Advice to support you and you child during dressing changes PIAG 145

Burns Unit

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Introduction

Dressing changes can be difficult experiences for children, parents and carers. Every child will react differently to having their dressings changed. We hope that this information leaflet will help guide you through the procedure and give you some ideas for helping your child. I

f you would like any further support or would like to speak to a member of the team before your child’s appointment please contact us via the number provided on the back page of this leaflet.

Why does my child need their dressings changed?

It is important to have regular dressing changes to keep the wound clean and free from infection. Even though it is recommended not to get the dressing wet or dirty, we understand it can be easily done with young children. Make sure to get in touch with the team if this does happen though as you will need the dressing changed earlier.

Where do we go for a dressing change?

You will be told where to go when you are given an appointment, but dressing changes usually happen in a nurse-led outpatient clinic, or on the burns unit. For more complex dressing changes your child might need to go to theatre. We will tell you these details before your appointment.

Medications

Medications for dressing changes in outpatient clinics

There are several medications used to help minimise pain and anxiety. It is likely that you will be asked to give your child some pain relief such as paracetamol (Calpol) approximately 30-60 minutes before your appointment time.

Medications for dressing changes on the Burn Unit

The doctors may recommend that your child be given the following when in hospital:

Oromorph: a form of morphine given as a syrup to help with pain

Midazolam: a sedative, given as a syrup, which reduces anxiety and can make your child feel sleepy. This is important because anxiety increases the perception of pain.

If your child is having Midazolam you will be asked to make sure they don’t have any food, milk or formula for six hours prior to admission. If needed, your child can have water up to two hours prior to admission.

Your child will also be placed on a bedside monitor so that the nurses can keep an eye on the level of sedation. They may fall asleep or just be calm or sleepy. Occasionally Micazolam can cause children to become agitated.

What happens during a dressing change?

The dressing change will take place either in a treatment room on the ward, or in a special bathroom on the ward. You can stay with your child during the dressing change.

If you think it would be helpful, you can ask for a Play Specialist to be present. Play Specialists are trained in techniques to support and distract your child.

The first stage is for the old dressings to be taken off. This involves removal of outer bandages, sometimes cutting them off with scissors and then using water to soak off the remaining dressings.

Once the dressings are off, the doctor may come to see how the wounds are healing and to make decisions about future treatment. The healing wound will need to be cleaned with water and gauze. New dressings are then put on. These may be different from the old ones depending on how the wound looks.

Setting a calm example

Dressing changes can understandably be stressful for parents and carers, and it can be hard to remain calm. Children are often sensitive to their parents’ or carers’ emotions.

Try to stay as calm and relaxed as possible as this can help your child to feel okay. Some of the following tips might help you.

Helpful tips

• Make sure you know what to expect during your child’s dressing change
• Use support such as another family member or friend to help you out
• Let the nurses know if you have any worries, concerns or questions
• Request support from the Burns Psychology Service
• If you would prefer not to see the dressing change this is okay too, and it might be that a family member/friend is able to stay with your child during the dressing change. This should be set up as an agreed plan prior to the dressing change appointment

Exploring the procedure

This will depend on the age of your child. Allow your child to talk to you about their dressing change and to ask you any questions about it. Think about the timing of when to tell your child they will be having a dressing change.

They will depend on their age and understanding but here is a rough guide:

Age 3 to 4 years – One to two days before

Age 5 to 6 years – Three to five days before

Age 7 to 11 years – Approximately seven days before

Age 12 and over – Actively involve your child from the start in planning

Before the procedure

• Allow your child to talk about their feelings and worries about having their dressings changed
• Reassure your child that it is okay to feel worried or upset about the appointment
• If your child does not want to talk about it, you could encourage them to play or draw a picture to explain their feelings
• Providing reassurance, praise and hugs will help them manage their feelings
• Use simple language to explain to your child what the dressing change will involve
• Be honest with your child that the dressing change might hurt, but also explain why they need to have it done
• Help your child to see the hospital staff as people who are trying to help them reassure your child that the staff have a lot of experience in burns and perform dressing changes all the time
• Children often know more about what is happening then they will admit. However, they can also misinterpret things that they hear
• You could ask your child questions to determine how much they know
• If you feel that your child would benefit from having a Play Specialist present during the dressing change to distract them and talk the procedure through with them, speak to staff before you and your child come into hospital

During the procedure

Distraction

Distract your child with fun or familiar activities and games, eg. playing games on a tablet/iPac, listening to music, watching a film on a handheld device, a favourite book or toy, physical distraction such as touch, patting, massaging, playing with your child’s hair etc.

Relaxation

This can help your child gain some control over physical feelings of anxiety. Encourage your child to practice breathing slowly and deeply to help them feel calm.

Holding and positioning

If possible it may be helpful to hold your child’s hand or support them in a position that is comfortable and appropriate for the procedure. Your child might like being close to you and it could help them feel less worried. Talk to the nurses about the best way to hold your child.

Coping Talk

Try to use coping talk (e.g. “You are doing really well) while your child is having their procedure, encouraging them and reassuring them throughout.

After the procedure

Talk openly about the procedure with your child. Think about what went well, what didn’t, and what helped your child to manage. Also think about anything that could be done differently next time.

Praise your child for what they have done even if they don’t manage to let the nurses change the dressing on that day.

You may agree beforehand that your child will get a reward following their dressing change, for example: stickers, a small gift, a trip out to their favourite place, visiting friends, a favourite snack or drink.

Looking after yourself

Self-care is important for us all, but during stressful times it can be easy to forget to look after yourself. Going through a burn injury is a very stressful experience for all involved, and you might find that putting all of your time and concern into helping your child through a stressful experience can leave you feeling more stressed and worn out.

It is important to try to remember to look after yourself as this will help you to feel better able to cope and to provide support for your child.

Tips for self-care

• Try to make sure that you get enough sleep, eat well-balanced meals and try to stick to regular routines
• Seek support from others. Because you are also responding to the trauma, it is very important to talk to other parents, friends, and/or Burns Team staff. Share your anxieties and frustrations with them, and don’t be afraid to ask for help
• Take time to deal with and think about your own feelings. It is often a lot harder to help your child if you are worried or upset. Try to talk about your feelings with your family and friends
• Remember that people in your own family may react in different ways. Remember that your child’s feelings may be very different from yours and that siblings may feel upset as well

Support agencies

Changing Faces
Tel: 0171 742 3205 www.chargingfaces.co.uk

Children’s Burns Trust
Tel: 020 7881 0902 | www.cbtrust.org.uk

Dan’s Fund for Burns
Tel: 020 7262 4039 www.dansfundforburns.org

Contact the Burns team

For more information about any of the services please contact one of the following:

Burns Unit

Tel: 0151 252 5400

Open 24/7

Physiotherapy department

Tel: 0151 252 5236

Open Monday to Friday from 9am to 5pm

Occupational Therapy department

Tel: 0151 252 5453

Open Monday to Friday from 9am to 5pm

Psychology department

Tel: 0151 252 5586

Open Monday to Friday from 9am to 5pm

This leaflet only gives general information. You must always discuss the individual treatment of your child with the appropriate member of staff. Do not rely on this leaflet alone for information about your child’s treatment.

This information can be made available in other languages and formats if requested.

PIAG: 145