After-care of pediatric burn victims: cultural considerations.

Dear Editor, As a graduate student at John F. Kennedy University, in each of my courses I am exposed to the limitations of conventional psychological thought when working with clients of non-dominant cultures. This, in the context of my interest in the use of behavioral medicine with vulnerable pediatric populations, has led me to discover that a good part of our current medical management of various problems, most specifically pediatric burn aftercare, is essentially devoid of any information regarding diversity factors. Given the increase in pediatric burn victims and the increasing changes in ethnicity in American society, it is very likely that healthcare providers will provide acute and post-acute care to burn victims with varying cultural backgrounds and practices [1, 2]. As family support is vital to the rehabilitation of a pediatric burn survivor, creating effective rehabilitation plans requires the intentional consideration and inclusion of these, and other, factors. Family support is the leading indicator of burned children’s quality of life after discharge [3–7]. Parents are a significant source of emotional strength for their children both during hospitalization and long-term healing [4, 8]. Studies also report that a child’s physical and emotional rehabilitation are positively related to supportive family systems [9–11]. Given that family support is so critical to the long-term recovery of the child, considering culturespecific attitudes, beliefs, norms, and behaviors is imperative to creating a rehabilitation regimen to which family members can and will adhere. Misunderstandings rooted in cultural differences often result in divided doses of antibiotics, antibiotics being replaced with faith healers, alternative or complimentary medicines being used in place of or in addition to prescribed medications with no knowledge of side effects, and not scheduling or attending regular follow-up visits. In this regard, even with the best of intentions, pediatric burn victims of racial and ethnic minority backgrounds may unwittingly receive suboptimal care by healthcare practitioners. To date, research on the effects of including cultural factors in pediatric burn care, particularly aftercare, has either yet to be conducted or is not widely available in published form. Post-acute and home-based burn management (both between and within cultures) needs considerable exploration. The effects of including complimentary or alternative medicines in a rehabilitation plan for burned children have not yet been published in the literature. Research from other fields indicates that identifying and incorporating the cultural context and preferences of families can have numerous benefits, including, but not limited to, improved trust and communication between families and healthcare providers, the identification of unique strengths and potential barriers associated with treatment adherence, and increasing the perceived competency of family members to cope with and actively participate in enhancing functional outcomes [12–14]. Knowing this, culturally appropriate strategies can and ought to be developed to increase the probability of successful healing among pediatric burn victims.