FAQ Category: Child

Without knowing that the problem is with your son’s meniscus, it’s hard to say why one type of surgery would be preferred over another. However, sometimes it is a better idea to open the knee with a traditional incision than do an arthroscopic surgery, with the slender, long reaching instruments.

A child’s joint is quite small, leaving not much room to maneuver. It’s possible that the surgeon feels more comfortable doing the open surgery, allowing him to see the entire joint, than try to do it arthroscopically.

Your knee is a complicated joint in that it has the knee cap protecting where the femur (thigh bone) and shin bone (tibia) meet. The knee needs tendons to help move the muscles, and it also needs cartilage – the menisci – to protect the knee. You have two menisci. One is the lateral meniscus (on the outside of your knee) and the other is the medial meniscus (on the inside of the knee).

The menisci attach to the tibia, staying in place with ligaments, sinewy tissue. The menisci are important because they act as shock absorbers, they stabilize the knee, allowing the body weight be distributed evenly across it, rather than on one or two points directly on the knee, and they lubricate the cartilage.

So, the menisci are important parts of your knee and should be treated if there are any injuries.

Through your description, it sounds like your niece may have had unstable slipped capital femoral epiphysis. That’s the long way of saying, it sounds like the upper part of her femur (thigh bone) slipped out of place and was causing a lot of pain.

The school of thought for children who have this disorder should have surgery within 24 hours of the first symptoms, if possible. This increases the chance of success and decreases the chances of complications. However, about half of children with unstable slipped capital femoral epiphysis do develop a complication called osteonecrosis or bone death. The blood that supplies nutrients to the bone cells is not flowing to those cells and the cells die.

Treatment of osteonecrosis varies according to the problem, but surgery is frequently done.

Overweight and obese children are becoming more common in Western society. The daily exercise that we used to get as kids is a lot less for the kids of today for a variety of reasons. Obesity is also a major health risk for children. Lifestyle-related illnesses, like type 2 diabetes and high blood pressure, are now being diagnosed in teens or even younger children.

Your hip puts up with a lot though the course of the day. It bears all your upper body weight and must be able to twist and turn in several ways. If a body is too heavy for the hip’s capacity, then yes, problems can and do occur. It’s best that you get your son’s hips checked, as well as your other children to prevent permanent damage.

Parental and family participation in pain programs for children is fairly typical. Since you are his main support system, it’s helpful if you understand what the program is trying to accomplish with your child, what the goals are, and how they hope to reach these goals.

Toward that end, you will probably be taught some basic concepts about the condition your child has and the biology of pain mechanisms. If they are using a particular pain management model, they will also instruct you in how it works.

Once your child is released to return home, your cooperation in follow-up will be essential. Identifying stressors in everyday life will be important — along with ways to manage these when they come up for your child. Pain and disability will be discussed openly. This may be new for families who have avoided talking about their child’s pain as a strategy to avoid bringing attention to it.

The effects of pain, fear of pain, school absence because of pain, and physical and social inactivity caused by pain are all points of discussion. If there are learning problems to deal with, school officials may also be called in to participate in the overall treatment plan. Patient, family, and school staff may need to understand relaxation and guided imagery techniques the child will be using at home and at school.

Many studies support the use of a multidisciplinary treatment (MDT) approach. As the name suggests, multiple disciplines are involved — pain specialists, nurses, physical therapists, psychologists, and pharmacists are only a few who might be part of the team.

Physical therapy is geared toward helping patients with chronic pain to do more even if there isn’t a reduction in their pain. Increasing physical activities, introducing physical training, and learning how to pace both are key features of the physical therapy program.

Sometimes additional modalities such as electrical stimulation, pool-therapy, biofeedback, and relaxation training are part of the physical therapy program. Children and teens are given goals to work on and exercise homework to carry out between sessions.

The therapist will also assess your child for something called fear-avoidance behaviors (FABs). FAB refers to how people stop moving in ways that might recreate their pain or possibly cause a reinjury. Identifying FABs early and intervening can help keep them from setting up a vicious pain-avoidance-pain cycle.

Your pediatrician is right — 80 to 90 per cent of children, teens, and adults with low back pain find that the symptoms go away gradually over a period of one to two weeks. But if it’s already been several weeks with no change in a normally active child, then it’s probably time to ask for a follow-up exam.

Given that the majority of back pain resolves spontaneously, doctors don’t order X-rays or other imaging studies routinely for back pain. Not only is it an added expense, but it can expose a child to unnecessary radiation at an early age. But when symptoms don’t improve over time and/or the child gets worse, then an X-ray and even lab work may be helpful diagnostic tools.

Some things may have changed from the first time your physician saw your son until now. That’s another reason why a second visit would be timely. Given enough time, a serious problem (when present) will get worse and reveal itself more clearly. It’s always better to catch things sooner than later. Early diagnosis and treatment can prevent more serious complications from developing.

School budgets are causing cut backs in things like annual vision and hearing screening, as well as routine scoliosis screening in fifth or sixth grade. These tests are still important but they are being turned back to the responsibility of the parents.

A specific appointment may not be needed. Many local audiologists provide free hearing checks for people of all ages. For vision screening and scoliosis screening, schedule a little extra time for your child during his or her well-child check up. Let the nurse or appointment desk know of your interest in these tests.

If your child needs to go in for any other reason before the annual physical exam, be sure and bring up these tests with your primary care provider. They can easily be done during any type of exam.

Many children who experience pain report that it lasts right on into their adult years. This alone would be enough reason to put your life on hold for a month and make a concerted effort to help your child.

What can be done to put a stop to this early on? Studies are few and far between on this topic. That’s why a recent study from Germany is so important. Children between the ages of 11 and 18 participated in an inpatient program lasting three weeks. Children in the study had moderate-to-severe pain lasting more than six months. Their parents reported school absences of at least one week out of the last four.

Two-thirds of the 167 children reported headache pain (tension type or migraine). The pain was enough to disrupt daily activities such as homework, sleep, physical activity, and attending school. In fact, one-fourth of the group wasn’t even in school when the study began.

Before entering the program, each child was tested for baseline pain intensity, level of pain-related disability, depression, and emotional distress. Number of days missed from school and number of pain relievers taken daily were also recorded.

The treatment program was multimodal, meaning a wide range of methods were used. For five to eight hours every day, the children met with behavioral therapists, psychologists, art therapists, and physical therapists. They participated in individual counseling, family therapy, and group therapy. When emotional trauma was present, specific eye-movement therapy was also included.

The children were required to do homework every day. They kept a journal listing what they learned in sessions each day. They practiced new techniques such as distraction, pain coping strategies, and physical exercise. Early on in the three-week program, family members were taught how to stop enabling and stop reinforcing pain behaviors. For example, they learned how to change daily routines to help support the child in going to school despite the pain.

The children were not just in and out of the program. There was a transition period to help integrate the new skills at home and at school. Halfway through the three-week program, they made home and school visits to put into practice what they had learned. Relapse prevention was part of the overall program as well.

Significant changes were observed in all areas measured. Half of the children taking pain medication when they came to the program were able to get off all pain relievers. Children had less pain and were able to attend school more often. Changes in emotional status were not as dramatic. School aversion and depression were less but still present in two-thirds of the group.

The authors analyzed the data using age and gender (boys versus girls) as predictive factors of outcomes. Neither one of these factors appeared to make a difference in the results. The most deciding factor of overall success was level of pain. Children who started the program with lower pain levels seemed to have the best results.

The authors concluded that a multimodal inpatient program aimed at the treatment of chronic pain in children and teens can be very successful. More than half were symptom-free with improved function at the end of three months’ time. This was true for a variety of pain disorders.

After years of suffering, that was a very positive result for those children. These findings suggest that it is possible to stop the vicious cycle of pain-disability-pain that these children experience.

Most primary care physicians and pediatricians have an on-going relationship with their patients. Their focus is on care from the cradle to the grave. And they take their mission seriously. The fact that your physician encouraged you to call first before consulting the Internet is a good example of the kind of care and service you should expect from this type of physician. It sounds like you are in good hands.

Whereas there’s nothing wrong with consulting the Internet for information, it is important to pay attention to your sources. Be aware that many websites offering information base their facts on one study or a single news report. And they don’t update their information. In some cases, information cited from studies in the 1990s is already out-of-date.

Physicians look to large-scale studies published recently in peer-reviewed (reliable) journals to help ensure the most accurate up-to-date information. When reading information on-line, look for dates when the information was published and posted. Look for reputable sources of that information. Unless presented by a well-known, reputable source, don’t count the website as the content expert.

You’ll notice with Multimedia Medical Group, information is up-to-date and referenced. At the end of each article reviewed, the source of the information is posted. Information comes from only reputable, peer-reviewed journals well-known in the field of medicine and orthopedics.

From reviewing the evidence, we know that today’s evidence suggests back pain in children is more likely to be nonspecific (unknown cause) or mechanical (caused by soft tissue or bony structures with movement). More serious disorders such as fractures, infection, or tumors can occur, but they are less common.

We also know that back pain is common in children — more common than we might expect. Most of the time, the cause remains unknown. Physicians have a model or algorithm for evaluating and diagnosing back pain in children that will reveal more serious causes when they are present. No doubt your child benefitted from her pediatrician’s assessment following these guidelines.

There are some studies that support the idea that serious causes of back pain in children can be missed or diagnosed late. That’s unfortunate but it can happen. Most of the time, with early examination and testing, any serious underlying cause of back pain in children and teens can be identified and treated quickly.

Sometimes, conditions such as infections, tumors (benign or malignant), or rheumatic conditions causing back pain present with vague, diffuse symptoms. The child can’t put a single finger on the owie or tell the parent exactly where it hurts. Children don’t always have the necessary language skills to describe all of their symptoms.

If the parent can’t see or feel anything wrong, and there’s no fever or swelling, it’s easy to assume it may be growing pains or something passing. And, in fact, many times, low back pain in children is nonspecific (unknown cause). After waiting 24- to 48-hours, the pain is gone.

Anything that lasts longer than 48-hours or is accompanied by other suspicious signs (e.g., diarrhea, constipation, fever, nausea, swelling, red streaks or rash of any kind) should be investigated by a medical doctor. Most serious causes of back pain are progressive — that means over time, the disease will advance until it becomes clear just what is the underlying condition.

But, it’s best to get an accurate diagnosis sooner than later. Early intervention is the key to the best outcomes.

Blount disease looks like bowlegs also known as tibia varum (singular) or tibia vara (plural). Bowlegs are common in toddlers and young children. The condition is called physiologic tibia varum when it’s a normal variation and the child will grow out of it. Most toddlers have bowlegs from positioning in utero (in the uterus). This curvature remains until the muscles of the lower back and legs are strong enough to support them in the upright position.

In some cases, abnormal growth of the bone causes the bowing to get worse instead of better over time. This is the condition we call Blount disease or pathologic tibia varum. Blount disease becomes obvious between the ages of two and four as the bowing gets worse. Overweight adolescents or teenagers can also develop this problem.

Blount disease is more than just a cosmetic deformity. is affected. In the early stages of this condition, the medial or inside edge of the bone breaks down and growth stops. Pain develops along with an uneven leg length, which can lead to an altered gait (walking) pattern, tripping, falls, and injuries.

What can be done about it? Treatment depends on the age of the child and the stage of the disease. Between ages birth and two, careful observation or a trial of bracing (also called orthotics may be done. If the child doesn’t receive treatment, Blount disease will gradually get worse with more and more bowlegged deformity. Surgery may be needed to correct the problem. For the obese child, weight loss is helpful but often difficult.

Surgical correction may be needed especially for the younger child with advanced stages of tibia varum or the older child who has not improved with orthotics. Surgery isn’t usually done on children under the age of two because at this young age, it’s still difficult to tell if the child has Blount disease or just excessive tibial bowing.

Between the ages of two and four, it becomes more obvious if the child has a true case of Blount disease and not just a normal anatomical variation that will get better with time. This type of Blount disease is referred to as infantile Blount.

Studies show that children with infantile Blount tend to have a higher rate of recurrence after surgical correction. Many require more than one surgery. When limb length differences occur, surgery is done to correct the increased angle and to lengthen the bone. It’s a gradual process that may require long-term surgical intervention.

You may be referring to the Multi-axial Correction (MAC) device made by the Biomet company. This external fixation system is able to make corrections in the angle of the bone from two separate angles and two separate planes of translation. It also corrects bone length and bone rotation.

That’s a lot for one fixator device to accomplish. Not only that, but as you will find out, it is easy to adjust (or monitor). The screws are turned one at a time, four times each day until the desired results are achieved. Usually this means the bone has lengthened enough to equal the other leg or the deformity is corrected (sometimes both).

Parental supervision may be all that’s required. The surgeon will instruct you and your child on what to do, how to do it, and what to expect. Periodic X-rays will be taken from a variety of angles to assess progress and make any corrections necessary.

This particular device has a secondary hinge that prevents additional deformities from occurring should the device be put on incorrectly. Unlike other devices, this feature makes it possible to correct the problem without going back into surgery. Surgeons say the advantages outweigh the disadvantages.

Flail limb or extremity refers to an arm or leg that the child doesn’t seem to be moving. The cause of the problem must be determined. It could be a broken bone, damaged nerve (resulting in a condition called brachial plexus palsy), or infection. X-rays may help rule out fractures or dislocations. Lab values can be used to assess for infections. An undiagnosed infection can spread and cause considerable bone and joint damage, so time is of the essence.

Damage at birth to the nerves in the upper limb can cause brachial plexus injuries. The child doesn’t move the affected arm. The arm may be in a characteristic position that tips the examiner off as to the underlying problem. For example, with damage to the nerves at C5 and C6 in the neck, the wrist and hand may end up stuck in the waiter’s tip position. The wrist is bent and the forearm is turned with the hand facing backwards (as if holding the hand out behind the back waiting for a tip).

A painful broken bone anywhere from the collarbone down can be the reason a child doesn’t move the arm. The cause of bone fractures must be determined. It could be from prolonged labor, forceps delivery, or child abuse.

Fortunately, bone healing is fast in infants this young. A makeshift sling out of soft stockinette may be all that’s needed in the way of treatment. Even easier and possibly safer is to pin the sleeve of the infant’s shirt to the main body of the shirt.

Hopefully within a day or two, you’ll be able to call and find out what caused the problem and what’s being done about it.

Fortunately orthopedic problems at birth or during the first few months of life are rare. Experts in this area remind us that children are not little adults. And newborns are not just little children. They have unique anatomy and physiology that requires some special attention. That’s why when problems are present at birth, an orthopedic surgeon is usually consulted. Knowing what’s normal at this age and what can happen to cause musculoskeletal problems is important. Even a specialist in children’s orthopedic problems may be challenged.

Foot problems in the newborn are probably the most common deformities present at birth. These include metatarsus adductus, equinovarus, calcaneovalgus foot, and congenital vertical talus.

Metatarsus adductus refers to a bean shape of the foot as the forefoot curves outward. This foot deformity occurs as a result of positioning during development inside the uterus (mother’s womb).

Many people have heard of clubfoot. The medical term for this deformity is talipes equinovarus. The foot is positioned in a toe pointed down position and ankle curved inward. It may occur by itself or it could be part of a bigger congenital problem (present at birth). Congenital conditions such as arthrogryposis, spina bifida, or Larsen syndrome often come with clubfoot deformities.

Calcaneovalgus foot and congenital vertical talus describe two separate conditions of misalignment of the bones of the foot. Both of these problems are easily recognizable just by looking at the child’s foot. In the case of calcaneovalgus foot, the bones and soft tissues are still flexible. With a vertical talus, the bone is dislocated resulting in a rigid deformity requiring surgery.

With most of these foot problems, treatment is started early with gentle stretching, serial casting, serial manipulation and casting, and sometimes surgery. For very mild problems, a wait-and-see approach may be all that’s needed. A second opinion can’t hurt. If it gives you the answers you need, then the time and financial investment may be well worth it to you.

Adults are not the only ones to suffer from chronic, disabling pain. Children and teens can also be limited by headache, stomach, and musculoskeletal pain severe enough to keep them from school and participation in sports or recreational activities. Many children experience pain that lasts right on into their adult years.

Two-thirds of children between the ages of 11 and 18 with chronic pain are headache sufferers. These can be tension-type headaches or migraines. Other sources of pain in this age group include rheumatic diseases, cancer, burns, and fibromyalgia.

The pain can be enough to disrupt daily activities such as homework, sleep, physical activity, and even attending school. Many of these children are on daily pain relievers. They experience emotional and psychologic imbalances. Help early on can relieve pain, improve function, and help the child get back to school on a daily basis.

There is much we don’t know about chronic pain in children. Studies are ongoing to find ways to help these children and their families.

Children in North America do seem to be getting less exercise than they did a generation or two ago. The society has changed in many ways and there are many reasons that are put up when people discuss why children aren’t as active any more. That being said, this inactivity is having an impact on health and health issues.

Children are now being diagnosed with illnesses like type 2 diabetes, once called adult-onset diabetes. More children are obese, more have cholesterol problem, and more are seeing doctors for aches and pains they may not have had if they’d been more active.

In one study, researchers found that children who were highly active had a lower risk of developing back pain as teenagers. Perhaps this, too, is another indication of how inactivity is having an effect on health.

It is true that physical activity helps lessen the risk of becoming ill or injured, as with a back injury. It used to be that children would be just sent outside to play and they’d be gone all day running around and exploring. Today, not so many children can do that. If both parents work, the children are usually in a daycare setting or even if they are home with a parent, there often aren’t children around to play with.

If you can’t allow your child to play outside because of where you are, you can still do things with your child, such as taking hikes, riding bikes, playing in the park. Physical activity can be had playing on a sports team but if you can’t afford that, there are many other options, like the ones just mentioned.

If you restrict the amount of sitting-activity time, your child will have to find something else to do and he or she will likely be more willing to do it if a parent does too.

Studies show that nondisplaced (broken but not separated) clavicular (collar bone) fractures do just fine with a simple arm sling. The figure-of-eight brace is no longer recommended. It was uncomfortable and didn’t change the final results.

The type of sling you saw to hold the arm down by the side is more for people who dislocate the shoulder anteriorly (in a forward direction). It keeps the arm in a position of external rotation, which evidently improves the results. The simple arm sling you have left of the three choices is no longer considered a good choice for anterior shoulder dislocations, but it is recommended for fractures of the clavicle.

When applied properly, it takes pressure off the collar bone while healing takes place. In a young teen, healing should take place fairly quickly. Your pediatrician will continue to monitor her progress and let you know when the sling can be removed. Repeat X-rays may be taken to evaluate the progress of the bone healing.

Most clavicle (collar bone) injuries in this age group are in the middle of the bone. If the two ends of the broken bone stay in place and don’t move apart, a simple sling can be used to immobilize the area until healing occurs. This type of nonoperative care is especially effective in younger athletes (less than 12 years old) because of their good potential for rapid bone growth.

Before these athletes can jump back into action, the surgeon must see that the child can move the arm fully and has strength equal to the uninvolved arm. X-rays must show that the bones have been knit back together.

Surgery to pin the bones together usually results in a more normal union of the fracture and faster return to sports. The surgical option is often recommended for older athletes with a displaced clavicular fracture. This age group doesn’t heal quite as quickly as the younger folks. They may need a longer period of time for rehab and recovery.

Nonunion (fracture doesn’t heal) or malunion (heals with deformity) are more common in the nonoperative group. The slightly displaced fracture in your child is considered a displaced fracture with malunion. The body will form a large callus of bone around the broken area. This will form a noticeable bump along the top of the clavicle that will eventually get smaller as the bone remodels itself. It may not go away completely. But its presence will not alter movement of the clavicle or the biomechanics of the clavicle-shoulder complex.