socioeconomic impact of children's burns—a pilot study

JBUR-4323; No. of Pages 9

Socioeconomic impact of children’s burns—A pilotstudy

Nadia Kilburn *, Baljit Dheansa

Brighton and Sussex Medical School and Queen Victoria Hospital, East Grinstead, United Kingdom

b u r n s x x x ( 2 0 1 4 ) x x x – x x x

a r t i c l e i n f o

Article history:

Accepted 12 March 2014

Keywords:

Socioeconomic

Psychological

Impact

Burns

Parents

Injured children

Non-injured siblings

a b s t r a c t

Objective: This pilot study aimed to gain empirical data on the social and economic impacts

of child burns on children and parents, in the context of the outpatient setting.

Method: A questionnaire was completed by 52 parents of paediatric patients attending the

burns outpatient department at Queen Victoria Hospital (QVH), East Grinstead, for at least

the third time. Children’s medical notes were used to extract demographic and medical

data. Quantitative data was analyzed statistically and qualitative data was analyzed man-

ually using content analysis.

Results: The financial burden related to the injury posed the greatest impact on parents, and

was mainly associated with making the journey to the hospital, with lower income house-

holds being most affected. Self-employed parents and those who had to attend more than 6

hospital appointments also ran into difficulties. On the whole, there was not a considerable

social impact on the burn-injured child, which may reflect the minor nature of burns in this

study (mean depth partial thickness, median TBSA 1.0%).

Conclusion: Parents were shown to perceive a greater impact from their child’s burn injury

than their child. Certain groups of parents were identified as requiring additional support

following the burn injury.

# 2014 Elsevier Ltd and ISBI. All rights reserved.

Available online at www.sciencedirect.com

ScienceDirect

journal homepage: www.elsevier.com/locate/burns

1. Introduction

Epidemiological studies show that there are around 6400

paediatric admissions for burns in the UK each year [1]. Queen

Victoria Hospital, East Grinstead, covers a population of 4

million people, and treats 500 child burns each year. Paediatric

burns are traumatic events with significant consequences in

physical, psychological and social dimensions. The physical

recovery period associated with burns can be long and may

involve multiple surgeries, and usually dressing changes,

topical treatments and self-care practices such as wearing

customized pressure garments and physiotherapy [2]. Several

studies suggest that 20–50% of paediatric burns patients

* Corresponding author at: 168 Freshfield Road, Brighton, East Sussex

E-mail address: [email protected] (N. Kilburn).

Please cite this article in press as: Kilburn N, Dheansa B. Socioeconodx.doi.org/10.1016/j.burns.2014.03.006

http://dx.doi.org/10.1016/j.burns.2014.03.0060305-4179/# 2014 Elsevier Ltd and ISBI. All rights reserved.

experience psychological sequelae, such as anxiety, sleep

disturbance, depression and PTSD [3–7]. Negative functional

outcomes often occur: Herndon et al. found increased

dependence in age-appropriate activities of daily living for

50% of burn-injured children [8]; whilst in Zyack et al.’s study,

85% of parents reported some level of interference with sports

and playing with other children [8,9]. Reports indicate social

withdrawal is present in two-thirds of children post-burn, and

is associated with poor peer relationships and negative public

perception [10].

Paediatric burns can also be stressful experiences for

parents, as they try to manage their own distress as well as

responsibilities of wage earning and caring for non-injure

siblings [3,11–13]. In a study by Woodward, 60% of mothers of

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mic impact of children’s burns—A pilot study. Burns (2014), http://

http://dx.doi.org/10.1016/j.burns.2014.03.006

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http://www.sciencedirect.com/science/journal/03054179

http://dx.doi.org/www.elsevier.com/locate/burns


Patient number

TSA Dep th Site Sever ity

1 0.3 super ficial PT/d eep PT

back minor

2 1 super ficial PT chest/ a bdo, leg minor3 1.5 deep PT han d moderat e/

major4 4 super ficial PT leg minor5 0.3 super ficial PT han d moderat e/

major6 1.5 super ficial PT leg minor7 1 super ficial PT/d eep

PThand moderat e/

major8 1 super ficial PT/d eep

PThand moderat e/

major9 0.5 super ficial PT han d moderat e/

major10 2 super ficial PT arm/shoulder minor11 2 super ficial PT head/n eck/face, e ars moderat e/

major12 1 super ficial PT arm/shoulder minor13 0.5 epidermis foot/toes moderat e/

major14 9 super ficial PT/d eep

PTarm/shoulder, back moderat e/

major15 1 super ficial PT chest/abdo minor16 4.5 super ficial PT chest/abdo minor17 0.3 super ficial PT han d moderat e/

major18 1 deep PT ears minor19 6 deep PT arm/shoulder minor20 0.3 super ficial PT han d moderat e/

major21 0.3 super ficial PT/d eep

PThand minor

22 2 epidermis leg minor23 0.5 epidermis han d moderat e/

major24 5 super ficial PT ears, chest.a bdo, hand, leg,

genitali amoderat e/ major

25 0.5 super ficial PT/d eep PT

foot/toes major

26 3 epidermis arm/chest minor27 1 super ficial PT/d eep

PTarm/shoulder minor

28 4 deep PT leg minor29 5 super ficial PT chest/abdo, arm/shoulder minor30 2.5 deep PT chest/abdo minor31 1.5 deep PT han d moderat e/

major32 2 super ficial PT face/ neck, chest moderat e/

major33 2 super ficial PT arm/shoulder minor

TSA- to tal sur face area

PT- partial thickness

34 8 deep PT/ full thickness

chest/abdo, arm/shoulder moderat e/ major

35 0.3 deep PT/ full thickness

hand moderat e/ major

36 3 super ficial PT/d eep PT

chest/abdo, arm/shoulder minor

37 0.3 deep PT finger moderat e/ major

38 0.5 full t hickness finger moderat e/ major

39 1 epidermis face/ head/neck moderat e/ major

40 0.5 deep PT finger moderat e/ major

41 3 super ficial PT chest/abdo, arm/shoulder minor42 2 super ficial PT arm/shoulder minor43 2 super ficial PT leg, foot/toes moderat e/

major44 2 super ficial PT face/ head/neck , a rm/shoulders moderat e/

major45 0.3 deep PT finger moderat e/

major46 0.3 epidermis leg minor47 0.5 deep PT han d moderat e/

major48 1 full t hickness leg minor49 0.3 super ficial PT arm/shoulder minor50 3.5 super ficial PT/d eep

PTfeet moderat e/

major51 1 full t hickness foot/toes moderat e/

major52 1.5 super ficial PT face/ head/neck moderat e/

major

Fig. 1 – Details of the burn injuries included in the study.

b u r n s x x x ( 2 0 1 4 ) x x x – x x x2


burn- injured children reported emotional upset, compared to

26% of mothers of children hospitalized for other reasons [14].

Likewise, Vigiliano et al. found that 80% of mothers of children

with burns exhibited emotional disturbance [15]. These

findings are supported by numerous other studies showing

that following their child’s burn, parents tend to go through a

process of guilt, self-blame, and anger, all of which may

contribute to the development of depression and anxiety [16–

18]. Moreover, parents of burn-injured children have been

found to have an increased risk of developing acute stress

response syndromes, including adjustment disorders and

post-traumatic stress disorders, with the latter shown to have

a prevalence rate in mothers of 18.8% [17,19,20].

There are also a number of studies focusing on the

psychosocial impact of burns on children, though this

predominantly focuses on severe burns for which the child

is hospitalized, and not on burns managed on an outpatient

basis. Given the large number of paediatric burns in the UK

and the fact that the majority of burn injuries are minor and

can be managed in outpatients [21], understanding the needs

of this overlooked population is essential.

There is also a substantial amount of studies focusing on

the psychological impact of child burn injury on parents, but

not on socioeconomic implications. This comes as a surprise

as there is a myriad of factors affecting family needs besides

psychological problems. Families may be facing the loss of a

wage earner while caring for the burn-injured child. Even

though medical care can be delivered free of charge in the UK,

the attendant costs of lost earnings, travel expenses, and

special arrangements to care for the child can be devastating.

Amongst the factors that contribute to long-term psychosocial

adjustment and health-related quality of life, good family

support has consistently been shown to be the most important

[22–26]. However the multiple stressors that parents can

experience may impede them from rendering and sustaining

support for their injured child [27].

It is these particular gaps in the literature that formed the

basis of this pilot study, the main aim of which is to gain

empirical data on the social and economic impacts of child

burns on the injured children and their families, in the context

of the outpatient setting. The socioeconomic factors focused

on included income and expenses, employment, family life

and relationships, recreational activities, school and travel.

2. Method

The study consisted of 52 participants, who were recruited

from the burns unit at Queen Victoria Hospital, East Grinstead

over a period of 10 weeks between January and March 2013.

The study’s inclusion criteria were parents of children (aged 6

months to 16 years) who were attending the outpatient

department for at least the third time. None of the children

had previously been hospitalised as a result of their burn

injury, nor had any received operative treatment. The medical

details of the burn injuries and how these burns were

classified in terms of severity are shown in Figs. 1 and 2. In

this study, minor burns were classified as all first degree burns;

second degree burns affecting less than 10% TBSA in children

over the age of 10 years; and second degree burns affecting less

Please cite this article in press as: Kilburn N, Dheansa B. Socioeconomic impact of children’s burns—A pilot study. Burns (2014), http://dx.doi.org/10.1016/j.burns.2014.03.006



Minor burns • All 1

stdegree burns

• 2nd

degree bu rns, < 1 0% TBSA i n 10 + years• 2

nddegree bu rns, < 5% TBSA i n <10 years

Moderate/ ma jor b urns • Ha nds, feet, face, genita ls• 2

nddegree bu rns, >10% TBSA i n 10+ yea rs

• 2nd degree bu rns, >5% TBSA i n <10 y ears• 3

rddegree bu rns, >1% TBSA

Fig. 2 – Classification of burn severity.

Source: Adapted from reference [34].

b u r n s x x x ( 2 0 1 4 ) x x x – x x x 3


than 5% TBSA in children under aged 10 years. Moderate and

severe burns were dually classified as burns to the face, feet,

hands or genitals; second degree burns affecting more than

10% TBSA in children over the age of 10 years; second degree

burns affecting more than 5% TBSA in children under aged 10

years; and third degree burns affecting more than 1% TBSA.

The exclusion criteria were parents of patients over the age of

16 years; parents who were not attending outpatients for at

least the 3rd time; and parents who did not understand the

information sheet. Also the child’s burn injury had to be the

result of an accident and not attributable to abuse or neglect.

Fig. 3 shows the potential and final populations from whom

data were accrued.

All parents of paediatric patients attending the outpatient

department for the first time were informed of the study

Childre n a sses eligibili ty (n=

Analysed (n= 52)• Excluded from an

Lost t o follow-up (qunot returned ) (n= 35

Pare nts received q u• Complete d questi

Alloca tion

Analysis

Follow-Up

Enrollme nt

Fig. 3 – Flow diagram to show potential and final


through an information sheet. Parents of patients due to

undergo their 3rd, or more, visit were then offered a

questionnaire. A minimum of a 3rd appointment was chosen

as there was a general consensus amongst departmental staff

that this is the approximate stage when parents begin to

experience socioeconomic difficulties. Participants were given

the option of filling the questionnaire out on site or returning it

during the next appointment. For each parent who consented

to participate in the study, their child’s medical notes were

used to extract demographic data and medical data related to

the burn injury, such as age and details of the burn injury.

The questionnaire (displayed in Fig. 4) given to parents

comprised of a mixture of qualitative and quantitative

questions, and collected data in 7 main areas: demographic

data such as relation to the child, household income and

details of household members; travel to the hospital;

employment; hospital appointments; impact on the family

and injured child; financial implications of the burn injury;

school and nursery. The types of quantitative questions

included numerical, multiple choice, categorical, and 5 and

7 point Likert scales. Qualitative data was gathered in the form

of free text within some questions.

The study adopted a number of quality control strategies.

Validity was established by requesting and responding to

feedback from the questionnaires by a panel of experts in the

field, including a consultant burns and plastic surgeon, two

clinical psychologists with a specialist interest in burns,

departmental nurses, parents of burn-injured children and the

Trust research committee. Reliability was ensured by encour-

aging participants to complete as much of the questionnaire,

sed for 115 )

Exc luded (n= 28)• Not meeting inc lusion criter ia

(n= 13)• De clined to participate (n= 15)

alysis (n= 0)

estionnaire )

estionnaire (n= 87)onnaire (n= 52)

population from whom data were collected.




b u r n s x x x ( 2 0 1 4 ) x x x – x x x4


in as much detail, as possible. Internal consistency (an

estimate of reliability) was achieved by firstly grouping

together similar questions measuring the same concept

within the questionnaire, such as journey to the hospital,

Fig. 4 – Study qu


hospital appointments and employment; and secondly, by

placing some questions examining the same topic at different

points in the questionnaire. For instance, questions examin-

ing the impact of the burn injury on parents and other

estionnaire.




Fig. 4. (Continued ).

b u r n s x x x ( 2 0 1 4 ) x x x – x x x 5


household members were asked in different ways at different

points throughout the questionnaire, as were questions

regarding help and support received. Rigour was achieved

by employing both qualitative and quantitative techniques in

order to explore subjectivity.

Quantitative data was incorporated into a Microsoft Excel

document and analyzed using Statistical Package for the

Social Sciences (SPSS) version 20, with statistical significance

placed at 0.05. Qualitative responses were analyzed manually

using elements of content analysis [28]. Ethical approval for

the study was granted by the Research and Development

Governance Committee at Queen Victoria Hospital; and the

City Road and Hampstead National Research Ethics Service

(NRES) Full Review Committee (REC ref: 12/LO/2026).

3. Results

Fifty-two out of a potential 102 parents completed the

questionnaire, giving a response rate of 51%. The average age


of the child was 4 years, with the 1–2 years age group making up

the highest proportion of the sample (see Fig. 5). The most

common type of burn was a scald, (n = 33, 63.5%) (see Fig. 6).

There was approximately an equal proportion of minor and

moderate/major burns (48%, 52% respectively). The mean depth

of the burns was partial thickness and the median TBSA (total

body surface area) affected was 1.0%, with an interquartile

range of 2.0% (lower quartile = 0.5%, upper quartile = 2.5%). The

median number of appointments attended was 6, with an

interquartile range of 4.0 (lower quartile = 4, upper quartile = 8).

The mean healing time for the burn was 19.36 days.

4. Issues with journey to the hospital andhospital appointments

Both quantitative and qualitative data indicated that the main

factors influencing how readily parents could make hospital

appointments were travel expenses, distance needed to travel,

the number of hospital appointments, convenience of




Fig. 5 – Age distribution of burn-injured children.

b u r n s x x x ( 2 0 1 4 ) x x x – x x x6


appointment times and employment status. There was no

correlation between household income and how easy parents

found the hospital journey (r = �0.091, p = 0.589). Of those

participants reporting they found the journey to the hospital

easy, 88.9% attended between 1 and 6 appointments, whereas

the remainder attended 7 or more appointments. There was a

moderate positive correlation between the convenience of

appointment times and how easy parents found the hospital

journey (r = 0.433, p = 0.02). The parents with the greatest

flexibility in their day to bring their child to appointments

were unemployed or housekeepers (66.7% of this group finding

it ‘‘easy’’); self-employed parents had the least flexibility to

bring their child to appointments (80% of this group finding it

‘‘difficult’’). The main themes arising in the qualitative

analysis on the difficulties with the journey to the hospital

were distance and expense:

‘‘Because it’s a long way for us to travel by train, it takes

nearly all day to get here and back.’’

Fig. 6 – Frequencies of burn-injury cause.


‘‘We spent £30 each time on diesel travelling to hospitals,

car park fees and toll charges, and my partner has had to

take time off work.’’

5. Impact on parents

The financial burden related to the burn injury posed the

biggest impact on parents, and was mainly associated with the

expense of travel to appointments. Over half of parents (56%,

n = 29) discussed the impact of travel costs in the qualitative

part of the questionnaire. Thirty-five percent of parents

reported that more attention was given to the child following

the burn injury; whilst 33% of parents reported increased

awareness of potential dangers and becoming more cautious

regarding safety, with several parents making adjustments to

make their home a safer environment for their child. Thirty-

five percent of parents self-reported emotional and psycho-

logical disturbance as a result of their child’s burn injury, with

common feelings of stress, guilt, worry and anxiety, as well as

shock, frustration, and depression. Parents who experienced

emotional and psychological implications as a result of the

burn injury were those with injured- children aged between 6

months to 2 years. Not all parents perceived an impact as a

result of their child’s burn, as 14 parents stated that there had

been no effect or a minimal effect. These parents all had

children with burns affecting �3% TBSA.

‘‘The petrol costs to travel so far are considerable and have

become a bit of a problem. It has also affected my ability to

work certain days as I’m self-employed (due to feeling so

awful or due to attending hospital appointments).’’

‘‘Due to the baby’s accident I am scared to leave him alone

for even a few seconds so it makes general tasks harder.’’

‘‘I am extra careful with radiator temperature, I have

thrown away the baby walker and bought a play pen which

is more suitable for when I’m cooking etc.’’

‘‘I’m an emotional, paranoid, anxious wreck. I cannot

concentrate and have become irritable as I blame myself

constantly. I am always tearful.’’

6. Impact on siblings

Twenty-five percent of participants to whom it was relevant

(n = 9), reported that the care of siblings was affected by the

burn injury. There was a relationship between the number of

hospital appointments and the impact of the burn injury on

the care of non-injured siblings: of the parents reporting that

the care of their other children had been affected, a greater

proportion attended 7 or more appointments (40%), whereas

just 15% attended between 1 and 6 appointments. The main




b u r n s x x x ( 2 0 1


way siblings were reportedly affected by the burn injury in the

qualitative responses was decreased time and attention was

available to them from parents. Other, less common ways in

which siblings were reportedly affected were emotional and

psychological disturbance, with parents reporting feelings of

jealousy and attention-seeking behaviours, and adoption of a

positive, caring role.

‘‘My other daughter has seen much less of her mother

which has affected her, she misses me.’’

‘‘I was away from home for 2 weeks initially whilst in

hospital and all the outpatient appointments mean I don’t

see them.’’

‘‘She (the sibling) is a little upset, more needy, wetting the

bed and holding onto urine.’’

‘‘I feel he’s (the sibling) is slightly jealous due to my

daughter getting more attention.’’

‘‘She’s (the sibling) very careful around her brother now

and trying to help with changing clothes and washing

him.’’

7. Impact on child

Seventy-six percent of children who were in nursery or school

had to take time off, however this was just for an average of 3.3

days, thus there was little need for parents to plan their child’s

return to school or nursery. Those children who had a longer

period away from school or nursery had burns taking longer to

heal (r = 0.581, p = 0.005). On the whole, there was not a

considerable social impact on the burn-injured child, however

for those who did experience an impact, activities such as

bathing and swimming (in 19% of children, n = 10), and sports

and general play (in 12% of children, n = 6) were affected; the

latter two related to burns to the extremities. All hand burns

were aged between 6 months to 2 years. There was also a direct

link between hand burns and impact on ADLS, as the 6

children whose ADLs were impacted upon all had burns to the

hand. There was no relationship between the size of the hand

burn and the limitations on ADLs.

‘‘She can’t have baths with her siblings- this upsets her. She

cannot go swimming. Holidays will be disrupted.’’

‘‘All hobbies are sports related so has currently stopped.

The pain stops him.’’

‘‘She has restricted use of her left hand so things like

getting dressed and eating are affected.’’


8. Discussion

The average age of the burn-injured child in this study was 4

years, with the 1–2 years age group making up the highest

proportion of this sample. This is consistent with existing

research showing children below the age of 5 years to have the

highest risk of burn injury, with the peak age being the

‘toddler’ group [12,29]. The most common type of burn was a

scald, (n = 31, 60%), consistent with previous literature that

reports scalds account for more than 50% of paediatric burns

[18,29,30].

The long distance needed to travel in order to attend

hospital appointments and the expenses associated with this

were a significant problem for many parents. This is likely to

be due to the fact that QVH is a tertiary centre covering a large

geographical distribution and therefore the journey for many

parents is long. These findings are likely to be applicable to the

general population of parents with burn-injured children, as

the majority of burns are treated in specialist centres covering

large geographical areas. Employment status appears to bear

some significance with regards to how readily parents are able

to attend appointments. Parents who struggled least to attend

appointments were either unemployed or housekeepers,

whereas self-employed parents struggled most; this may be

because there is nobody to cover their work for them or, they

may not be protected by sickness pay.

Although this study did not aim to identify the psychologi-

cal impact of child burn injuries on parents, nor were any

standardized tools used to measure this, the emotional and

psychological disturbance experienced by some parents

infiltrated into the qualitative responses. Psychological per-

turbation tended to occur for parents of infants. Although

there is nothing in the literature that helps to explain this, one

could speculate that it is because parents feel a greater sense

of responsibility to protect an infant, who is more helpless

than an older child. Guilt, anxiety and stress were the most

common emotions parents experienced following their child’s

burn injury. This is in keeping with the literature that shows

guilt and anxiety are amongst the most common psychologi-

cal implications of child burn injury on parents [16–18]. Some

parents became more safety-conscious following their child’s

injury, whilst others became more attentive or overprotective;

these could both be coping mechanisms for their stress and

anxiety, as recognized in the literature [16,25,31]. It is also

possible that the psychological and emotional responses of

some parents were induced or exacerbated by the financial

strain related to the child’s burn, indeed this is a risk factor for

psychological problems in adults with burn injuries [30].

When parents had to attend more than six hospital

appointments, the care of non-injured siblings suffered,

presumably due to the decreased time and attention given

to them, as reported by parents. Some non-injured siblings

reportedly expressed feelings of jealousy and exhibited

attention-seeking behaviour, which may be a result of reduced

parental attention. Some siblings became more caring and

protective towards the injured child. This is consistent with

findings from Mancuso et al.’s study, whereby parental reports

indicated that non-injured siblings became more protective of

their injured brother or sister and developed a more empathic

4 ) x x x – x x x 7




b u r n s x x x ( 2 0 1 4 ) x x x – x x x8


sensibility [32]. The fact that the burn injury did not impact the

majority of non-injured siblings may be attributed to the

relatively minor burns in this sample in comparison to burns

for which children are hospitalized. This notion is also

supported by findings from Mancuso et al., showing that

siblings of children with severe burns displayed difficulties in

social competence, whereas siblings of children with minimal

burn injuries showed no such difficulties [32].

The biggest impact of the burn injury on children in this

study was time was taken off school or nursery, with an average

of 3.36 days missed. This is much lower than the 22 days

reported in a study by Staley et al. however, children in their

study had more severe burns for which they stayed in hospital

for an average of 30.8 days [33]. Comparable to a study by Tyack

et al. on the functional outcome of children following a burn

injury, our study found that sports, playing with other children

and sleep were some of the activities affected [9]. However only

19% of parents in this study reported a level of interference with

these activities, as opposed to 85% in Tyack et al.’s study. The

discrepancy between these findings may be due to the fact that

children in Tyack et al.’s study had more severe burns for which

skin grafts were performed. The children who suffered burns to

the hand were between 6 months to 2 years; this could be

reflective of this age group’s curiosity and increasing ability to

explore their environment using their hands. There was a direct

link between hand burns and ability to perform ADLs in our

study. In Herndon’s study looking at quality of life following a

major thermal injury in children, 50% of children were unable to

perform age-appropriate ADLs, as opposed to 11% of children in

this study [8]. The children included in Herndon’s study suffered

severe burns involving greater than 80% TBSA, compared to the

burns in our study whereby the median TBSA affected was 1.0%

[8]. Thus it could be inferred that children with burns experience

an impact on ADLs, the extent of which relates to burn severity

and location.

9. Limitations

One of the main limitations of this study is the small sample

size, which means that generalization to larger populations is

restricted, as does the fact that this was an exploratory study

on a population that up to now has been overlooked. One must

also be aware of possible selection bias. Families that were

experiencing less of an impact may have found the time and

energy to fill in a questionnaire, whereas those who felt

overwhelmed did not. This bias would have moderated the

results to suggest a minimal impact of the burn injury. On the

other hand, families that were experiencing problems may

have been more engaged by the subject and therefore more

likely to complete the questionnaire, which would have led to

an overestimation of the impact on families. Furthermore, the

number of children who did not attend because of travel or

financial reasons may have been underestimated.

10. Conclusion

This pilot study contributes an aspect to burn injury research

that has not yet been investigated and serves as a foundation


for continued investigations in this area. Parents were shown

to perceive a greater impact from the burn injury than their

children. The financial burden posed by the burn injury was

identified as the greatest issue and this was largely associated

with travel to the hospital. This was a problem for 56% of

parents in our study, and therefore could potentially be an

issue for 280 parents attending the paediatric burns unit at

QVH each year. Self-employed parents and those who were

required to attend more than 6 appointments particularly

experienced various issues related to the burn injury. Thus

additional support could be directed at these groups, poten-

tially in the form of support with travel costs or the provision

of specialist care more locally. The study shows that the

impact of even minor outpatient paediatric burns is significant

because of the large numbers affected. This is particularly

important as without support for this large population of burn-

injured children and their parents, many children may not be

treated appropriately. Future work needs to be done to identify

a mechanism by which this may occur. Empirical data from

this pilot study will form the basis of semi-structured

interviews for a future study, in order to achieve this.

Conflict of interest statement

None declared.

Acknowledgement

The authors wish to thank Dr Emma Klinefelter for her advice

with editing the manuscript.

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socioeconomic impact of children's burns—a pilot study

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