The burned child : scarred for life? : a study of the long-term psychosocial adjustment of paediatric burn survivors

Master Thesis


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Paediatric bum injury is a significant social problem in South Africa. Despite the magnitude of the problem and its potentially devastating physical, psychological and social consequences, the plight of bum-injured children in the local context is an unrecognized one, and has thus escaped empirical scrutiny to date. The purpose of this study is therefore to investigate the long-term psychosocial sequelae of children who survive thermal injuries with a view to determining their obstacles to optimal psychological functioning and social reintegration. It is intended that the findings of this research be utilized in the development of a contextually appropriate rehabilitation programme for these children. The sample comprised 40 paediatric bum survivors ( referred to as the participants) between the ages of 8 and 21 years and their respective caregivers, all of whom were recruited from the admission records to the Red Cross War Memorial Children's Hospital and the Tygerberg Hospital. Data was collected from three sources: the medical records of each of the participants, and by conducting semi-structured individual interviews with each of the 40 participants and their caregivers. The content of the interviews aimed at eliciting a rich and contextually situated description of the bum injury, its subsequent treatment, the nature of the behavioural and emotional distress experienced by the participants and their scholastic adjustment. The effect of paediatric bum injury on the family and the caregivers' use of social support resources were also explored. A substantial component of the interview focused on the impact of disfigurement on the social relationships of the burned child. The participants' use of coping strategies and social support in mediating against the negative effect of strained social interactions was also considered. The interviews concluded with an investigation of the future prospects of the participants as voiced by themselves and their caregivers. The data was analysed by conducting a thematic analysis of the narratives of the participants and their caregivers. In terms of the findings, the participants and their caregivers chronicled may challenges with post-bum adjustment, both psychologically and socially. The emotional and behavioural difficulties experienced by many of the participants included depressive, suicidal and anxious behaviour; changes in sleeping patterns; lack of bladder and bowel control; and general delinquent conduct such as lying, stealing and promiscuity. Furthermore, many participants evidenced poor scholastic adjustment and significant academic lag. Social ridicule in the form of name-calling and bullying, evoked by the participants' disfiguring bum scars, was found to be a pervasive problem, particularly at school. The challenges experienced by the participants in social interactions were compounded by their lack of adaptive strategies for coping with the consequences. of their injury. The responses of the caregivers in this research provided testament to the notion that paediatric bum injury is an assault on the family as a unit, and has ramifications that extend beyond the burned child. The limited social resources available to these caregivers complicated the daunting task of caring for a burn disfigured child in the long-term. The findings of the present research therefore clearly indicate that children who sustain bums as well as their caregivers are a population greatly in need of intervention to provide adequate preparation for the psychosocial consequences of a bum injury. As such, several contextually appropriate recommendations are suggested. These include the implementation of a school reintegration programme, the introduction of bum camps, the creation of a full-time post for a social worker or psychologist.inJhe Bums Unit, establishing support_groups for both bum-injured children and their caregivers, and the .. need for education regarding the prevention, causes and treatment of paediatr:ic bum injury.