A Child With Oppositional Behavior After a Burn Injury: A Role for Inpatient Developmental Pediatrics Consults.

A 5-year-old autistic girl struggled with challenging behaviors during hospital treatment for burns. At home, she did well with predictable routines and noise-cancelling headphones. In the hospital, unpredictable schedules and new environments led to hitting, running away, and refusing therapy. This shows how important familiar routines and sensory supports are for autistic children in medical settings.

This case report describes a 5-year-old autistic girl who developed severe behavioral challenges during inpatient rehabilitation following extensive burn injuries. The child exhibited aggressive behaviors, hyperactivity, and therapy refusal that interfered with her recovery. Her pre-admission history revealed successful behavioral management at home through structured routines and environmental accommodations. The hospital environment disrupted these supports with variable therapy schedules and sensory challenges.

A developmental pediatrics consultation was requested to address medication options for oppositional behaviors. The case highlights the importance of autism-informed care in medical settings and the need for environmental modifications to support autistic children during hospitalization.

Autistic children may require specialized environmental accommodations during hospitalization including predictable schedules, sensory supports, and routine maintenance. Medical teams should consider developmental pediatrics consultation early when caring for hospitalized autistic children.

Single case report limits generalizability. No intervention outcomes reported. Limited detail on specific environmental modifications attempted or their effectiveness.

A 5-year-old girl with a history of autism spectrum disorder was admitted to inpatient rehabilitation after extensive accidental burns requiring skin grafts to her upper body. During her admission, she had increasingly aggressive behaviors toward staff, hyperactivity, impulsivity, and refusal to participate in therapies. She resisted transitions between activities, hit her bed rails, and eloped from her room. Goals during physical therapy sessions included stretching and strengthening her scarred extremities to increase mobility.

Her behavior increased her risk of healing complications and became a significant barrier to progress in her rehabilitation. The medical team consulted developmental and behavioral pediatrics to recommend medications for oppositional behaviors not responding to behavioral strategies.A developmental and behavioral pediatrics consulting team of physicians and nurses met the patient, gathered history, and observed the child in the hospital. The patient's developmental history was significant for expressive language delay and autism spectrum disorder. At home, she preferred solitary play and spinning objects and had an intense interest in horses.

In the school setting, she was supported with an individualized education plan and special education services. In crowded areas, she wore noise-canceling headphones to accommodate auditory sensory hypersensitivity. Her mother reported maintaining a strict schedule at home around mealtimes, bath time, and bedtime, which provided comfort and limited tantrums. She had never needed medication to manage behaviors at home or at school in the past.When the developmental pediatrics team observed her in the hospital, she eloped from a physical therapy session in the gym and refused to participate in a hospital school session.

Therapies occurred at variable times throughout the day, and she resisted transitions between therapies. She frequently complained of itching from healing burn sites and had developed new daytime urinary incontinence. During examination, she engaged in back-and-forth ball play and sought reassurance from her parent. Therapists, nurses, and behavioral health providers were interested to hear any ideas to support her.

What should the developmental and behavioral pediatrics team recommend?