Special Considerations for Pressure Garments in Children with Burns

Yu-Li SUNG
2 days ago
3 min read

Yu-Li Sung, Physical Therapist and Director, Medical Device Center

Sunshine Social Welfare Foundation

Special Considerations for Pressure Garments in Children with Burns

Pressure garments play a vital role in controlling hypertrophic scar growth in children following burns. Due to their rapid growth and higher collagen production, young children are more prone to "exuberant" scar formation. Proper use of pressure garments can significantly aid in managing scars, but burn rehabilitation therapists must consider several unique factors when working with pediatric patients. This post highlights the benefits, as well as special considerations for pressure garments in children with burns.

Why Pressure Garments Are Essential for Children with Burns

Children’s skin produces collagen more rapidly than older adults as part of the body’s natural growth and healing process. While this ability aids in faster wound closure, it can also lead to excessive collagen buildup, resulting in thick, raised scars. Left unmanaged, scars can cause functional limitations and aesthetic concerns. Pressure garments help control scar growth by applying pressure over them.

Additionally, scars that haven’t matured often itch intensely, making children prone to scratching, sometimes to the point of causing skin injury. Pressure garments can act as a protective barrier, minimizing skin damage from scratching. Therapists can advise parents to alleviate itching by gently patting the area or applying a cold compress to soothe the skin.

Special Considerations Pressure Garments in Children with Burns

While pressure garments offer significant benefits, they must be used carefully to accommodate a child’s unique developmental needs. Children's bones, muscles, and soft tissues are in continuous development. Excessive or prolonged pressure from garments can potentially lead to unintended skeletal or dental deformities. Studies have documented such disturbances in children undergoing pressure garment therapy for facial burns. For instance, research indicates that pressure garment use can alter facial growth, inhibiting maxillary horizontal growth and mandibular anterior-inferior growth during the period of garment use. Although facial bones' growth and development seem to return to normal after discontinuing garment use, some lasting changes may remain [1].

To balance scar management with developmental needs, the therapist can use the following precautions:

1. Scheduling Wear Pauses

Therapists should recommend scheduled pauses during the day. For example, the child can remove garments before lunch and put them back on after a post-lunch nap. These breaks should align with the child’s daily routine to minimize disruption and resistance. Importantly, pauses should not exceed one hour at a time to prevent scars from becoming raised.

2. Scheduling Frequent Follow-Ups

Children grow quickly, and garments can soon become too tight, restricting movement or compromising their effectiveness. Monthly follow-ups are crucial to assess fit, make adjustments, or order new garments.

3. Engaging Parents and Caregivers

Therapists should provide clear guidance to parents, helping them understand the importance of consistent wear while accommodating the child’s comfort and daily activities. Educating caregivers about proper garment care, including cleaning and maintenance, ensures garments remain effective and hygienic. Because friction from the pressure garment fabric on the skin can occasionally cause irritation or small wounds, particularly in active children, therapists should also teach parents to inspect the skin regularly for signs of redness, blistering, or breakdown and report any concerns promptly.

4. Addressing Compliance Challenges

Children may resist wearing pressure garments due to discomfort or restricted movement. Older children may also feel that garments make them look conspicuous and they may become highly self-conscious of their peers’ reaction.

Strategies to improve compliance include:

Using brightly colored or patterned fabrics, or adding cute clothing decals to make garments more appealing.
Encouraging wear during play or other enjoyable activities.
Involving children in their care routine to foster cooperation.
Practicing different scenarios with children to help them be better prepared to address questions from friends or strangers.

Conclusion

Pressure garments are invaluable tools for managing pediatric burn scars, but their use requires careful planning and monitoring. By understanding children’s unique needs and growth patterns, therapists can optimize scar management while ensuring safety and comfort.

References

[1] Fricke, N. B., Omnell, M. L., Dutcher, K. A., Hollender, L. G., & Engrav, L. H. (1999). Skeletal and dental disturbances in children after facial burns and pressure garment use: a 4-year follow-up. The Journal of burn care & rehabilitation, 20(3), 239–249.