title: An assessment of early Child Life Therapy pain and anxiety management: A prospective randomised controlled trial.
abstract: BACKGROUND
  Burns remain extremely painful and distressing in young children. The consequences of poorly managed pain and anxiety can be life-long. Whilst Child Life Therapy (CLT) has been shown to be effective in many situations, few studies have looked at the effectiveness of CLT in regard to reducing pain and anxiety in children undergoing burn dressing changes.
  
  
  METHODS
  A prospective, randomised controlled trial was conducted, comparing CLT versus standard care in relation to pain and anxiety scores of children undergoing their initial burn dressing change. Pain and anxiety were assessed by an independent observer and questionnaires completed by the child, parent/caregiver and nursing staff.
  
  
  RESULTS
  50 subjects were recruited in each treatment group; median age 2.3 years (CLT) and 2.2 years (standard care). The median total body surface area (TBSA) burnt was 0.8% (CLT) and 0.5% (standard care). The majority were partial thickness dermal burns (88% CLT, 94% standard care). Rates of parent anxiety and pre-procedural child pain and anxiety were similar. Combined and scaled pain and anxiety scores in the CLT group were significantly less than in the standard treatment group (p=0.03). Whilst pain was significantly better in the CLT group (p=0.02), fear scores, wound outcomes and the need for skin grafting were not statistically different in either group.
  
  
  CONCLUSIONS
  The presence of a Child Life Therapist, with their ability to adapt to the environment, the child and their family, significantly reduced the experience of pain during paediatric burn dressings.
authors.affiliation: The Children's Hospital at Westmead Burns Research Institute, The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW 2145, Australia. Electronic address: ela.hyland@gmail.com.
authors.forename: Ela J
authors.initials: EJ
authors.lastname: Hyland
authors.affiliation: The Children's Hospital at Westmead Burns Research Institute, The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW 2145, Australia.
authors.forename: Rachel
authors.initials: R
authors.lastname: D'Cruz
authors.affiliation: The Children's Hospital at Westmead Burns Research Institute, The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW 2145, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia.
authors.forename: John G
authors.initials: JG
authors.lastname: Harvey
authors.affiliation: The Children's Hospital at Westmead Burns Research Institute, The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW 2145, Australia; The Department of Child Life Therapy, The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW 2145, Australia.
authors.forename: Jordyn
authors.initials: J
authors.lastname: Moir
authors.affiliation: The Children's Hospital at Westmead Burns Research Institute, The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW 2145, Australia; The Department of Child Life Therapy, The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW 2145, Australia.
authors.forename: Christina
authors.initials: C
authors.lastname: Parkinson
authors.affiliation: The Children's Hospital at Westmead Burns Research Institute, The Children's Hospital at Westmead, Cnr Hawkesbury Rd and Hainsworth St, Westmead, NSW 2145, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia.
authors.forename: Andrew J A
authors.initials: AJA
authors.lastname: Holland
mesh_terms: D001007:Anxiety / Q000523:psychology / Q000628:therapy*; D001458:Bandages; D002056:Burns / Q000523:psychology / Q000628:therapy*; D002675:Child, Preschool; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain; D059408:Pain Management / Q000379:methods*; D010989:Play Therapy / Q000379:methods*; D016896:Treatment Outcome
keywords: Anxiety; Burns; Child Life Therapy; Paediatric; Pain