Behavioral observations were conducted on 40 children admitted consecutively to an inpatient pediatric burn care unit (PBCU) over a 6‐month period. Children's responses to the PBCU environment as well as adult responses to patients were assessed. Data indicated that children most frequently (a) were oriented and alert, (b) emitted vocalizations or verbalizations, (c) were environmentally engaged, (d) and demonstrated positive or neutral affective responding. Adult‐child interactions occurred during the majority of observations. Age was found to be significantly related to the type of distress response exhibited. Positive responses indicative of patient well‐being were found to be associated with environmental engagement and the presence of other patients. In general, little evidence emerged to support the notion of a PBCU response pattern which resembles that observed in pediatric intensive care units (i.e., ICU syndrome). The use of observational methods for studying the behavioral adaptation of children in medical settings and the implications of the data for the design of interventions on PBCUs are disc