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The role of parental acute psychological distress in paediatric burn re-epithelialization
Erin A Brown1,2, Alexandra De Young1, Roy Kimble1,3
1Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, South Brisbane, Qld, Australia.
Insights
Parental post-traumatic stress symptoms (PTSS) significantly delay a child's burn wound re-epithelialization, even after accounting for child pain. This highlights the crucial role of parental psychological well-being in pediatric burn recovery.
Area of Science:
- Pediatric Burn Care
- Wound Healing Research
- Psychological Impact on Physical Recovery
Background:
- Parental acute psychological distress is common after pediatric burns and linked to child distress.
- Psychological stress and pain are known to affect wound healing in various populations.
- Parental distress can influence a child's procedural coping and overall recovery.
Purpose of the Study:
- To investigate the impact of parental acute psychological distress and observed behaviors on a child's re-epithelialization rate.
- To determine if parental distress influences wound healing independently of child procedural distress.
- To identify key factors predicting the time to re-epithelialization in pediatric burn patients.
Main Methods:
- Prospective observational study with longitudinal outcome assessment.
- Recruited 83 parents of children aged 1-6 years with burns.
- Measured parental psychological distress (PTSS, guilt, fear, anxiety/depression) and observed parent-child behavior during dressing changes. Child procedural distress (pain, fear) was reported by parents and nurses. Re-epithelialization time was determined by consultants.
Main Results:
- Wound depth and size explained 28% of the variance in re-epithelialization time.
- Child peak-procedural pain accounted for an additional 6% of the variance.
- Parental post-traumatic stress symptoms (PTSS) significantly accounted for an additional 5% of the variance in re-epithelialization time.
Conclusions:
- Parental PTSS is a significant, yet often overlooked, factor influencing pediatric burn re-epithelialization.
- The association between parental PTSS and delayed wound healing is independent of child procedural pain.
- Further research is needed to elucidate the mechanisms underlying this parental psychological influence on pediatric burn recovery.
Objectives:
Following a paediatric 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. The influence of psychological stress and perceived pain on wound healing has been demonstrated in several laboratory and medical populations. This paper investigates the influence of parental acute psychological distress and procedural behaviour on the child's rate of re-epithelialization, after controlling for child procedural distress.
Design:
A prospective observational study with longitudinal outcome.
Methods:
Eighty-three parents of children 1-6 years old reported acute psychological distress (post-traumatic stress symptoms [PTSS], guilt, pre-procedural fear, general anxiety/depression symptoms) in relation to their child's burn. A researcher observed parent-child behaviour at the first dressing change, and parents and nurses reported child procedural distress (pre-, peak-, and post-procedural pain and fear). These variables, along with demographic and injury information, were tested for predicting time to re-epithelialization. Date of re-epithelialization was determined by the treating consultant.
Results:
Days to re-epithelialization ranged from 3 to 35 days post-injury. A hierarchical multiple regression analysis found wound depth and size significantly accounted for 28% of the variance in time to re-epithelialization. In Block 2, child peak-procedural pain significantly accounted for 6% additional variance. In Block 3, parental PTSS significantly accounted for 5% additional variance.
Conclusions:
Parental PTSS appears to be an important but under-recognized factor that may influence their child's burn re-epithelialization. Further investigation is required to understand the mechanisms contributing to this association. Statement of contribution What is already known on this subject? Psychological stress delays wound healing, and this relationship has been found in paediatric burn populations with procedural pain. Parental psychological stress is often present after a child's burn and is related to the child's procedural coping and distress. What does this study add? Parental post-traumatic stress is related to delayed child burn re-epithelialization. This association is in addition to procedural pain delaying re-epithelialization.
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