Supporting Children in Reconnecting With Parents and Siblings Changed by Burn Trauma
By Megan Bronson, RN, MSN, CS
Trauma can derail families and challenge their most basic sense of safety in the world. Both children and parents may feel the psychological and emotional effects of trauma for months or even years after the trauma occurs. When a parent or sibling is physically and emotionally changed by traumatic injury, such as burn injury, children need appropriate assistance in confronting and accepting these changes so that they can adjust and move on with their family.
Both physical and psychological changes need to be addressed honestly with children. A child’s questions require truthful, simple, and to-the-point answers. At times, especially with severe burns, the outcomes of both physical and psychological recovery may be uncertain for a period of time. Children can better handle this uncertainty if we are honest with them, provide them with age-appropriate information, and help them to manage their feelings.
DETERMINE THAT TIMING IS RIGHT
A child’s initial exposure to a traumatized parent or sibling is especially important in laying the groundwork for the process of accepting the changes in that family member. Appropriate timing is essential in reintroducing a child to the family member who has experienced traumatic injury. The appropriateness of timing in addition to the physical and psychological readiness and preparation of both the child and the patient are important considerations. Consider the stage of physical healing of the burn survivor. It may be better to wait until there is less swelling, bruising, disfigurement, etc., especially with younger children. Involve the child and his or her parents in this decision.
CONSIDER DEVELOPMENTAL STAGE AND TEMPERAMENT OF THE CHILD
Sometimes a child as young as 3 or 4 years old can visit a parent or sibling in a critical care setting and see past the physical trauma, machines, dressings, etc. Some children are by nature more sensitive than others and need to be handled with an awareness of this tendency. Consider the child’s wishes while at the same time maintaining appropriate parental control on important issues such as when and how often to visit in a critical care setting. Some children are adamant about wanting to visit and cannot be deterred. Be truthful and factual with the child about what he or she will see. Some children imagine things to be far worse than reality if they are not allowed to visit. Sometimes children may be angry that their family member looks so different and may refuse to believe that this is really their parent or sibling. Remember that reconnecting is a process, not an event, and that patience and persistence pay off.
HELP THE CHILD TO MAINTAIN CONNECTION
It is essential that the connection between a child and his or her injured parent or sibling be maintained during hospitalization and recovery. Encouraging the child to make cards, draw pictures, or make other art projects to be displayed in the patient’s room serves to maintain connection and helps the child to feel less helpless. The concrete expressions of love and concern in a child’s art also serve to encourage and motivate the family member who is the patient. Helping children to make audiotapes or home videos to be played for the patient can also be of amazing help to both. I have seen these work miracles, not just in the maintenance of emotional connection but also in engaging the will of the patient to fight for his or her own recovery and in providing motivation in rehabilitation.
HELP THE PATIENT TO RESUME HIS OR HER ROLE IN THE FAMILY
Having the patient reconnect with a child through activities once enjoyed together, such as board games, cards, reading books, drawing, watching fun movies, is also helpful. Play can help the family to heal and to reconnect. Enabling a hospitalized parent to pick out a special gift, such as a stuffed animal, to serve as a transitional object for the child can help a child endure periods of separation from the parent and are helpful in providing concrete proof of attachment. It is best if the parent can give the gift to the child directly; if not, the parent can send it to the child with a personal note.
PREPARE THE CHILD FOR WHAT HE OR SHE WILL SEE
Children are inherently inquisitive and interested in new environments and equipment. Taking them into an empty critical care room, allowing them to look around and ask questions, and explaining to them how machines, tubes, monitors, and other equipment are used to help their family member lessens fear and uncertainty. Showing how prosthetics work, explaining the purpose of dressings, etc., can also be helpful. Telling a child “Any question is all right,” and asking such questions as “Is there anything else you are wondering about?” create a safe environment for a child to explore his or her worries and concerns. Sometimes taking a Polaroid picture of the parent or sibling who is the patient and allowing the child to see the picture and ask questions and express feelings is a very helpful first exposure and allows the child to begin to desensitize to the changes in their family member before they see them. This technique is especially helpful when there are dramatic changes, such as facial burns and/or disfigurement, loss of body parts, or loss of limbs and prostheses. This also protects the patient, who may be at a vulnerable place in their own recovery process, from the child’s initial emotional reaction to these changes.
HONOR THE CHILD’S FEELINGS
Provide the child with an emotionally safe place for their feeling process. Children may feel angry, hurt, outraged, sad, and afraid related to the changes in their parent’s or sibling’s appearance. Children are by nature egocentric and it is essential that we not shame their feelings as selfish and unwarranted. Encouraging children to talk about their feelings away from the injured family member decreases the likelihood that these feelings will be acted out in inappropriate or destructive ways. Stating the obvious, “Sometimes kids feel angry, sad, scared, or confused when their family is going through something like what your family is going through,” and then asking, “Do you ever feel some of those feelings?” gives children specific permission to talk about what is troubling them.
Lenore Terr, MD, who wrote Too Scared to Cry: How Trauma Effects Children and Ultimately Us All1 states that the most common fears of children in the wake of a traumatic event are (1) fear of another more frightening event, (2) fear of separation, (3) fear of death, and (4) fear of helplessness. Allowing children to talk about their fears openly not only helps the fear to lessen but also permits the child, and the adults who are helping them, to develop a plan of action that restores some sense of situational control to the child.
Dramatic changes in a parent’s or sibling’s appearance and function is loss, not only to the patient but to their family as well. Grief is the process through which we heal loss. The child may be angry and want the parent, brother, or sister “back the way that they were.” “Magical” thinking supports denial and it also protects children from having to deal with too much reality all at once. A child’s denial and magical thinking needs to be handled with gentle hands. Helping a child to identify what has changed, and also what has not, will help them to deal with difficult realities a little at a time.
PLAN FOR REENTRY
We are an externally referenced culture; by that I mean that we measure our self-worth externally—by how much we have materially, by how much money we make, by how we look and how others react to how we look, and by what we have. We remain a society focused compulsively on appearance and physical perfection. Survivors of physical trauma, such as burn injury, need to challenge, modify, and replace these values with values that reflect love, compassion, and caring for the person dealing with physical differences, such as scarring and loss of body parts.
When we emphasize to the child the importance of who he or she is in his or her heart and soul and place the same emphasis on who their parent or sibling really is inside, we do a great service to the family’s healing. I have had the privilege to know countless burn survivors over the years of my work, many who suffered devastating trauma which left them physically changed forever. The survivors I know who have been able to transcend their injuries, physical differences, and challenges are those who have come home to who they are deep within themselves and have found selfacceptance that surpasses the superficial. They also have learned to respond assertively to negative comments, staring, and intrusive questions about their changed appearance. Children can be taught these assertive responses also.2,3
Children are affected deeply by the serious burn injury of a family member and need to be considered in the plan of care of the burn center. When children are allowed to be an active part in the recovery process of a sibling or parent, their sense of belonging in the family is restored and their family is enhanced.
1. Terr L. Too Scared to Cry: How Trauma Effects Children and Ultimately Us All. New York: Basic Books, 1990.
2. Quayle B. “When People Stare.” Burn Support News. Summer 2001.
3. Quayle B. “Tools to Handle Questions and Teasing.” Burn Support News. Fall 2001.
Bronson M. “Helping the Traumatized Child to Reclaim Life.” Burn Support News. April 2002.
Clark A. “Helping Children Understand and Cope with the Experience of Hospitalization.” Burn Support News. April 2002.
Mancuso MG. “Don’t Forget the Siblings.” Burn Support News. Fall 2002.
Note: The aforementioned articles from Burn Support News are also available through The Phoenix Society website, http://www.phoenix-society.org, under Family Resources.
Megan Bronson, RN, MSN, CS, is a registered nurse and psychotherapist, specializing in grief, trauma, and traumatic loss. She is a frequent presenter at World Burn Congress and is on the professional advisory board of The Phoenix Society.
This story is an excerpt from The Phoenix Society’s® Burn Support News, Fall Edition 2004, Issue 3. Burn Support News is a quarterly publication that contains articles on the emotional, psychological, and social aspects of burn recovery. All Rights Reserved.
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