Mobilization in Children With Burns in the Pediatric Intensive Care Unit: Outcomes and Barriers

Pediatric patients with burn injuries in the intensive care unit require the care of a multidisciplinary team. Occupational and physical therapists play a vital role in edema management, positioning, orthoses fabrication, and advancement of functional and developmental activities. Early mobilization in the intensive care unit is increasingly recognized as the standard of care for pediatric patients. However, outcomes and barriers specific to the pediatric burn population have not been evaluated. This study aimed to describe early mobilization practices in pediatric patients with burn injuries, identify the barriers to their participation, evaluate changes in mobility levels throughout intensive care unit admission, and examine the impact of total body surface area burn on mobility progression. We retrospectively reviewed 108 children with burns who were admitted to the intensive care unit at a pediatric burn center. Patient demographics and therapy visit-level data within the first 14 days of intensive care unit admission, which included level of activity performed and barriers to participation, were analyzed. Children with higher total body surface area burns had significantly lower levels of activity (P = .002). Barriers to therapy participation were common with 66% of children missing at least 1 physical therapy session and 55% missing at least 1 occupational therapy session within the first 14 days of intensive care unit admission. The most common barriers included patient involvement in testing or procedures (54%) and nursing concern about medical status (12%). Future research and quality improvement initiatives should prioritize interventions that address and mitigate barriers to implementation of early mobilization in this patient population.