Abstract
The complex problems which severely burned children must overcome and adjustment which their families have to face, have been discussed since 1970. The author has selected cases demonstrating significance of family assistance to prevent the "psychological" hypothalamic death.
The psychical frustration may be the lethal factor regardless of the somatic prognosis. To influence favourably this factor there has been utilized assistance of family members throughout the long-term course of treatment.
Nevertheless any tragical event in the child's family may play a detrimental role. The most harmful form of child abuse (the "Münchhausen by proxy syndrome") involves mothers, apparently deeply caring, who plan to get rid of their child by means of malnutrition, gradual intoxication or in our practice burn.
When the child requires admission to hospital they wish to act as "accompaniment" and under the shelter of an institution they may succeed to kill their child. Diametrically opposite role had the father of a two-year old girl with scar disfigurement of face, hands and severe inhalation injury.
During her rehabilitation period she lost her mother and brother. Her father (kind-hearted, responsible man) lost his wife and son.
The extreme sorrow influenced also the results of psychological therapy though the girl's father was most helpful. However, the long-lived continual follow-up was indispensable.
The other example is an eleven-year old boy also with severe scar disfigurement of face and neck, in whom multiple procedures of reconstruction were performed. Medical advances can be coped with by doctors equipped not only with high professional skills, but also must be aware of their ethical duties towards their patients - both as an individual and as a part of the social context