Behavioral Aspects of Pediatric Burns Issues in Clinical Child Psychology Series Editors: Michael C. Roberts, University of Kansas-Lawrence, Kansas Lizette Peterson, University of Missouri-Columbia, Missouri BEHAVIORAL ASPECTS OF PEDIATRIC BURNS Edited by Kenneth J. Tarnowski CHILDREN AND DISASTERS Edited by Conway F. Saylor HANDBOOK OF DEPRESSION IN CHILDREN AND ADOLESCENTS Edited by William M. Reynolds and Hugh F. Johnston INTERNATIONAL HANDBOOK OF PHOBIC AND ANXIETY DISORDERS IN CHILDREN AND ADOLESCENTS Edited by Thomas H. Ollendick, Neville J. King, and William Yule MENTAL HEALTH INTERVENTIONS WITH PRESCHOOL CHILDREN Robert D. Lyman and Toni L. Hembree-Kigin A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher. Behavioral Aspects of Pediatric Burns Edited by J. KENNETH TARNOWSKI University of South Florida Fort Myers, Florida SPRINGER SCIENCE+BUSINESS MEDIA, LLC Library of Congress Cataloging-in-Publication Data Behavioral aspects of pediatr1c burns 1 ed1ted by Kenneth J. Tarnowski. p. cm. -- <Issues in cl1nical chlld psychology> Includes bibliographical references and index. ISBN 978-1-4757-9391-8 ISBN 978-1-4757-9389-5 (eBook) DOI 10.1007/978-1-4757-9389-5 1. Burns and scalds 1n chlldren--Psychologlcal aspects. 1. Tarnowski, Kenneth J. II. Series. [DNLM, 1. Burns--1n infancy & chlldhood. 2. Burns--psychology. 3. Child Behavior. WO 704 8419 1994] RD96.4.B44 1994 617.1'1'0083--dc20 DNLM/DLC for L1brary of Congress 94-30884 CIP ISBN 978-1-4757-9391-8 © 1994 Springer Science+Business Media New York Originally published by Plenum Press, New York in 1994 Softcover reprint of the hardcover 1st edition 1994 Ali rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher To my extraordinary parents, Bill and Ellen and wife, Pat, for their support, love, and encouragement Contributors F. Daniel Armstrong, Ph.D., Department of Pediatrics, University of Miami School of Medicine, Miami, Florida Patricia Blakeney, Ph.D., Shriners Bums Institute, Galveston, Texas Christopher P. Brandt, M.D., Department of Surgery, Case Western Re serve University School of Medicine, MetroHealth Medical Center, Cleve land, Ohio Ronald T. Brown, Ph. D., Departments of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, Georgia Joseph P. Bush, Ph.D., Graduate School of Psychology, Fielding Institute, Santa Barbara, California Arden D. Dingle, M.D., Departments of Psychiatry and Behavioral Sci ences and Pediatrics, Emory University School of Medicine, Atlanta, Georgia Marion Doctor, M.S.W., Children's Hospital Bum Center, University of Colorado School of Medicine, Denver, Colorado Richard B. Fratianne, M.D., Department of Surgery, Case Western Re serve University School of Medicine, MetroHealth Medical Center, Cleve land, Ohio Caryl L. Gay, Ph. D., Department of Pediatrics, University of Miami School of Medicine, Miami, Florida vii viii CONTRIBUTORS Russell T. Jones, Ph.D., Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia Nadine J. Kaslow, Ph.D., Department of Psychiatry and Behavioral Sci ences, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia Kamela Koon-Scott, Ph.D., Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Grady Memorial Hospi tal, Atlanta, Georgia; present address: Department of Pediatrics, University of Florida College of Medicine, University Medical Center, Jacksonville, Florida Jacqueline D. Levy, Ph.D., Department of Pediatrics, University of Miami School of Medicine, Miami, Florida Marlene T. Maron, Ph.D., Otter Creek Associates, Burlington, Vermont Thomas Pruzinsky, Ph.D., Department of Psychology, Quinnipiac Col lege, Hampton, Connecticut L. Kaye Rasnake, Ph.D., Department of Psychology, Denison University, Granville, Ohio Kenneth J. Tarnowski, Ph.D., Department of Psychology, University of South Florida, Fort Meyers, Florida Vasiliki Zaharopoulos, Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia Preface In recent years, considerable professional attention has centered on the behavioral aspects of various childhood illnesses and injuries. Indeed, child health psychology has grown exponentially over the past decade. One index of this growth is found in the number of texts that have recently appeared in the area (Gross & Drabman, 1990; Karoly, 1988; Krasnegor, Arasteh, & Cataldo, 1986; Levine, Carey, Crocker, & Gross, 1982; Routh, 1988; Russo & Varni, 1982; Tuma, 1982; Varni, 1983). In general, these texts provide summaries of the psychological literature across a variety of established (e.g., oncology) and emerging (psychoneuroimmunology) areas of child health. Until recently, many books on the psychological aspects of pediatric health provided no or minimal information about the psychosocial plight of child burn victims. In some instances, pediatric burns might be men tioned parenthetically as another example of a population for which behavioral treatment procedures (e. g., pain management) may be of value. In part, the relative inattention devoted to this population may be related to the perception that the literature in this area is sketchy and charac terized by significant methodological and substantive shortcomings. In many instances, this perception is largely justified. However, it is also the case that the pediatric burn literature has evolved considerably over the past decade and that the incidence of, and morbidity associated, with severe burn injuries mandates immediate and increased attention by mental health professionals. Several factors prompted the development of the current volume. In the process of providing inpatient and outpatient assessment, treatment, and consultation and liaison services to burned children and their families, it has been time-consuming and often disappointing to search the litera ture for materials of potential value in answering specific referral ques- ix X PREFACE tions. Common referral questions often involve issues pertaining to acute psychological reactions, pain management, and long-term psychosocial sequelae. A summary of the existing literature that extends well beyond the scope and detail of a typical book chapter wouk' be of obvious value. Another impetus for the book involved consideration of the uniqueness of bum injuries. Severe nonfatal bums by thermal, electrical, chemical, or radiation causes constitute the most serious form of human injury (McLoughlin & McGuire, 1990). Bums share characteristics with other types of acute injuries (e.g., orthopedic), as well as those of chronic illness (e.g., sickle-cell disease). As such, not only do they pose unique clinical considerations but also warrant increased attention from a developmental perspective. These injuries, and the circumstances surrounding their occurrence, have the potential to seriously disrupt a variety of important developmental processes. Indeed, the fact that severe pediatric bums do not invariably cause such devastating or lasting disruption attests to the impressive resiliency of children and families. Finally, it is important to call attention to the fact that the vast majority of pediatric bums are entirely preventable. The purpose of the book is to survey the literature on the behavioral aspects of pediatric bums and to consider the implications for prevention, consultation, treatment, and follow-up. The book is divided into four sec tions. The goal of the first section is to provide a general introduction to the topic of pediatric bums including epidemiological, medical, and surgi cal aspects. The second section of the book considers broadly the acute reactions and long-term psychosocial sequelae associated with severe bum injury. In the third section of the book, a variety of behavioral topics are considered. The goals of the contributions in this section are to build on the information presented in earlier chapters and to acquaint the reader with the range of applied considerations that one confronts in the context of clinical work with this population. Issues relevant to consultation and liaison, pain management, body image disturbance, school reintegration, family functioning, and injury prevention are discussed in detail. The final section highlights and integrates the themes of the previous chapters and provides a general prospectus to guide future clinical and research efforts. The book is intended for mental health professionals (psychologists, psychiatrists, social workers, and counselors), physicians (surgeons, pedi atricians), nurses, and other specialists (child life workers) who are in volved in the inpatient/outpatient care of burned children and their fami lies. Wherever possible, an attempt is made to draw conclusions and establish recommendations based on review of the pediatric bum litera ture. For several topics, readers may be surprised at the limitations of and gaps in the primary literature. In such instances, every effort is made to