The Effect of Cartoon Character-Printed Band Use During Burn Dressing on Fear, Stress, Pain, and Physiological Parameters in Children: A Randomized Controlled Trial

Burn injuries are among the most common causes of hospitalization in children and often require repeated painful dressing changes. These procedures can provoke significant fear, stress, and pain, negatively affecting children's cooperation, recovery, and overall treatment experience. Traditional approaches to pain management in burn care frequently rely on pharmacological methods, which may have limitations or adverse effects. Therefore, complementary, non-pharmacological interventions are needed to support children during painful procedures.

The CARE-BURN Trial investigates the impact of using cartoon character-printed adhesive bands as a simple, visual, and child-friendly distraction tool during burn dressing. The intervention is designed to create a more comforting and engaging environment for the child by integrating familiar cartoon images into the medical materials. The visual appeal of the bands is expected to distract children's attention from the painful stimulus, enhance their sense of security, and reduce anxiety and perceived pain intensity.

This randomized controlled study includes children aged 7-11 years who are receiving inpatient or outpatient burn treatment. Participants will be randomly assigned using the Urn randomization method to one of two groups:

Intervention Group: Dressing with cartoon character-printed adhesive bands

Control Group: Dressing with standard plain adhesive bands

Measurements:

Children's Fear Scale (CFS)

Wong-Baker FACES Pain Rating Scale

Perceived Stress Scale for Children (PSS-C)

Physiological parameters: heart rate, oxygen saturation, and respiratory rate

Assessments will be conducted at three time points: before, during, and after the dressing procedure. All data will be collected by trained researchers using standardized procedures.

The expected outcomes include decreased levels of fear, stress, and pain, as well as improved physiological stability among children in the intervention group compared to the control group.

The CARE-BURN study aims to demonstrate that low-cost, visually appealing, and child-centered materials can enhance the comfort and cooperation of pediatric patients during invasive or painful treatments. This approach may provide practical insights for pediatric nurses and healthcare providers seeking to humanize burn care and reduce children's distress during routine medical procedures.

Inclusion criteria

• Children aged 6 to 11 years at the time of enrollment.
• Hospitalized children diagnosed with superficial partial-thickness or deep partial-thickness burns (second-degree burns).
• Total Burned Body Surface Area (TBSA) ≤ 10%, calculated using the Rule of Nines or Lund-Browder chart.
• Burn location limited to upper extremities, lower extremities, or trunk.
• Scheduled to undergo routine burn dressing procedures in the pediatric ward.
• Ability of the child to communicate pain and anxiety verbally.
• Written informed consent obtained from parent or legal guardian, and assent from the child when appropriate.

Exclusion criteria

• Children with full-thickness (third-degree) or fourth-degree burns.
• Burns involving the face, scalp, neck, or genital region.
• TBSA > 10%.
• Presence of cognitive impairment, developmental delay, or neurological disorder that may interfere with outcome assessment.
• Presence of chronic pain conditions or regular use of analgesics unrelated to burn treatment.
• Initial burn dressing performed in an intensive care unit (ICU).
• Refusal of the child or parent/legal guardian to participate.