FAQ Category: Child

It used to be thought that back pain in children was rare and when it did occur, the pain was usually caused by something serious. Over the years, however, doctors have learned that children and teens can experience back pain at the same rate as adults.

Lower back pain is very common among adults in the developed world and the most recent numbers that have come to light regarding children, is that as many as 36 percent of them may have lower back pain, with the number increasing if the child or teen participates in competitive sports.

Much of lower back pain, for both adults and children, is never diagnosed. As long as your son has been tested and examined for his back pain, and the doctors have not diagnosed an injury or problem, it’s likely that your son’s problem falls into the “unknown” category.

A child with back pain is examined to be sure that there isn’t a physical reason for the pain. This means that the doctors will look for a problem that the child may have been born with or a problem that has developed as the child grew.

To do this, usually x-rays of the back are the first step. If the x-rays don’t show anything but the doctor wants to look further, he or she can use more in-depth imaging such as a computed tomography scan (CT scan) or magnetic resonance imaging scan (MRI).

Blood tests may be done to rule out some illnesses that can cause back pain and also bone scans are sometimes useful in finding a diagnosis.

It’s important to keep in mind that many cases of back pain in children, as with adults, never are given a cause.

Many children are born with a hip dysplasia, especially on the left side. It seems to be more common on that side for some reason.

Doctors have noticed that many children who have a dysplasia on one side, also have one on the contralateral or other hip as well, albeit very mild or moderate. The issue is, they don’t know if the child is born with it and it’s only discovered later on because it is so subtle or if the dysplasia develops over time as the child matures.

Regardless of the origins, many doctors are monitoring the seemingly not-affected hip to see what happens.

Hip dysplasia is a condition where the hip doesn’t form properly. The problem can be mild, where the ball part of the hip joint doesn’t quite fit into the socket or it the joint can be completely out. One hip can be affected or both can be.

For some reason, hip dysplasia does happen more often in girls than boys and often it is the first child who is affected. Children who are born in the breech position (feet first) are at higher risk of hip dyplasia as well.

Doctors have found that the problem does also run in families. This doesn’t mean that if you have a child with hip dysplasia, your child will too, but that some families – such as yours perhaps – have a higher rate of hip dysplasia than other families.

Treatment of scoliosis with a back brace is done to prevent further curvature of the back. To do this, the patient must wear the brace for as long as the doctor recommends and in the proper manner. Failure to do so will result in the treatment failing.

To determine how and how long to brace the back, the doctor has to take into account many issues. These include:

After taking this all into account, the doctor will recommend the brace and the length of time for it to be worn. The patient must visit the doctor on a regular basis so the curve or curves’ progression can be monitored as the treatment may have to be adjusted if the scoliosis appears to be worsening.

Scoliosis, curvature of the spine, can be mild or severe, or anything between. Many people have mild scoliosis and have never been aware of it. Others have moderate scoliosis with their doctors monitoring the curves to see if they get worse.

So, treatment of scoliosis depends on how severe the curve is, how many curves there are and – importantly – if the scoliosis impacts the patient’s life.

Some curves can make the chest cavity too small for the lungs to expand properly, compromising the ability to breathe. When scoliosis affects other body parts or systems, then treatment is likely necessary.

In terms of the curve itself, generally, if the curve is less than 20 degrees, the doctor may take a wait-and-see approach.

Toe walking, walking on the balls of the feet or the toes, is fairly common when children are young. Healthy children, without any neurological (nerve) disorders generally outgrow this type of walking by the age of five years.

Some children, however, like your son, continue to toe walk for longer than is the average. Toe walking can be a sign of a disorder like cerebral palsy or a problem with neurological system. For this reason, if a child continues to walk on his or her toes after age five, it’s generally a good idea to get this checked in order to rule out any possible causes.

It’s entirely possible that your granddaughter has the same thing that your son had, and that sounds like ITW, or idiopathic toe walking. Most children with ITW have no physical reason to do it, they just do. That being said, it is important for your granddaughter to be checked to ensure that something else isn’t causing the toe walking. If there is another problem, then catching it early can help in management and treatment.

In studies done on children with ITW, researchers have found that many are able to change their gait to be more “normal” when they are asked to – and this is the big difference between children with ITW and those with a disorder like cerebral palsy.

Peer pressure among teens is a much more powerful influence than what parents usually have to say. If she’s spending time with other friends who smoke, the message to quit my not be present. But if her core group of friends don’t smoke, then they may be able to convince her not to continue.

Studies show that girls are more susceptible to low back pain associated with smoking. The greater their exposure to cigarettes, the more likely they will develop low back pain. More people who smoke are depressed or sad, but it’s not clear if that’s why they start smoking or if tobacco use negatively alters mood.

Studies show that exposure to nicotine decreases blood flow to the discs between the vertebrae in the spine. There’s even some evidence that nicotine changes the genetic code. The result is irreversible change at the cellular level in the disc.

Of course, telling teens about these problems doesn’t always result in a positive change in their behavior. Many adolescents and young adults simply don’t believe anything will ever happen to them.

The most powerful educational tool may be the American Cancer Society’s brochure Benefits of Smoking Cessation. This is available on-line at www.cancer.org/. It shows how in the first 20 minutes, blood pressure and pulse start to return to normal. By the end of one day, the risk of a heart attack has gone down.

By the end of the third day without tobacco, nerve endings are starting to repair themselves. The sense of smell and taste increases. Within two weeks to two months the ability to exercise has improved. There’s less huffing and puffing and better circulation.

The benefits are outlined up to and including 15 years after quitting. Perhaps something educational by a well-known organization would have an effect — if not right now, then sometime down the road.

SCFE stands for slipped capital femoral epiphysis. It is a condition in which the growth center of the hip (the capital femoral epiphysis) has slipped backwards on the top of the femur (the thighbone).

Treatment is usually surgical to pin the bones in place. The pin is left in place permanently or in some cases, until the child has reached growth maturity. This is an important step to stop any further slippage of the epiphysis. The less slip, the lower the risk of problems in the hip during the child’s life.

Avascular femoral necrosis is a concern with SCFE. This refers to a loss of blood to the head of the femur. Without enough blood and oxygen, the bone cells can start to die. If the condition progresses far enough, the head of the femur collapses.

Chondrolysis is another potential complication. The articular cartilage of the joint starts to break down and dissolve. The joint space narrows and there’s an increase in stiffness of the hip joint. Both necrosis and chondrolysis can lead to early degenerative arthritis.

Early intervention can help prevent some of these problems from happening. The surgeon will watch the other hip carefully for any signs of developing SCFE. Some experts advise pinning the capital femoral epiphysis in the uninvolved hip to keep it from slipping later. There is much debate about whether or not this step is needed.

A recent study from Children’s Hospital of Philadelphia (CHOP) strongly supports the use of preventive (prophylactic) pinning. The risk and rate of a second slip are both high enough to warrant this type of treatment. The pin can be inserted in the unaffected hip at the same time surgery is done on the first hip.

A slipped growth plate most likely refers to a condition called slipped capital femoral epiphysis (SCFE). The capital femoral epiphysis is the curved part of the growing bone at the top of the femur (thighbone). The actual growth plate is called the physis. The physis is the flat base at the bottom of the femoral head.

As many as two-thirds of the children with a SCFE on one side will develop the same condition in the other hip. If it hasn’t already happened at the time of the first slip, it is most likely to occur within six to 18 months.

Studies show that a second slip occurs much more often when the first slip is moderate-to-severe. The risk of a second slip is present until the growth area is complete and the physis closes.

For patients at high risk of a second slip, some surgeons advise putting a pin (or screw) into the unaffected hip. The pin holds the capital femoral epiphysis in place and keeps it from starting to slip.

Preventive (prophylactic) pinning reduces the number of X-rays the child is exposed to. Prophylaxis also makes it possible for the child to remain active without concern that the second hip is going to slip. Your surgeon will be able to review your son’s X-rays and medical treatment and offer you his or her best advice about what to do.

There aren’t very many studies reporting on the number or rate of injuries among ballet dancers. From the little bit of information reported from professional dance companies, it seems that injuries are very likely.

Most of the injuries are in the legs and back as a result of overuse. Repetitive motions during long hours of training are common before injuries develop. There are cycles of injuries based on the dance calendar. For example, there is a higher rate of injury at the start of the dance calendar and around the time of a performance. For students, injuries also develop during the training cycle with ballet exams.

If your daughter is dancing for fun and enjoyment rather than in a competitive mode, then she is not as likely to be injured. Most ballet instructors require each girl meet certain benchmarks of development before going en pointe. For example, they must be menstruating, have sufficient standing leg turnout, and ankle strength.

There doesn’t seem to be a place in the ballet world for girls between the ages of 12 and 18 who don’t want to train en pointe. If you decide to direct your daughter in other ways, modern, jazz, hip-hop, and tap are alternative options that may be acceptable. There are injuries with any type of dance. But the rate of injuries for these forms of dance remains unknown.

Legg-Calve-Perthes disease is a disease where the femoral head, or the ball part of the hip joint, loses its blood supply. It is a temporary disorder that eventually heals as the body absorbs the dead bone cells and makes new ones.

Unfortunately, for some children, the femoral head does become permanently damaged and they may require surgery later on that hip.

Treatment for Legg-Calve-Perthes ranges from very simple to complex. The child may have to rest and restrict activities, and medications may be needed for the pain or discomfort. Some situations need traction or bracing, while yet others require surgery.

Physiotherapy is also used in many cases to keep the surrounding muscles strong while the hip is recuperating.

It’s not always possible to diagnose Legg-Calve-Perthes disease right away because the symptoms might be vague at first and they can resemble many other problems with the hip.

The signs and symptoms of Legg-Calve-Perthes are:

– hip pain that worsens with activity

– limping

– pain in the thigh or knee

So, as you can see, these symptoms may not always be automatically attributed to Legg-Calve-Perthes disease.

The anterior cruciate ligament or ACL is one of the most important ligaments in the knee. Ligaments are thick fibrous tissues that hold bones together. A torn ACL is a relatively common sports injury but can happen through other means, like a fall.

Torn ACLs are becoming more common in children as they participate in more sports and in more athletic competitions, as well as in regular play. Surgeons have had to repair torn ACLs in children as young as three years old.

Studies show that teens whose primary caregiver (parent or other adult) has back pain are likely to have back pain, too. This is called familial back pain. The cause remains unknown. There could be a genetic predisposition to back pain. If this is true, there may be specific factors that trigger the first episode.

There may be other family factors involved, too. Influences on children include the parent(s)’ response to back pain, use of medications, and seeking medical treatment. If both parents (or caregivers) have back pain, the chances of the child developing back pain increase.

Some social scientists think that parent-child back pain is a sign of family distress. Instead of focusing on the real problems, the family pays attention to the physical distress of its members.

Other behavioral factors may be a part of the overall picture. For example, parents who smoke and who are physically inactive may suffer from more back pain than active adults who don’t smoke. Children of smokers are much more likely to have back pain when compared with children of nonsmokers.

Studies are underway to help sort out all the various factors. If scientists can identify modifiable risk factors, then prevention plans can be developed. Modifiable risk factors can be changed — usually by a change in behavior. This may be a change in diet, activity level, or other lifestyle choice.

This question has been raised by scientists around the world. But the studies on this topic are very limited right now. And the results from these studies don’t agree. Some studies report there is a familial link with back pain. Others did not detect a positive relationship.

Most recently, a group of researchers in Western Australia set up a large study of 14 year-olds and their family caregivers. Through a process of several surveys and physical exams of over 1600 teenagers, data was collected and analyzed. They found that factors such as parent age, gender, income, and stress levels weren’t linked with the child’s back pain.

The chances of developing back pain went up when both parents (or both caregivers) had back pain. And the more family life stress events that were present, the greater the likelihood that the teen would experience back pain. Low-income families with significant life stress were more likely to suffer back pain.

How much is genetics and how much can be linked to psychosocial or behavioral factors is unclear. For now, the familial link appears to be real. Future studies will seek to find specific factors that are involved. These could include beliefs about pain and behaviors in reaction to pain. Lifestyle factors such as diet and activity levels will also be studied.

It may seem at first glance that it would make sense to do surgery to correct a clubfoot, the casting method, the Ponsetti method is often successful. The use of the casting can make it so if a child does need surgery, it may only be one procedure (Achilles tendon release, for example) instead of several surgeries.

Casting for clubfoot can be done with either type of cast, Plaster of Paris or a semi-rigid fiberglass. While it is known that the fiberglass cases are more convenient for parents in terms of their weight and ease of care, a recent study has shown that the plaster cast is more effective than the fiberglass.

Complex regional pain syndrome, or CRPS, is a syndrome that usually affects adults, but children as young as three years old have been diagnosed with it.

Complex fractures with multiple fragments often require external fixation. You didn’t mention whether it was the femur (thigh bone) or tibia (lower leg bone).

Either one can have a long, spiral fracture of the diaphysis (shaft). This can require pins to hold it in place while healing takes place. External fixation also allows for earlier weight bearing. And there are fewer problems with the bone fragments moving or dislocating. A short fracture line might not need plates, pins, or screws to hold it in place. Intramedullary nailing is another name for this type of treatment.

When fractures can be realigned without an incision, the procedure is called a closed reduction. When the leg must be opened to give the surgeon a direct view of what’s going on, then it’s called an open reduction. Sometimes fractures of the long bones can be treated with a tiny incision. The procedure is referred to as minimally invasive.

It’s not too late to request more information about your daughter’s fracture. If she is still in the hospital, ask the nurse in charge to explain what was done and why. Or request this information at your next follow-up visit with the surgeon.