Self- and parent-perceived stigmatisation in children and adolescents with congenital or acquired facial differences

doi:10.1016/j.bjps.2012.06.004

Journal of Plastic, Reconstructive & Aesthetic Surgery

Volume 65, Issue 12, December 2012, Pages 1664-1670

https://doi.org/10.1016/j.bjps.2012.06.004 Get rights and content

Summary

Background

The risk of social stigmatisation is an important determinant in the decision for plastic and reconstructive surgery in children and adolescents. The purposes of this cross-sectional study were threefold: (1) to assess self- and proxy-reported stigma experiences of children and adolescents with congenital or acquired facial differences; (2) to compare patients versus controls; and (3) to identify predictors of perceived stigmatisation.

Methods

Data were obtained from a cohort of 87 children (ages 9 months to 16 years) with facial burn scars, port-wine stains, infantile haemangioma or congenital melanocytic nevi, using parent questionnaires (n = 85) and standardised interviews in children older than 7 years (n = 29). Perceived stigmatisation was assessed with the Perceived Stigmatization Questionnaire. Self-reported stigmatisation was compared versus a matched control group consisting of 29 children and adolescents without a facial difference. Medical, demographic and parental psychological variables were examined as predictors of proxy-perceived stigmatisation.

Results

Patients with a facial difference reported significantly higher levels of stigma experiences than control subjects. A majority of the patients reported having experienced expressions of pity, staring or startled reactions; and about one-quarter had been teased about their facial difference. Multivariate analysis indicated that proxy-perceived stigmatisation was predicted by larger size of the facial difference and greater age of the child. Gender and type of facial difference (acquired vs. congenital) had no significant impact.

Conclusions

These results demonstrate that children with a facial difference are at higher risk of experiencing stigmatisation than children without a visible difference. Children with a facial difference that covers more than 25% of their face are particularly vulnerable to stigmatisation and therefore need special monitoring.

Section snippets

Participants

Participants were recruited at University Children's Hospital in Zurich, Switzerland (n = 63) and at University Children's Hospital in Freiburg, Germany (n = 24). Inclusion criteria were as follows: (1) a visible facial burn scar, infantile haemangioma, port-wine stain or congenital melanocytic nevus, with a current size of at least 1 cm²; (2) age between 9 months and 16 years; (3) at least 6 months post-trauma for burn patients; (4) no wearing of a facial compression mask by day at the time of

Sample characteristics

Overall, data from 87 patients were collected (M_age = 6.17, SD = 4.66). In two of the 31 cases involving a child aged 7 years or more, only the child participated, whereas in three of those cases, only the parent participated. Therefore, the final tally was 85 parent reports; 29 self-reports from patients; and 29 self-reports from controls. Sample characteristics are summarised in Table 1, for preschool and school-age patients separately. In preschool patients, the majority of cases had a

Discussion

Overall, our results confirm our principal hypothesis that children with facial differences are at high risk for experiencing stigmatising behaviours, such as staring, startled reactions, teasing and expressions of pity. This is in-line with previous reports.9, 16 Even though teasing and making fun of are common experiences in school-age children, the comparison with matched controls demonstrates that individuals with facial differences experience more negative social behaviours than peers

Conclusions

Children and adolescents with a facial difference experience a variety of stigmatising behaviours, such as staring and teasing. Their risk of stigmatisation is greater than among non-disabled children and increases, the larger the facial difference and the older the child. Provision of care for children and adolescents with facial differences ideally includes psychosocial assistance.

Conflicts of interest statement

None of the authors has any interests to disclose. No outside funding were received.

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^☆

Meetings at which parts of this research has previously been presented:

1. Appearance Matters 4 Conference, Bristol, 23–26 June, 2010.

2. International Expert Meeting for Large CMN and Neurocutaneous Melanocytosis, Tubingen, 6–8 May, 2011.

3. 19. Jahrestagung des Arbeitskreises “Das schwer-brandverletzte Kind”, Stuttgart, 20–21 May, 2011.

4. 6th Word Congress on Paediatric Burns, Zurich, 20–23 August, 2011.

View full text

Self- and parent-perceived stigmatisation in children and adolescents with congenital or acquired facial differences☆

Summary

Background

Methods

Results

Conclusions

Section snippets

Participants

Sample characteristics

Discussion

Conclusions

Conflicts of interest statement

Body Image

Br J Plast Surg

Clin Psychol Rev

J Plast Reconstr Aesthet

J Plast Reconstr Aesthet Surg

Maxims or myths of beauty? A meta-analytic and theoretical review

Psychol Bull

Perceived functional impact of abnormal facial appearance

Plast Reconstr Surg

Stigma: notes on the management of spoiled identity

Visibly different: coping with disfigurement

Children's experience of living with a craniofacial condition: perspectives of children and parents

Clin Child Psychol Psychiatry

Facial disfigurement: problems and management of social interaction and implications for mental health

Aesth Plast Surg

School peer victimization of young people with craniofacial conditions: a comparative study

Psychol Health Med

Stigma experiences in youth with facial differences: a multi-site study of adolescents and their mothers

Orthod Craniofac Res