic review and meta-analysis in pediatric burn wound care reported that VR was associated with reduced pain scores (SMD -1.44; 95 percent CI -2.03 to -0.85) and anxiety scores (SMD -0.61; 95 percent CI -0.93 to -0.29) and decreased the time patients spent thinking about pain ^[39]. A separate 2026 pediatric systematic review and meta-analysis across the care continuum reported a significant, consistent VR effect on procedural pain (pooled SMD -0.95; 95 percent CI -1.31 to -0.59) ^[40], and a 2025 technology-assisted review concluded VR and similar tools are promising and effective for reducing pain in pediatric and adolescent burn patients ^[41]. In a randomized controlled trial in children aged 7 to 12, the VR group showed significantly lower pain, fear, and anxiety during burn dressing than no-VR controls ^[42].

Pharmacologic prevention of post-traumatic stress¶

Pharmacologic prevention of pediatric burn PTSD has been tested but remains unsettled. An early pilot reported that pediatric burn patients with acute stress disorder symptoms responded to low-dose imipramine ^[4]. A randomized controlled trial of sertraline found it was a safe drug and somewhat more effective than placebo at preventing PTSD symptoms according to parent report, though not by child report, suggesting sertraline may prevent the emergence of PTSD symptoms in children ^[37]. By contrast, a randomized trial of acute propranolol found the prevalence of PTSD, anxiety, and depression was similar in children who received propranolol acutely and those who did not ^[38]. A yearlong oxandrolone-plus-propranolol regimen has been studied for combined reduction of postburn scarring and improvement of long-term psychosocial outcomes in children with massive burns ^[43].

Family-directed and resilience interventions¶

Several interventions treat the parent or the parent-child dyad rather than the child alone. A controlled trial of the Family-Centered Empowerment Model reduced parental stress and improved the quality of life of children aged 1 to 12 with chemical burns ^[19]. A quasi-experimental study of a resilience-training program for mothers and their hospitalized children significantly reduced anxiety levels in both mothers and children over time ^[20]. A separate randomized controlled trial of maternal resilience training produced greater improvements in child pain intensity and in maternal resilience in the intervention group ^[21]. Cosmetic camouflage delivered to children with burn scarring produced significant improvements in socialization, school, and appearance scales on the Paediatric Quality of Life Inventory, with peer-problem psychopathology scores decreasing ^[25].

Complications¶

Body image and identity in the developing child¶

Disfigurement lands differently on a child because the self is still forming. Pediatric burn survivors must often live with permanent disfigurement and physical disabilities ^[52]. Because young children are actively developing the concept of self, severe facial burns can alter a child's sense of identity and place the child at high risk for future emotional and psychological disturbance ^[22]. Appearance concern is common and time-varying: in a youth burn cohort, approximately 20 percent reported appearance concerns over the first 2 years, after which the rate declined gradually to around 10 percent after 3 years ^[6]. Health-related quality of life in children after burns generally increases over time, but longer-term problems persist specifically in the domains of parental concern and appearance ^[7].

Persistent and time-varying psychological problems¶

Not every burned child develops chronic psychopathology, and several cohorts are reassuring. In a 10-year-post-burn adolescent cohort, levels of problem behavior were similar and levels of depression lower than in comparable reference populations ^[24]. A long-term study described pediatric burn survivors as young people of average intelligence, still in school or employed, and within normal limits on measures of psychological adjustment ^[50]. A Finnish follow-up found re-examined patients had good school marks and educational qualification rates that did not differ from the national average ^[51]. The clinically useful reading is that outcomes are heterogeneous: many children adjust well, a minority develop persistent anxiety, depression, and social-functioning difficulty ^[1], and the task is to identify the minority early.

Special Considerations¶

Caregiver, parent, and family burden¶

The family is both an affected party and a determinant of the child's recovery. Following a pediatric burn, parents commonly experience high levels of acute psychological distress, which has been shown to increase child psychological distress as well as child procedural distress ^[14]; parental post-traumatic stress has even been related to delayed child burn re-epithelialization ^[14]. More mothers than fathers reported clinically significant acute stress reactions, and both parents are seriously affected by their child's burn trauma ^[15]. Maternal anxiety scores were higher in burn families than in fracture or non-injured comparison groups and remained comparatively high six months later even as they decreased over time ^[17]. Vulnerability markers for parental distress included lower emotional stability, younger maternal age, and poorer family functioning ^[16]. The parent-child asymmetry is striking even at the extremes of injury: in a cohort of 25 children surviving burns of 80 percent or greater total body surface area, the children's behavioral problems as reported by parents and teachers were within normal limits, yet measures of parental stress clearly differentiated the burn population ^[54].

The burden extends across the whole family system. A scoping review found that parents had to endure blame, shame, and guilt; partners faced difficulty re-establishing emotional connection; siblings expressed jealousy and feeling like outsiders; and children of a burned parent dealt with exclusion from care ^[18]. Sibling perceptions of body image are shaped alongside the survivor's, with visible changes in appearance and function governing how both the childhood survivor and the siblings perceive their bodies ^[26]. In longitudinal pediatric follow-up, survivors actually scored higher than healthy children on language, emotional behavior, and family functioning domains in later months, a reminder that family adaptation can move in a positive direction ^[23].

Family functioning as a predictor of child outcome¶

Family environment is one of the most consistent levers on pediatric adjustment. Good family relationships and younger age at burn injury were the only significant predictors of good quality of life in a pediatric burn cohort, and psychological adjustment was likewise predicted by family relationships ^[11]. In young adults burned during childhood, increased family conflict was associated with decreased psychological adjustment as measured by the total problem score ^[12]. The specific family dimensions matter: on the Family Environment Scale, parents of untroubled burned children scored higher on cohesion and organization and lower on conflict than parents of troubled children, even when parental trauma reactions and depression did not differ between the groups ^[56]. Long-term follow-up has identified the quality of family support as the single most important factor influencing a survivor's postburn adjustment ^[10], and a postburn family-adaptation model describes specific interventions burn staff can make with family members to facilitate the child's adjustment ^[10]. Meta-analysis places the parental-adjustment variable and the child's premorbid psychological functioning among the measurable predictors of adjustment problems ^[13].

School re-entry and the burn community¶

Re-entry into school and social life is its own clinical milestone. The SA-LIBRE framework treats school, peer relations, and community participation as a distinct family-and-social functioning domain ^[32], and the proposed pediatric minimum outcome set names school reintegration explicitly ^[9]. Burn camp is a recurring community resource: campers describe it as a place of belonging and acceptance where they do not have to hide their bodies and can integrate their scars into their body image positively ^[27], and a literature review found burn camp can decrease camper isolation, improve self-esteem, and promote coping and social skills ^[28].

Resilience and post-traumatic growth¶

Adjustment is shaped by coping resources, not only by injury severity. An integrative review found coping strategies, premorbid psychopathology, and personality consistently featured as predictors of adjustment ^[44]. Psychological resilience partially mediated the relationship between dispositional optimism and subjective well-being in burn patients ^[45], and the strongest predictors of post-traumatic growth were active coping and social support ^[46]. These resources are modifiable, which is what makes resilience-training trials in mothers and children ^[20,21] a rational target rather than a soft adjunct.

Sex and severity gradients¶

Outcome is patterned by sex and severity within pediatric and young-adult cohorts. In a mass-casualty survivor cohort, females had worse burns, longer hospitalization and rehabilitation, and later school and social re-entry, with a higher proportion experiencing disability and mental trauma at follow-up ^[47]. In young adults burned during childhood, female survivors, those burned prior to school entry, and adolescents not yet transitioned into adulthood reported better quality of life than their counterparts, while larger TBSA, male sex, being burned after school entry, and the transition into adulthood marked the groups needing long-term psychosocial intervention ^[8].

Outcomes¶

Long-term pediatric outcomes span mental health, body image, school and social function, and quality of life, and they are heterogeneous rather than uniformly poor. Health-related quality of life in children after burns generally increases over time, with persistent problems concentrated in parental concern and appearance ^[7]. Appearance concerns affect roughly one in five youth in the first 2 years and decline thereafter ^[6]. Many survivors reach adulthood within normal limits on adjustment, intelligence, schooling, and employment measures ^[50,51], while a minority carry chronic anxiety, depression, and social-functioning difficulty ^[1]. The factors that most consistently separate good from poor trajectories are not burn size alone but child peritraumatic anxiety and pain, parental post-trauma reactions, and family functioning ^[1], with family relationships and quality of family support repeatedly identified as the dominant determinants ^[10,11]. Resilience, active coping, and social support operate as protective resources ^[44,45,46].

Controversies and Evidence Gaps¶

The largest gap is intervention evidence for long-term outcomes. A 2026 pediatric systematic review across the care continuum found that while VR has a robust effect on procedural pain, robust evidence supporting interventions for long-term psychological outcomes remains limited, and that mental-health interventions remain underutilized and inconsistently applied even though physical rehabilitation is well integrated ^[40]. Cognitive-behavioral, creative, and psychosocial interventions showed promise but varied in effectiveness ^[40].

Measurement is poorly standardized. Standardization in measurements related to quality of life and psychological stress following pediatric thermal injury is explicitly described as much needed ^[49]. The proposed pediatric minimum outcome set is a response to that fragmentation but is not yet a settled standard ^[9]. An integrative review of adjustment concluded that the field should move from identifying predictors toward clarifying the concept and parameters of psychosocial adjustment and developing and evaluating interventions ^[44].

Pharmacologic prevention of pediatric PTSD remains unresolved. Sertraline showed a benefit by parent report but not child report ^[37], and propranolol showed no significant effect on PTSD, anxiety, or depression ^[38] — leaving no clearly established pharmacologic prophylaxis and a discrepancy between parent- and child-reported endpoints that itself complicates trial interpretation. This divergence is itself a named controversy: long-term follow-up work has explicitly questioned why some researchers find that a majority of this population suffers psychological disturbance while others show a largely normal population with no premorbid psychopathology ^[58]. Several reassuring long-term cohorts ^[24,50,51] sit alongside cohorts documenting substantial persistent distress ^[1,3], and the literature has not fully reconciled which child, injury, and family characteristics drive that divergence; family functioning and parental adjustment are the most consistent candidates ^[11,13] but are not yet operationalized into a validated pediatric risk-stratification tool.

References¶

[1] Bakker A, Maertens KJ, Van Son MJ, Van Loey NE. "Psychological consequences of pediatric burns from a child and family perspective: a review of the empirical literature." Clinical psychology review 2013. PMID: 23410718. ↩

[2] Chouinard NH, Ndongo Sonfack DJ, Chang SL, Bergeron F, Beaudoin Cloutier C, Guertin JR. "Exploring the Prevalence of Post-traumatic Stress Disorder and Post-traumatic Stress Symptoms in Parents Within 12 Months of Child Burn Injury: A Systematic Review." Journal of burn care & research : official publication of the American Burn Association 2024. PMID: 38421036. ↩

[3] Landolt MA, Buehlmann C, Maag T, Schiestl C. "Brief report: quality of life is impaired in pediatric burn survivors with posttraumatic stress disorder." Journal of pediatric psychology 2009. PMID: 17890286. ↩

[4] Robert R, Blakeney PE, Villarreal C, Rosenberg L, Meyer WJ. "Imipramine treatment in pediatric burn patients with symptoms of acute stress disorder: a pilot study." Journal of the American Academy of Child and Adolescent Psychiatry 1999. PMID: 10405506. ↩

[5] Saxe GN, Stoddard F, Hall E, Chawla N, Lopez C, Sheridan R, et al. "Pathways to PTSD, part I: Children with burns." The American journal of psychiatry 2005. PMID: 15994712. ↩

[6] Weed VF, Canenguez K, Romo S, Wang SL, Kazis L, Lee AF, et al. "The Use of a Brief Measure to Assess Longitudinal Changes in Appearance Concerns for Youth Recovering From Burn Injuries." Journal of burn care & research : official publication of the American Burn Association 2019. PMID: 30371792. ↩

[7] Spronk I, Legemate CM, Polinder S, van Baar ME. "Health-related quality of life in children after burn injuries: A systematic review." The journal of trauma and acute care surgery 2018. PMID: 30256329. ↩

[8] Murphy ME, Holzer CE, Richardson LM, Epperson K, Ojeda S, Martinez EM, et al. "Quality of Life of Young Adult Survivors of Pediatric Burns Using World Health Organization Disability Assessment Scale II and Burn Specific Health Scale-Brief: A Comparison." Journal of burn care & research : official publication of the American Burn Association 2015. PMID: 25167373. ↩

[9] Ghandurah A, Alghadier M. "Rehabilitation Outcomes of Pediatric Burn Survivors in Saudi Arabia: A Thematic Narrative Review and Policy Implications." Saudi medical journal 2026. PMID: 42237971. ↩

[10] Watkins PN, Cook EL, May SR, Still JM, Luterman A, Purvis RJ. "Postburn psychologic adaptation of family members of patients with burns." The Journal of burn care & rehabilitation 1996. PMID: 8808363. ↩

[11] Landolt MA, Grubenmann S, Meuli M. "Family impact greatest: predictors of quality of life and psychological adjustment in pediatric burn survivors." The Journal of trauma 2002. PMID: 12478042. ↩

[12] Rosenberg L, Blakeney P, Thomas CR, Holzer CE, Robert RS, Meyer WJ. "The importance of family environment for young adults burned during childhood." Burns : journal of the International Society for Burn Injuries 2007. PMID: 17512667. ↩

[13] Noronha DO, Faust J. "Identifying the variables impacting post-burn psychological adjustment: a meta-analysis." Journal of pediatric psychology 2007. PMID: 16882947. ↩

[14] Brown EA, De Young A, Kimble R, Kenardy J. "The role of parental acute psychological distress in paediatric burn re-epithelialization." British journal of health psychology 2019. PMID: 31389153. ↩

[15] Bakker A, Van Loey NE, Van der Heijden PG, Van Son MJ. "Acute stress reactions in couples after a burn event to their young child." Journal of pediatric psychology 2012. PMID: 22836747. ↩

[16] Phillips C, Rumsey N. "Considerations for the provision of psychosocial services for families following paediatric burn injury--a quantitative study." Burns : journal of the International Society for Burn Injuries 2008. PMID: 17618055. ↩

[17] Kent L, King H, Cochrane R. "Maternal and child psychological sequelae in paediatric burn injuries." Burns : journal of the International Society for Burn Injuries 2000. PMID: 10751698. ↩

[18] Bayuo J, Wong FKY. "Issues and concerns of family members of burn patients: A scoping review." Burns : journal of the International Society for Burn Injuries 2021. PMID: 32534893. ↩

[19] Mohammadzadeh E, Varzeshnejad M, Masoumpour A, Ahmadimehr F. "The impact of the family-centered empowerment model on the children's quality of life with chemical burns and their parent's perceived stress." Burns : journal of the International Society for Burn Injuries 2023. PMID: 36028413. ↩

[20] Shaygan M, Dehghan Manshadi Z, Hosseini FA, Shaygan M. "Building resilience: A promising approach to reduce anxiety in mothers and hospitalized children with burn injuries." Burns : journal of the International Society for Burn Injuries 2025. PMID: 39842044. ↩

[21] Hosseini FA, Shaygan M, Shayegan M. "Effects of resilience training for mothers on maternal resilience and children's pain in pediatric burn units in a randomized controlled trial." Scientific reports 2025. PMID: 40382408. ↩

[22] Kung TA, Gosain AK. "Pediatric facial burns." The Journal of craniofacial surgery 2008. PMID: 18650717. ↩

[23] Kazis LE, Lee AF, Rose M, Liang MH, Li NC, Ren XS, et al. "Recovery Curves for Pediatric Burn Survivors: Advances in Patient-Oriented Outcomes." JAMA pediatrics 2016. PMID: 26953515. ↩

[24] Liber JM, Faber AW, Treffers PD, Van Loey NE. "Coping style, personality and adolescent adjustment 10 years post-burn." Burns : journal of the International Society for Burn Injuries 2008. PMID: 18375068. ↩

[25] Maskell J, Newcombe P, Martin G, Kimble R. "Psychological and psychosocial functioning of children with burn scarring using cosmetic camouflage: a multi-centre prospective randomised controlled trial." Burns : journal of the International Society for Burn Injuries 2014. PMID: 23770131. ↩

[26] Lehna C. "Childhood burn survivors' and their siblings' perceptions of their body image." Journal of pediatric nursing 2015. PMID: 25308398. ↩

[27] Cox ER, Call SB, Williams NR, Reeves PM. "Shedding the layers: exploring the impact of the burn camp experience on adolescent campers' body image." The Journal of burn care & rehabilitation 2004. PMID: 14726756. ↩

[28] Maslow GR, Lobato D. "Summer camps for children with burn injuries: a literature review." Journal of burn care & research : official publication of the American Burn Association 2010. PMID: 20644489. ↩

[29] Arumugam PK, Thayal PK. "Validation of Indian Adaptation of Burn Outcomes Questionnaire-Hindi Version (I-BOQ-HV) for Pediatric Subgroup 5 to 18 Years." Journal of burn care & research : official publication of the American Burn Association 2021. PMID: 33095880. ↩

[30] Tyack Z, Ziviani J, Kimble R, Plaza A, Jones A, Cuttle L, et al. "Measuring the impact of burn scarring on health-related quality of life: Development and preliminary content validation of the Brisbane Burn Scar Impact Profile (BBSIP) for children and adults." Burns : journal of the International Society for Burn Injuries 2015. PMID: 26421693. ↩

[31] Simons M, Kimble R, McPhail S, Tyack Z. "The longitudinal validity, reproducibility and responsiveness of the Brisbane Burn Scar Impact Profile (caregiver report for young children version) for measuring health-related quality of life in children with burn scars." Burns : journal of the International Society for Burn Injuries 2019. PMID: 31147101. ↩

[32] Rencken CA, Rodríguez-Mercedes SL, Patel KF, Grant GG, Kinney EM, Sheridan RL, et al. "Development of the School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE5-12) Profile: A Conceptual Framework." Journal of burn care & research : official publication of the American Burn Association 2021. PMID: 34228121. ↩

[33] Brown EA, De Young A, Kimble R, Kenardy J. "Development and validity of the Burns-Child Adult Medical Procedure Interaction Scale (B-CAMPIS) for young children." Burns : journal of the International Society for Burn Injuries 2019. PMID: 30274811. ↩

[34] Kramer DN, Hertli MB, Landolt MA. "Evaluation of an early risk screener for PTSD in preschool children after accidental injury." Pediatrics 2013. PMID: 24062371. ↩

[35] Fassel M, Grieve B, Hosseini S, Oral R, Galet C, Ryan C, et al. "The Impact of Adverse Childhood Experiences on Burn Outcomes in Adult Burn Patients." Journal of burn care & research : official publication of the American Burn Association 2019. PMID: 30873544. ↩

[36] Wang YQ, Huang JQ, Wu ZH, Chen JJ. "[Effects of stepwise acute pain management on acute pain and post-traumatic stress disorder in children with burns: a prospective randomized controlled study]." Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns 2021. PMID: 33706428. ↩

[37] Stoddard FJ, Luthra R, Sorrentino EA, Saxe GN, Drake J, Chang Y, et al. "A randomized controlled trial of sertraline to prevent posttraumatic stress disorder in burned children." Journal of child and adolescent psychopharmacology 2011. PMID: 22040192. ↩

[38] Rosenberg L, Rosenberg M, Sharp S, Thomas CR, Humphries HF, Holzer CE, et al. "Does Acute Propranolol Treatment Prevent Posttraumatic Stress Disorder, Anxiety, and Depression in Children with Burns?" Journal of child and adolescent psychopharmacology 2018. PMID: 29161523. ↩

[39] Lou J, Xiang Z, Li J, Cui S, Huang N, Jin G, et al. "The beneficial impact of virtual reality in the burn wound care of pediatric patients: An updated systematic review and meta-analysis." Burns : journal of the International Society for Burn Injuries 2025. PMID: 40763481. ↩

[40] Nguyen A, Chikoti R, Bell D. "Pain, Distress, and Psychological Sequelae in Pediatric Burn Care: A Systematic Review and Meta-Analysis of Interventions Across the Care Continuum." Journal of burn care & research : official publication of the American Burn Association 2026. PMID: 41081740. ↩

[41] Larasati A, Widyani NMS, Tania F. "Technology-assisted Pain Management in Pediatric and Adolescent Burn Care: A Systematic Review and Meta-analysis." The Journal of craniofacial surgery 2025. PMID: 39704514. ↩

[42] Kaya M, Karaman Özlü Z. "The effect of virtual reality on pain, anxiety, and fear during burn dressing in children: A randomized controlled study." Burns : journal of the International Society for Burn Injuries 2023. PMID: 35753857. ↩

[43] Herndon D, Capek KD, Ross E, Jay JW, Prasai A, Ayadi AE, et al. "Reduced Postburn Hypertrophic Scarring and Improved Physical Recovery With Yearlong Administration of Oxandrolone and Propranolol." Annals of surgery 2018. PMID: 30048322. ↩

[44] Attoe C, Pounds-Cornish E. "Psychosocial adjustment following burns: An integrative literature review." Burns : journal of the International Society for Burn Injuries 2015. PMID: 26359733. ↩

[45] He F, Cao R, Feng Z, Guan H, Peng J. "The impacts of dispositional optimism and psychological resilience on the subjective well-being of burn patients: a structural equation modelling analysis." PloS one 2013. PMID: 24358241. ↩

[46] Rosenbach C, Renneberg B. "Positive change after severe burn injuries." Journal of burn care & research : official publication of the American Burn Association 2008. PMID: 18535462. ↩

[47] Ma H, Tung KY, Tsai SL, Neil DL, Lin YY, Yen HT, et al. "Assessment and determinants of global outcomes among 445 mass-casualty burn survivors: A 2-year retrospective cohort study in Taiwan." Burns : journal of the International Society for Burn Injuries 2020. PMID: 32499049. ↩

[48] Padalko A, Cristall N, Gawaziuk JP, Logsetty S. "Social Complexity and Risk for Pediatric Burn Injury: A Systematic Review." Journal of burn care & research : official publication of the American Burn Association 2019. PMID: 30918946. ↩

[49] Partain KP, Fabia R, Thakkar RK. "Pediatric burn care: new techniques and outcomes." Current opinion in pediatrics 2020. PMID: 32371842. ↩

[50] Blakeney P, Herndon DN, Desai MH, Beard S, Wales-Seale P. "Long-term psychosocial adjustment following burn injury." The Journal of burn care & rehabilitation 1988. PMID: 3220876. ↩

[51] Zeitlin RE. "Long-term psychosocial sequelae of paediatric burns." Burns : journal of the International Society for Burn Injuries 1997. PMID: 9429023. ↩

[52] Landolt M. "[Psychological aspects of severe burn injuries in childhood and adolescence]." Praxis der Kinderpsychologie und Kinderpsychiatrie 1996. PMID: 8868969. ↩

[53] Ehde DM, Patterson DR, Wiechman SA, Wilson LG. "Post-traumatic stress symptoms and distress 1 year after burn injury." The Journal of burn care & rehabilitation 2000. PMID: 10752742. ↩

[54] Blakeney P, Meyer W, Moore P, Murphy L, Broemeling L, Robson M, et al. "Psychosocial sequelae of pediatric burns involving 80% or greater total body surface area." The Journal of burn care & rehabilitation 1993. PMID: 8300704. ↩

[55] Thomas CR, Blakeney P, Holzer CE, Meyer WJ. "Psychiatric disorders in long-term adjustment of at-risk adolescent burn survivors." Journal of burn care & research : official publication of the American Burn Association 2009. PMID: 19349893. ↩

[56] LeDoux J, Meyer WJ, Blakeney PE, Herndon DN. "Relationship between parental emotional states, family environment and the behavioural adjustment of pediatric burn survivors." Burns : journal of the International Society for Burn Injuries 1998. PMID: 9725682. ↩

[57] Thurber CA, Martin-Herz SP, Patterson DR. "Psychological principles of burn wound pain in children. I: theoretical framework." The Journal of burn care & rehabilitation 2000. PMID: 10935822. ↩

[58] Gilboa D. "Long-term psychosocial adjustment after burn injury." Burns : journal of the International Society for Burn Injuries 2001. PMID: 11348741. ↩