Visible scars and self-esteem in pediatric patients with burns

The supposition of often made that visible scarring is more psychologically damaging than are "hidden" burn scars, but little evidence exists to support that idea. We compared the self-evaluations of 28 male and 21 female pediatric patients with burns to the amount and visibility of scars. Males were 6 to 18 years old at the time of burn and sustained 15% to 99% total body surface area burns. They were evaluated 1 to 6 years after their burn injury. Females constituted a similar group. They were 5 to 18 years old at the time of burn, sustained 15% to 94% total body surface area burns, and were evaluated 1 to 7 years after their burn injury. All of the children underwent evaluation with the Piers-Harris Children's Concept Scale, evaluating themselves on intellectual and school status, physical appearance, anxiety, happiness and satisfaction, and behavior and popularity. Scores from these parameters were compared against each child's "visible" scars as seen on the face, head, neck, and hands. Also, comparisons were made with the numbers of reconstructive needs in these areas. Significant inverse correlations were found in the males. As the number of scars increased in these areas, the patient's scores for "physical appearance" and "happiness and satisfaction" decreased (p < 0.001). Other psychologic parameters were not affected. There was no effect by age of patient, and no significant correlations were found for the female group. The results emphasize the importance of the burn team's awareness that pediatric survivors of burns may appear superficially to be adjusting well, while harboring grave self-deprecating feelings. Those with "visible" scars will need special support to enhance self-esteem.