Child Life specialists work in the inpatient units and outpatient clinics to help patients and families adjust to the health care experience. Using developmentally supportive play activities and medical play, Child Life specialists help patients adjust to the health care experience and prepare for and undergo treatments and procedures. Child Life specialists also help patients and families transition from inpatient care to outpatient care, home care and the return to school.

While going back to school can be challenging for children who have been burned, it is often beneficial for them to re-establish peer connections and re-engage in academic and social activities as soon as they are medically able. The Pediatric Burn Center offers a School Re-entry Program, in which a team from the hospital visits the child’s school to help prepare classmates and teachers for the child’s return. The program helps students understand more about burns, burn prevention and the specific needs of your child. The Child Life specialist will speak with you about setting up school re-entry for your child.

For questions regarding Child Life support in the inpatient setting, contact Peyton Hutchins at 410-502-8036. For questions regarding Child Life support in the outpatient clinic, contact Brittany Krauth at 410-614-1479.

Your child may need physical and/or occupational therapy during and after discharge from the Pediatric Burn Center. Your burn care team will assist you in arranging outpatient therapy prior to discharge or during your outpatient appointment.

Splints

If your child need splints for his arms and/or legs, your therapist will specifically fit your child for them. They need to be worn as instructed in order to prevent deformity and muscle tightness. Your child’s splints must be washed in cold water every day using a mild soap. The splint must be re-applied only when completely dry. If you notice any red, blistered areas, or if your child reports tingling, numbness or abnormal sensations while wearing the splint, remove the splint from the affected area and contact your child’s therapist immediately.

Exercise

While in the hospital, rehabilitation therapists gave your child specific exercises to do. It is important that your child continue these exercises after arriving home. It is also important for your child to gradually increase his or her activities at home. Your child’s therapist and physicians will monitor progress in the Pediatric Burn Outpatient Clinic.

Burn injuries pose an array of serious psychological issues for patients and families. In addition to the shock and stress of being acutely injured, children may face changes in appearance and threats to self-esteem, adherence to painful and chronic treatments and therapy and the toll of a long hospital stay.  Throughout the treatment process, parents and other caregivers may feel responsible for the injury and siblings may feel guilty or overlooked.  The burned child may be more clingy than usual or experience tantrums more often.  Relaxation training and distraction techniques help children manage the pain that can come with treatments. Therapy, counseling and coping strategies help patients and families cope with behavior changes and integrating back into the community and home life. In our program, all families meet with a child psychologist who focuses on the needs of the child and family to support optimal coping with this challenging experience.  Children receive a personalized assessment, ongoing monitoring and tailored interventions throughout the recovery process.

The social worker on the burn service meets with all patients and their families individually during the child’s hospitalization. During the initial interview, the social worker will ask questions about the child’s living arrangements, any prior hospitalizations and the circumstances surrounding the child’s burn injury. The emphasis is on trying to understand what the child was like before the burn, with the goal of returning the child as much as possible to that prior level of functioning.
During the child’s hospital stay, the social worker will provide initial crisis intervention, continued supportive counseling to both patient and families and referrals to community resources. The social worker will also assist families in navigating the hospital system, applying for medical insurance, lodging for out-of-town families and in meeting other needs during the child’s hospitalization. Working closely with the other members of the medical team, the social worker also helps ensure that patients’ physical, social and emotional needs are met during the hospital stay and when they return to the community.

Mechanical Debridement

Surgical wound treatment services include mechanical debridement, a procedure in which loose tissue and blisters are removed. Patients are medicated to decrease the pain, but some amount of discomfort may be unavoidable. It is necessary to remove the loose or blistered tissue in order to check the depth of the wound, decrease the risk of infection and allow medications to reach the deeper burned areas.

Skin Grafting

For third-degree, or full thickness, burns, skin grafting is used because the skin will not heal on its own. General anesthesia is administered so that the patient experiences no pain or memory of the surgery. If the burn wounds are over large areas, several trips to the operating room for grafting may be needed. The exposed healthy tissue underneath may be covered with one or a combination of the following:

• An autograft, or skin obtained from a non-burned area of the patient’s body
• An allograft, or skin obtained from a human donor
• Cultured epithelial cells, or skin that has been grown in a laboratory from a small sample of the patient’s own skin
• Integra artificial skin, composed of a top layer that serves as a temporary synthetic epidermis and a bottom layer that serves as a foundation for the regrowth of dermal tissue

The grafted area is covered with multiple layers of dressings and usually kept damp with an antibiotic solution. The dressing stays in place for three to five days. After that time, the dressings will be “taken down” to be observed by the doctors and nurses to determine how well the graft has healed. If your child has a donor site from an autograft procedure, a protective dressing will be placed over this area. The donor site will heal in about 10 to 14 days but may require dressing changes on a daily basis.