Pain, Distress, and Psychological Sequelae in Pediatric Burn Care: A Systematic Review and Meta-Analysis of Interventions Across the Care Continuum

Pediatric burn injuries can lead to both acute procedural distress and longer-term psychological challenges, including anxiety, depression, and post-traumatic stress symptoms. While physical rehabilitation is well integrated into burn care, mental health interventions remain underutilized and inconsistently applied. This systematic review and meta-analysis evaluate procedural and psychological strategies used to improve mental health and pain-related outcomes in pediatric burn survivors. A comprehensive search of PubMed, Embase, and Scopus was conducted for studies published from January 2000 to December 2023. Eligible studies included pediatric burn patients (≤18 years) and evaluated interventions targeting either acute pain/anxiety during wound care or longer-term psychological recovery. Random-effects meta-analyses were performed for studies reporting extractable continuous outcomes. Heterogeneity was assessed using I2 and τ2 statistics. Twenty-four studies involving 1705 pediatric burn patients were included. Interventions addressed either procedural distress (eg, virtual reality [VR], music therapy) or psychological sequelae (eg, cognitive-behavioral therapy, pharmacologic treatments, school-based support).VR demonstrated a significant and consistent effect in reducing procedural pain, with a pooled standardized mean difference (SMD) of -0.95 (95% CI, -1.31 to -0.59, P < .0001, I2 = 0%). Music therapy showed a nonsignificant pooled effect (SMD = -0.47, 95% CI, -6.62 to 5.69, P = .51, I2 = 80.8%), though individual studies suggested benefits in older children or when paired with physical therapy. Cognitive-behavioral, creative, and psychosocial interventions showed promise but varied in effectiveness. Virtual reality is a robust, nonpharmacological intervention for procedural pain management in pediatric burn care. However, robust evidence supporting interventions for long-term psychological outcomes remains limited.