Having a burn injury is a hard experience for children, their parents and guardians, and their families. But it is also an opportunity to build resilience. Resilience is the ability to adapt and overcome challenges. Resilience also refers to the ability of other people and systems to help the child overcome challenges. Children who are resilient often have caring and engaged parents or guardians, a supportive extended family, support from a burn center and their community, and supportive schools. This fact sheet is meant to help parents and guardians understand possible emotional reactions after a burn injury and to provide strategies that promote resilience.

What to Expect Right After the Burn Injury

Recovery from a burn injury can be difficult; however, there are many ways to support children during this process. Children can respond to trauma in various ways, depending on their age, personality and developmental stage, making it difficult for parents to determine when their child might need help. It is normal to see some dramatic changes in behavior initially following a trauma and during the acute hospitalization. You can help to build your child’s resiliency after the injury. Resiliency is the ability to overcome challenges and bounce back stronger. You should always consult your child’s medical team at your local burn center for help with these issues.

What Are Common Behavior Changes?

Burn injury can be stressful on children and their families. Some children may have dramatic changes in behavior and emotions after a burn. Anxiety, sadness, irritability, and adjustment problems are some of the many changes that children experience and parents often see. For some children, these changes last only a short time, but other children may struggle for weeks or months to adjust to life after a burn. No two children respond the same way. A child’s response to a traumatic event can vary based on their age, personality, developmental stage, and the social support they receive. Several reactions are common following a burn injury:

  • Sadness and withdrawal. Your child may be quiet and may not want to talk to others. They may appear sad, have little interest in activities, or seem more emotional than normal.
  • Regression. Your child may act younger than his or her age. For example, a preschool-aged child who was toilet-trained may go back to using diapers. An older child may be less independent or suddenly rely heavily on a parent or guardian.
  • Loss of independence. Your child may be needy and less sure of themselves.
  • Fear. Your child may be afraid of being alone and may have strong reactions to anything that reminds them of the burn.
  • Separation anxiety. Your child may get upset about being away from parents or loved ones.
  • Sleeping problems. Your child may not be able to fall sleep or stay asleep.
  • Nightmares. Your child may have nightmares.
  • Irritability or aggression. Your child may be angry or moody or lash out.
  • Appetite changes. Your child may not want to eat or may want to eat too much.
  • Adjustment difficulties. Your child may have a tough time adjusting to the hospital or to changes that have occurred because of the burn.

These changes in behavior may recur, even after treatment. Some children may have new emotional changes or changes in behavior as new stressors arise.

What Is Acute Stress Disorder and Post-Traumatic Stress Disorder?

Some children have strong reactions after a traumatic burn injury, including

  • Feeling like the burn is happening all over again,
  • Having nightmares,
  • Feeling edgy or overly anxious,
  • Being overly on guard about getting burned again, and
  • Trying to avoid anything that reminds them of the burn.

All these reactions, called acute stress symptoms, are normal in the first three days after the burn injury. The reactions typically go away with time and support. If they don’t get better or if they interfere with the child’s ability to function, the child may develop acute stress disorder (if occurring within one month of the injury) or posttraumatic stress disorder (PTSD) (if the symptoms persist for months after the injury). The good news is that there are several effective treatments for posttraumatic stress, and most children recover fully. Parents and siblings may also experience symptoms of PTSD. To learn more about the symptoms of acute stress disorder and PTSD, please see the following fact sheet: https://msktc.org/burn/factsheets/PTSD-After-Burn-Injury.

Building Resilience in Children

Parents and guardians are an important part of a child’s emotional recovery. Positive family support is one of the biggest predictors of a child’s recovery and adjustment. You can help your child by being present and available, listening to them, and validating his or her concerns. It is also important to model a positive, hopeful, and adaptive way of reacting to challenges. Children look to their parents and guardians for cues on how to react to difficult situations; you can serve as a model for your child as they navigate this difficult time. One of the best ways to model positive coping is to return to a normal routine as soon as possible, and wound care, stretching, etc. can be worked into this routine. Children thrive in environments that are predictable. Having a predictable schedule and routine that closely mirrors what they were doing before the burn is important. This includes returning to school as soon as they can and the parent(s) returning to work as soon as possible after the burn.

Some children may want to talk about the event and/or burn; for these children, it can be helpful to let them talk about their experiences and answer questions. It’s also helpful to gently make sure that the child ends their burn story with the understanding that the burn event is over and that they are safe. Other children may not be ready to talk about their burn, and that is okay. There is no need to push your child to talk. Respect how your child responds and watch for signs of anxiety or discomfort. Some children may not be able to communicate their needs verbally, but you can still watch their behavior for clues of what they need. Reach out to your burn care team or pediatrician who can put you in touch with a mental health professional with training in trauma care if your child:

  • Has a change in behavior that lasts for one month after coming home from the hospital. There is a typical period of adjustment after a burn injury. However, if your child’s behavior hasn’t returned to what it was before the burn within a month after their injury, think about getting help.
  • Has behaviors that get in the way of returning to normal routines. For example, your child may be physically ready to return to school, but they may be scared and not want to leave home.

There are several ways to help your child build resilience after a burn:

  • Spend time with your child through play, talking, fun activities, and shared activities. Make sure that your child feels loved, safe, and valued.
  • Build self-esteem and confidence in your child by allowing them to have as much control and independence as they can handle in a responsible way. Encourage your child to make choices after the burn, even if they are small choices. Encourage your child to problem solve when faced with difficulties. Praise your child when you see them trying to respond well to challenges.
  • Model how to respond to challenges in a positive way. It may be helpful to think out loud to help your child understand your thought process. Accept that your child may look differently now. Your child may have a difficult time accepting that they look different from their peers. What your child needs first is acceptance from you—the parents.
  • Have the same rules and expectations for your child after the burn as you did for them before the burn. After a burn, parents might have the tendency to go easy on their child or not enforce rules about behavior. This can cause a child to worry. For example, they may start thinking, “I must be really hurt if my mom/dad is letting me get away with this.” Your child may not be able to do the same chores that they did before the burn. But you can find appropriate chores that your child can do to contribute to the family.
  • Help older children find meaning in what they have been through. Many older children struggle with how much their lives have changed after a burn. But over time, these children may also experience some positive changes, called posttraumatic growth. Dealing with adversity leads to growth. Help your child to identify personal strengths and new activities and help them feel hope for the future.
  • Connect with family, community, or religious supports. Make sure that your child has support from close family members and loved ones. Consider introducing your child to other children who have had a burn injury. Your area may offer summer camps for children with burn injuries. Ask your local burn provider for a list of these camps.
  • Ask if your hospital has school re-entry services. Work with your child’s school to make sure that staff are ready to support your child when they return to school.

Parental and Sibling Reactions to a Child's Burn

Parents or guardians and siblings may also have stress symptoms after a child’s burn. This is known as secondary traumatic stress. These feelings are expected and common. It is important for parents and guardians to recognize their own emotional reactions to their child’s burn injury and to take care of themselves and seek help if the reactions don’t go away with time.

Things you can do:

Take time for yourself. Get back into the activities that relax and energize you. Socialize with friends, meditate, take walks, and connect with your spouse. It is important for your child to see that you are getting back into your normal routine.

Make sure that you eat well, get enough sleep, and exercise. It is important for you to be physically and emotionally healthy so that you can be the best support for your child.

Recognize when you feel sad or guilty about your child’s injury and recognize when these feelings affect your parenting. For example, if you feel guilty, you might be more lenient and less strict about your child’s behavior. You might let them get away with talking to you disrespectfully. You might allow your child to make demands or give them a lot more gifts than you normally would. These changes in your parenting style can have a negative impact on your child. Instead, say, “I love you enough to know that you will get through this and we will be cheering you on.” If you always rescue your child from discomfort and frustration, they may not learn how to handle such emotions and challenges. Believe in your child’s strength, and they will believe in themselves.

Consider peer support by asking your burn center to introduce you to other parents who have a child with a burn injury. The Phoenix Society trains peer supporters through its SOAR program and offers online support groups for parents of children with burn injuries.

Consider seeking counseling for more support.

Siblings are also affected by the burn injury. Consider the following when supporting siblings:

  • Always include siblings in discussions about the burn injury. Never blame siblings for the circumstances of the burn.
  • Give extra attention or spend one-on-one time with your other children if you are able.
  • Seek out camps or support groups for siblings of survivors of trauma.
  • Consider getting siblings involved in caring for your child with a burn. Let siblings help IF THEY WANT TO, but don’t force them to help. Encourage siblings to get back to their own activities.
  • Consider seeking counseling for siblings if they are struggling.

Stressful life events, such as a burn, will happen. But you can choose to use those events to build resiliency in your child, so that they don’t feel like a victim or more vulnerable.

Resources

The National Child Traumatic Stress Network: https://www.nctsn.org/audiences/families-andcaregivers

The Phoenix Society: http://www.phoenix-society.org

The Knowledge Translation Center Fact Sheet on PTSD: https://msktc.org/burn/factsheets/PTSDAfter-Burn-Injury

 

Authorship

Help Your Child Recover—Build Your Child’s Resilience After a Burn Injury was developed by Shelley Wiechman, PhD, ABPP; and Brent Smith, PhD, in collaboration with the Model Systems Knowledge Translation Center.

Source: The health information content in this fact sheet is based on research evidence and/or professional consensus and has been reviewed and approved by an editorial team of experts from the Burn Injury Model Systems Program.

Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider about specific medical concerns or treatment. The contents of this fact sheet were originally developed under a grant (number H133A110004) from the U.S. Department of Education, National Institute on Disability and Rehabilitation Research. It was updated under the American Institutes for Research Model Systems Knowledge Translation Center, with funding from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant numbers 90DPBU0004 and 90DP0082). NIDILRR is a Center within the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS). The contents of this fact sheet do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government.

Copyright © 2022 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.

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