Procedural pain and parental posttraumatic stress: Consequences for young child burn wound re-epithelization

Ms Erin Brown1,2, Dr Alexandra De Young1, Prof Roy Kimble1,3, Prof Justin Kenardy2

1Centre For Children’s Burns & Trauma Research, South Brisbane, Australia, 2The University of Queensland, St Lucia, Australia, 3Pegg Leditschke Children’s Burns Centre, Lady Cilento Children’s Hospital, South Brisbane, Australia


Background. The influence of psychological stress on wound healing has been found in several laboratory and medical populations. While pain has been linked to healing previously, the role of a parent’s wound-related stress regarding pediatric wound re-epithelization has not been investigated. Methods. The current study measured several aspects of the child’s and parent’s experience at the child’s first burn dressing change, and investigated the impact on wound re-epithelization. Eighty-three families’ behaviors were observed by a researcher. Parents completed psychological distress measures (posttraumatic stress symptoms, guilt, procedural anxiety, general anxiety/depression symptoms). Parents and nurses reported the child’s pre-, peak and post-procedural pain and anxiety. Days until re-epithelization were estimated based on when the wound clinically assessed as re-epithelized and the child was discharged from the clinic or referred to scar management.

Results. Days to re-epithelization ranged from 3-35 days post-injury. Using hierarchical multiple regression analyses, injury severity (wound depth and size) and parent education were entered as control variables. Control variables accounted for 37% of the variance, F(3,79)=15.26, p<.001. Other sample characteristics did not influence re-epithelization. Child peak procedural pain and child distress significantly influenced re-epithelization, ∆Fs(3,78)>5.10, ps<.027, ∆R2s>.04. One point increases accounted for 0.47 day and 0.99 day delays in re-epithelization, respectively. Parental PTSS and guilt also significantly influenced re-epithelization, ∆Fs(3,74)>4.08, ps<.047, ∆R2s>.03. One point increases accounted for 1.43 and 0.28 day delays in re-epithelization, respectively.

Conclusions. The findings indicate parent-reports of child procedural pain, parental traumatic stress and guilt are an important yet undervalued influences on paediatric re-epithelization.


Erin Brown has recently completed her PhD with the Centre of Children’s Burns and Trauma Research, and the University of Queensland.


ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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