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Scar Perception in School-aged Children After Major Surgery in Infancy
C Imren1, H IJsselstijn1, M J Vermeulen2
1Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015 CD Rotterdam, the Netherlands.
Insights
Most children perceive childhood surgery scars neutrally or positively, with little impact on quality of life. However, some girls experience negative perceptions, highlighting the need for ongoing scar assessment and support.
Area of Science:
- Pediatric Surgery
- Psychological Impact of Scars
- Child Health Outcomes
Background:
- Long-term effects of childhood surgery scars on well-being are not fully understood.
- This study investigates scar perception and its psychological impact in school-aged children.
Purpose of the Study:
- To assess how children perceive surgical scars.
- To determine the association between scar perception and health status, quality of life, self-esteem, and body image.
- To identify factors influencing negative scar perception and embarrassment.
Main Methods:
- Retrospective cohort study of 454 children (8-17 years) post-surgery.
- Utilized patient-reported outcomes for scar perception and embarrassment.
- Included psychological assessments via questionnaires.
Main Results:
- 34% found scars 'nice-looking', 49% 'indifferent', 12% 'ugly'.
- 91% reported no scar embarrassment; 3% frequent embarrassment.
- Negative perception linked to lower self-esteem in girls and poorer body image in boys.
- Girls reported negative perceptions (OR: 1.54) and embarrassment (OR: 4.29) more often.
Conclusions:
- Childhood surgical scars are generally perceived neutrally or positively, with minimal impact on health status and quality of life.
- Negative scar perception and embarrassment are uncommon but more prevalent in girls.
- Routine scar assessment at ages 12 and 17 is recommended, with support for at-risk children.
Background:
The long-term effects of childhood surgery scars on health status, quality of life (QoL), self-esteem, and body image remain uncertain. This study explores these effects in school-aged children.
Methods:
We conducted a retrospective cohort study involving 454 children (58% boys; 8-17 years) who had undergone surgical correction of anatomical anomalies or neonatal ECMO. Data included patient-reported scar perception and scar-related embarrassment, along with psychological assessment via questionnaires.
Results:
About 34% of children rated their scars as 'nice-looking', 49% as 'indifferent', and 12% as 'rather ugly'. Most children (91%) never experienced scar-related embarrassment, while frequent embarrassment was reported by 3%. Surgical scar correction was desired by 6% of the 8-year-olds and 19% of the 17-year-olds. Scar perception did not significantly affect health status or QoL. However, negative scar perception was associated with lower self-esteem in girls and a more negative body image in boys. Girls were more likely to report negative scar perception (OR: 1.54, 95%-CI: 1.06-2.24) and scar-related embarrassment (OR: 4.29, 95%-CI: 1.77-10.44).
Conclusion:
Children who underwent surgery in the neonatal period and subsequently grew up with scars resulting thereof, mostly perceive them either indifferently or positively, with minimal effect on health status and QoL. Nonetheless, some children, particularly girls, experienced negative perceptions of their scars, although scar-related embarrassment was rare. We recommend integrating scar assessment into routine follow-up at ages 12 and 17, and offering appropriate and timely guidance and support to children at risk for negative effects of scars.
Level Of Evidence:
III.
