Video-Guided Jaw Relaxation and Breathing Exercises in Children With Burns

Effects of Video-Guided Jaw Relaxation and Breathing Exercises on Anxiety, Fear, and Dressing Duration in Children With Burns: A Three-Arm Randomized Controlled Trial

This randomized controlled trial aims to evaluate the effects of video-guided jaw relaxation and video-guided breathing exercises on anxiety, fear, and dressing duration in children with burns. Children aged 4-10 years receiving inpatient care in a pediatric burn unit will be randomly assigned to one of three groups: video-guided jaw relaxation, video-guided breathing exercise, or control. Children in the intervention groups will perform the assigned exercise simultaneously with a 5-minute video before burn dressing, while children in the control group will receive routine care. Anxiety and fear will be assessed at three time points: before the intervention (T1), immediately after the intervention and before dressing (T2), and immediately after dressing (T3). Dressing duration will also be recorded. The study will determine whether these brief, video-guided non-pharmacological interventions reduce anxiety and fear associated with burn dressing and affect dressing duration in children.

Burn dressing procedures can be stressful and anxiety-provoking experiences for children. Repeated exposure to painful dressing procedures may contribute to anticipatory anxiety and fear, which can further complicate the child's experience of burn care. Non-pharmacological interventions may provide a simple and supportive approach to managing these responses alongside routine clinical care.

Jaw relaxation is a relaxation technique that does not require sequential contraction and relaxation of multiple muscle groups. The technique involves allowing the lower jaw to drop slightly, keeping the tongue relaxed on the floor of the mouth, relaxing the lips, and maintaining a slow breathing rhythm consisting of inhalation, exhalation, and rest. Although jaw relaxation has been investigated in adults with burns, evidence regarding its use in children with burns is lacking. This study adapts the technique for children using a brief video-guided approach.

This study is designed as a three-arm randomized controlled trial involving children aged 4-10 years receiving inpatient treatment in a pediatric burn unit. A total of 60 children will be assigned to one of three groups: a video-guided jaw relaxation group, a video-guided breathing exercise group, or a control group. Children in the video-guided jaw relaxation group will watch a 5-minute video demonstrating jaw, tongue, and lip relaxation combined with a slow inhale-exhale-rest breathing rhythm and will perform the demonstrated exercises simultaneously. Children in the video-guided breathing exercise group will follow a 5-minute video demonstrating the same slow breathing rhythm without instructions related to relaxation of the jaw, tongue, or lips. The control group will receive routine care without either video-guided intervention.

Anxiety and fear will be assessed at three time points: before the intervention (T1), immediately after the intervention and before burn dressing (T2), and immediately after completion of the dressing procedure (T3). Anxiety will be assessed using the Children's Anxiety Meter-State, and fear will be assessed using the Child Fear Scale. The total duration of the dressing procedure will also be recorded using a stopwatch.

The study aims to determine and compare the effects of video-guided jaw relaxation and video-guided breathing exercises on anxiety, fear, and dressing duration in children undergoing burn dressing. The findings may provide evidence for a brief, developmentally appropriate, and easily applicable non-pharmacological intervention that can be integrated into pediatric burn care.

Inclusion Criteria:

• Children aged 4-10 years
• Receiving inpatient treatment in the Pediatric Burn Unit
• Having undergone at least three previous burn dressing procedures
• Able to communicate in Turkish
• No visual or hearing impairment that would prevent participation in the video-guided intervention
• No administration of an anxiolytic medication before the dressing procedure that could affect the study outcomes
• No burns involving the face or neck
• Child and parent/legal guardian willing to participate in the study and provide the required assent/consent

Exclusion Criteria:

• Child or parent/legal guardian requesting withdrawal from the study
• Inability to tolerate or complete the assigned video-guided jaw relaxation or breathing exercise
• Development of a serious clinical complication or requirement for intensive care during data collection
• Inability or refusal to comply with the study protocol, including discontinuation or refusal of the assigned intervention