Leading the Way in Pediatric Burn Care Education at the American Burn Association

Tools Designed for Long-Term Success

To help achieve the best possible outcome for each patient, Lori and her team carefully balance functional play with techniques such as positioning, immobilization and specialized casting.

Positioning is the practice of arranging the body in specific ways to relieve joint strain, promote healing, prevent muscle tightness and maximize movement.

"Our goal with positioning is always to provide alignment while reducing stress on the wound and optimizing the patient's function," said Lori, who went on to explain that the position that feels most comfortable after a burn injury isn't always the best for recovery. "Children often want to keep injured joints bent, but over time that can cause the skin and tissues to tighten. By positioning the body in a way that gently stretches those areas, we can help preserve movement and prevent complications."

When additional support is needed, the team may use serial soft casting. This technique involves applying a cast that is replaced every few days or weeks to gradually improve movement and function.

"This type of casting provides a prolonged, gentle stretch and retains body warmth within the area. This combination helps the body relax the skin and muscles around the area of injury, allows for better pain control, and promotes a feeling of safety and protection for the child," said Lori.

Soft casting also serves another important purpose. Following a skin graft procedure, children may wear soft casts for periods of immobilization to optimize skin length and support wound healing. Even when casted, a child's rehabilitation remains an active process.

"Developmentally appropriate activities along with art and music to promote movement and strengthening can still be done at home and in the community," said Lori.

The Value of an ABA-Verified Pediatric Burn Care

Shriners Children's Boston is the longest-running American Burn Association-verified pediatric burn center in New England. The benefit of having a seasoned pediatric team is the experience of understanding how a child's age, developmental level and functional skills impact their care.

"Our therapists know when movement and stretching are important, versus when immobilization and protection are the more appropriate intervention to promote healing," Lori said. "This leads to optimal outcomes for our pediatric patients."

Not all burn centers across the country have pediatric clinicians knowledgeable in burn care and may not have a burn center close enough for families to access.

"In these cases, children are often managed in the same way as adult burn patients, but there are significant differences that need to be considered from early wound care through skin maturation," said Lori. "Understanding these differences allows a clinician to incorporate current and future needs into the treatment interventions and help optimize a patient's outcomes."

Physical and occupational therapists get creative when engaging with pediatric burn survivors to keep them motivated to move.

"Our staff builds rapport and trust with the patient along with their caregivers to help get a child's buy-in on therapy goals," said Lori. "Once we build trust and understanding, the patients and their families often are more invested to ensure progress continues outside of the hospital setting."