"Coming to terms" - the post-burn recovery journey of parent-child dyads: A constructivist grounded theory

Paediatric burn injuries pose a critical global health challenge, affecting millions of children annually. Beyond the immediate physical harm, burns disrupt developmental trajectories, leaving enduring psychological, physical, and relational impacts as children transition into adulthood. While advancements in acute care have improved survival rates, understanding the dyadic recovery process between parent and children remains underexplored. The prolonged and complex nature of post-burn recovery necessitates sustained caregiver support, emphasising the need to examine how parent-child dyads experience and collectively navigate this journey.

To generate a theory explaining how parent-child dyads experience and navigate through the post-burn recovery process.

Constructivist grounded theory.

Paediatric burn survivors with a discharge status of up to 1 month or more and their informal caregivers who were present throughout the period of hospitalisation.

Initial purposive and subsequent theoretical sampling approaches were employed. Data were collected through face-to-face dyadic interviews at mutually agreed time and locations, supplemented by field notes. Concurrent data analysis utilised constant comparative approach to iteratively refine emerging codes and categories. To ensure congruence with the dyadic interviewing approach, the constant comparative approach employed did not only focus on uncovering categories, but also the content (emerging narratives) and interaction (how parents and children communicated noting areas of convergence and divergence in their narratives).

Twenty-three (23) parent-child dyads participated in the study. The children and parents (19 mothers and 4 fathers) are aged 10-16 years and 33-49 years respectively. The core category, Coming to Terms, conceptualises the dyadic recovery journey from injury occurrence to acceptance and adaptation. Three interrelated categories characterised this process: (1) Being with Each Other in a Trauma Bubble (mutual emotional entrapment in acute distress), (2) Living with the Scars (physical and psychological marks shaping identity), and (3) Navigating the Recovery Maze (collaborative adaptation to post-burn realities). The Theory of Coming to Terms underscores post-burn recovery as an emotionally fraught negotiation marked by asymmetrical burdens for dyads, requiring reconciliation with lasting physical, psychological, and relational consequences. Although most aspects of the recovery journey showed commonalities across dyads, a notable divergence emerged in attitudes toward scars: while parents and older children tended to conceal these marks, younger children often chose to display them openly.

The findings highlight the dyadic interconnectedness in post-burn recovery, advocating for rehabilitative frameworks that prioritise both objective clinical outcomes and subjective experiences. A family-centered approach is critical to integrate ongoing support for children and caregivers.