Acute stress symptoms in young children with burns.
OBJECTIVE
Posttraumatic stress disorder symptoms are a focus of much research with older children, but little research has been conducted with young children, who account for about 50% of all pediatric burn injuries. This is a 3-year study of 12- to 48-month-old acutely burned children to assess acute traumatic stress outcomes. The aims were to (1) assess the prevalence of acute traumatic stress symptoms and (2) develop a model of risk factors for these symptoms in these children.


METHODS
Acute stress symptoms were measured using the Posttraumatic Stress Disorder Semi-Structured Interview and Observational Record for Infants and Young Children. Children's responses were then assessed, including behavior and physiological measures for developmental/functional consequences. A path analysis strategy was used to build a model of risk factors. Risk factors assessed in this model included observed pain (Visual Analogue Scale), parent symptoms (Stanford Acute Stress Reaction Questionnaire), and magnitude of trauma (total body surface area burned).


RESULTS
Of the 64 subjects meeting inclusion criteria, 52 subjects agreed to participate. These children were highly symptomatic; almost 30% of these children had acute stress symptoms. A path analysis model yielded two independent pathways to acute stress symptoms: (1) from the size of the burn to the mean pulse rate in the hospital to acute stress symptoms and (2) from the child's pain to the parents' stress symptoms to acute stress symptoms. This model accounted for 39% of the variance of acute stress symptoms and yielded excellent fit indexes.


CONCLUSIONS
A high percentage of acute stress symptoms were identified in young children with burns. A model of risk factors, including the size of the burn, pain, pulse rate, and parents' symptoms, was identified.
Stoddard
Frederick J
FJ
Drs. Stoddard, Saxe, and Ronfeldt are with the Department of Psychiatry, Shriners Burns Hospital, and Massachusetts General Hospital, Harvard Medical School, Boston; Dr. Saxe is also with the Boston University Medical Center/National Child Traumatic Stress Network; Dr. Sheridan is with the Department of Surgery, Shriners Burns Hospital, and Massachusetts General Hospital, Harvard Medical School, Boston; Ms. Drake is currently with and Ms. Burns and Edgren were formerly with the Department of Psychiatry, Shriners Burns Hospital.. Electronic address: fstoddard@partners.org.
Saxe
Glenn
G
Drs. Stoddard, Saxe, and Ronfeldt are with the Department of Psychiatry, Shriners Burns Hospital, and Massachusetts General Hospital, Harvard Medical School, Boston; Dr. Saxe is also with the Boston University Medical Center/National Child Traumatic Stress Network; Dr. Sheridan is with the Department of Surgery, Shriners Burns Hospital, and Massachusetts General Hospital, Harvard Medical School, Boston; Ms. Drake is currently with and Ms. Burns and Edgren were formerly with the Department of Psychiatry, Shriners Burns Hospital.
Ronfeldt
Heidi
H
Drs. Stoddard, Saxe, and Ronfeldt are with the Department of Psychiatry, Shriners Burns Hospital, and Massachusetts General Hospital, Harvard Medical School, Boston; Dr. Saxe is also with the Boston University Medical Center/National Child Traumatic Stress Network; Dr. Sheridan is with the Department of Surgery, Shriners Burns Hospital, and Massachusetts General Hospital, Harvard Medical School, Boston; Ms. Drake is currently with and Ms. Burns and Edgren were formerly with the Department of Psychiatry, Shriners Burns Hospital.
Drake
Jennifer E
JE
Drs. Stoddard, Saxe, and Ronfeldt are with the Department of Psychiatry, Shriners Burns Hospital, and Massachusetts General Hospital, Harvard Medical School, Boston; Dr. Saxe is also with the Boston University Medical Center/National Child Traumatic Stress Network; Dr. Sheridan is with the Department of Surgery, Shriners Burns Hospital, and Massachusetts General Hospital, Harvard Medical School, Boston; Ms. Drake is currently with and Ms. Burns and Edgren were formerly with the Department of Psychiatry, Shriners Burns Hospital.
Burns
Jennifer
J
Drs. Stoddard, Saxe, and Ronfeldt are with the Department of Psychiatry, Shriners Burns Hospital, and Massachusetts General Hospital, Harvard Medical School, Boston; Dr. Saxe is also with the Boston University Medical Center/National Child Traumatic Stress Network; Dr. Sheridan is with the Department of Surgery, Shriners Burns Hospital, and Massachusetts General Hospital, Harvard Medical School, Boston; Ms. Drake is currently with and Ms. Burns and Edgren were formerly with the Department of Psychiatry, Shriners Burns Hospital.
Edgren
Christy
C
Drs. Stoddard, Saxe, and Ronfeldt are with the Department of Psychiatry, Shriners Burns Hospital, and Massachusetts General Hospital, Harvard Medical School, Boston; Dr. Saxe is also with the Boston University Medical Center/National Child Traumatic Stress Network; Dr. Sheridan is with the Department of Surgery, Shriners Burns Hospital, and Massachusetts General Hospital, Harvard Medical School, Boston; Ms. Drake is currently with and Ms. Burns and Edgren were formerly with the Department of Psychiatry, Shriners Burns Hospital.
Sheridan
Robert
R
Drs. Stoddard, Saxe, and Ronfeldt are with the Department of Psychiatry, Shriners Burns Hospital, and Massachusetts General Hospital, Harvard Medical School, Boston; Dr. Saxe is also with the Boston University Medical Center/National Child Traumatic Stress Network; Dr. Sheridan is with the Department of Surgery, Shriners Burns Hospital, and Massachusetts General Hospital, Harvard Medical School, Boston; Ms. Drake is currently with and Ms. Burns and Edgren were formerly with the Department of Psychiatry, Shriners Burns Hospital.
D002056:Burns / Q000453:epidemiology* / Q000523:psychology*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology; D040701:Stress Disorders, Traumatic, Acute / Q000175:diagnosis* / Q000453:epidemiology*; D011795:Surveys and Questionnaires