This is a part of the podcast series from the Model Systems Knowledge Translation Center on Returning to School After Burn Injury. The Southern California Burn Model System team discusses possible psychological challenges a child may face when returning to school after a burn injury, and possible solutions. 

Challenges from a psychosocial perspective for our patients when they leave this hospital … I think the biggest one for me is that they're gonna look different than their peers. This is especially hard if they were in a classroom, had a burn injury, and are going back to the same classmates. They're gonna have scars that are visible. They might be in pressure garments, which can look very radical for people who have never seen them before. Or they might have bulky dressings because of their burn wounds. And part of our job as a burn center and as a surgeon is really to prepare patients and their parents for that transition.

We do try to start this dialogue early, whether if they're in the inpatient for long term with, long term with me, I'll start talking about it then. Otherwise, in clinic we will have a discussion about what's gonna happen next and when you go back to school. Obviously as a surgeon, I need help from the multidisciplinary burn team, so child life or psychologists, our therapists. All of these people are really involved in this process of going back to school, which can be really hard. 

I think that returning to school brings up a few challenges. It can be exciting, and also for a child returning to school after having been in the hospital and potentially with visible changes … kids are naturally inquisitive and curious and want to know about things and may have missed their friend. And so I think one of the major challenges that can happen is how the child is able to communicate about what happened and to do that in a way where they still feel like they have power over, you know, the narrative that they're able to share. Otherwise it's just a big emotional adjustment to be in the hospital, to transition home, and then to go back to school. They may have differences in their abilities or the ways that they participate and interact with others. And so adjusting to the transitions can be emotionally challenging.  

I think there's such a trauma for many children, and so there can, you know, definitely be triggers. There can be anniversaries that could upset a child, you know, and they're going to school and not everyone knows about those things, and they may be distracted easily because they're thinking or they're worried about a, something that's happening related to their medical that no one really knows about. I think there's also the emotional aspect of, you know, I, I can't do things the same way I used to. I used to run really fast, but now I can't. Or, you know, I wanted to be a soccer player and right now I can't do that. So I think there's, it really depends on what the child, what's important to the child. But there's, there are definitely a lot of different aspects that can be emotionally triggering for a child who has any type of trauma.

I think that, you know, while the child is in the hospital and going through such active and intense treatment for burn recovery, there's not as much time for emotional processing of what happened and the ability to understand and make sense of what happened also depends on the age of the child. But I think that that can be one of the challenges. You know, we recommend that children go back to school as soon as they are able, that they return back to their routine as soon as they're able to, cause we know that can help them emotionally and mentally as well. But it's not uncommon that they may be grieving and processing as they're also reintegrating. And so I think navigating that challenge of having so much going on potentially internally and the adjustments, while also trying to show up and learn and be in school can be, can be a lot. Regardless of, I think, how the kid is doing overall, which is why working with the family and the siblings and the school can be really helpful to normalize it, bring more support, and try to de-stigmatize some of the challenges that can come with it.

Most kids do just fine after burn injury. Returning to school hopefully is an exciting occasion where, we can support them and they feel supported in their journey and return back to school along with their siblings and their parents and the school environment, so the teachers. Some kids do struggle more than others, and that is totally okay. I think when that happens, our hope is that there's already a network around them, including peer support, that the school is aware, and that the family knows if they need more help or if the child needs more support, that they know where to go to ask for that. And that it's totally appropriate and good to ask for it early. 

Visit https://msktc.org/burn and get the answers you need from experts who conduct innovative and high-quality research, provide patient care, and work to improve the health and overall quality of life for people with burn injury. That’s https://msktc.org/burn.