FAQ Category: Child

The decision as to how long a cast should be put on a broken arm depends on how the x-ray looks after a set period of time, usually 4 weeks. If your son’s doctor felt that the arm had healed sufficiently and it was safe to take off the cast, this would have been based on what the x-ray showed.

Keeping a cast on for longer won’t necessarily benefit the fracture, however. Even after 6 weeks, the bone can be fragile and you would still have to be careful. It takes a while for the bone to heal completely and regain its full pre-break strength.

Bone refracturing in the forearm is not uncommon in children. Because of their activities and the way they play, the fractures can happen easily. In a recent study, researchers found that children with breaks closest to their wrist had a higher risk of breaking their arm again than did children with their break closer to their elbow.

To reduce the chances of a bone breaking again in the same place, some children wear splints for several weeks after the cast is removed. They may also be advised against participating in certain types of activities for a while after the splint has been removed.

It is a reality that emergency room personnel must be on the look out for child abuse. As you say, one of these signs could be frequent visits because of injuries.

Unfortunately, it does happen from time to time that a red flag is raised and parents are put under suspicion when they may be innocent. However, for the most part, the doctors and nurses are able to look at the situation and draw conclusions from the actual injury. Certain types of fractures in certain age children, for example, are a strong indicator for abuse because of the way the bones are broken.

If you and your child are open with the staff and are able to explain the injuries, it isn’t likely that they will think you are hurting him.

Doctors have to be on the look out for child abuse, particularly in emergency departments where children come with broken bones and other injuries.

From experience, the medical community has learned that certain types of breaks don’t often happen in certain age children, although accidents do happen. For example, a complete fracture of the thigh bone is not a common injury among children who can’t walk yet. In a recent study, researchers examined the records of 20 children under the age of 1 year who had these fractures. They found that 10 were victims of abuse and 5 were highly suspicious.

Osteoporosis is a common problem in older adults, especially postmenopausal women. But studies show that it’s becoming an increasing problem in children now, too.

There are several factors to explain this phenomenon. Bone mass is affected by genetics, environment, use of certain medications, and the presence of other diseases.

Heredity and genetics accounts for about 80 per cent of an individual’s bone mineral density (BMD). Environment makes up the other 20 per cent. Nutrition and physical activity are the two key factors in a person’s environment affecting bone growth and development.

Getting the right amounts of calcium, vitamin D, and phosphorus are especially important to building BMD in childhood and adolescence. Phosphorus is responsible for the weight of bone mineral. The more dense and heavier bones are, the less risk there is of fracture and bone loss. We get phosphorus from our diets.

Animal studies suggest that too much phosphate and not enough calcium can lead to osteoporosis. Children’s intake of phosphate increases through soft drinks. There is some evidence to suggest that too much phosphate is linked with increased fracture rates.

If a child gets enough calcium every day, then phosphate from a cola drink won’t have a negative effect. But when carbonated beverages replace daily intake of calcium from milk, then a problem can develop.

Yes. The daily need for calcium is based on size. The most important time for calcium intake is during early growth and development. Children not yet fully grown but who will be tall need more calcium for their growing bone size.

The greatest need for calcium is during puberty when growth spurts occur. Getting the right amount of calcium for each phase of growth can be difficult, since children’s growth rates and patterns can’t be predicted.

Since girls and women are at greatest risk for osteoporosis, it’s important to pay attention to this aspect of health throughout all phases of life.

Young girls and teens who diet or who have eating disorders may be malnourished with too-low of a protein intake. The result can be retardation in bone growth and bone formation. Those who don’t exercise regularly are also at increased risk. Women after menopause also have higher rates of osteoporosis leading to fractures.

Doctors recommend getting adequate calcium, vitamin D, and phosphorus intake on a daily basis. Regular, consistent, good nutrition and physical activity seem to be the best way to build up bone.

Sideline management of sports injuries can be a very difficult task at any age. The results of some injuries don’t show up right away. Players often underreport or fail to report symptoms in an effort to return to the game sooner.

It’s best to have someone with your team who has training in emergency medical care. Heat stroke, unknown heart conditions, fracture, dislocations, and blunt-force trauma require immediate medical attention.

Basic first aid for musculoskeletal injuries follows the RICE principle. R is for rest. The player is removed from the activity and the injured part is protected or splinted. I is for ice, which is applied to the injured or swollen area. C refers to compression. An ace bandage or other type of wrap may be used to help control swelling. And finally, E for elevation: the limb should be kept above the level of the heart when resting.

Head injuries can be difficult to assess on the sideline. A quick mental status test of memory and concentration can be done. The player is asked questions such as: Which team are we playing? What quarter is it? Who did we play last week?

Anytime there is doubt or question about the seriousness of an injury, medical attention should be sought after. Many coaches are pressured by players and parents to keep the athlete in the game. They may be unaware of how serious an injury really is. Careful monitoring by all concerned (parents, player, trainers, coaches) is always the best approach to any injury.

Brain injuries are one of the most common sports injuries, especially among football players. Every year 300,000 brain injuries occur in high school athletes alone.

Concussions make up the bulk of these injuries. A concussion is a mild traumatic injury to the brain. It can be caused by acceleration (speeding up) or deceleration (slowing down) forces. This is more likely during a car accident or bad fall. In sports, concussions occur more often by a direct blow or hit by another player.

When to return a player to the field is a difficult decision. Waiting a week to 10 days after a concussion is very good advice. Most players do recover fully during this time. However, there is a possibility of more long-term problems developing.

Postconcussive syndrome can occur if a player returns to the game too soon after the injury. An undiagnosed fractured skull or hematoma (internal bleeding) can cause further brain injury. Watch for any of the following signs and symptoms:

A greenstick fracture is exactly what it sounds like – picture a soft twig from a tree. If you bend the twig, it will likely only break partially, leaving the outside of the bend broken, but the inner part still intact. That’s what happens with long bones in a child as they are still soft enough to bend somewhat.

This type of fracture still needs to be set and casted or braced. The chances of complications are small and the majority of greenstick fractures heal well, without any problems.

Clubfoot is a deformity of the bones in the midfoot and heel. It causes the foot and ankle to turn inward. The foot cannot rest flat on the floor.

Treatment for clubfoot is usually a three-step process. First, the bones of the foot are manipulated into as neutral a position as possible. A cast is applied to hold it there. As correction takes place, the cast is taken off. The bones are moved again to a more normal alignment. A second cast is applied. This procedure continues until the deformity is corrected.

Sometimes the tendon to the heel is cut to help the process along. The final step is to wear a foot abduction brace. The brace holds the foot and ankle in the correct position as the child grows and develops. At first the brace is worn all the time. It is only taken off to bathe and dress the child.

After about three months, the brace can be removed during the daytime. It’s only worn during naps and at night. This allows the child to move freely with the foot in the normal position.

Many studies have shown this treatment works well. But it must be carried out daily. These same studies show that for families who do not follow the program, the clubfoot deformity comes back.

Gently encourage your children to use the brace as prescribed. Make sure they understand the purpose of the bracing. Perhaps suggest they talk with their doctor about the program and its importance.

The Ponseti Method is named after the physician who first developed and tested it: Dr. Ignacio Ponseti. The treatment is a conservative way to correct a foot deformity called clubfoot or talipes equinovarus.

Children are born with this condition. The foot is curved inward at the ankle. The toes are often pointed downward. With the ankle in this position, the foot cannot straighten out. The child won’t be able to put the foot flat on the floor when walking. Instead, the child walks on the outside edge of the foot. This can create many problems.

Early intervention is always advised. With the Ponseti method, the bones of the foot are manipulated into a more neutral or normal position. A cast is placed on the foot, ankle, and lower leg.

Each week, the cast is removed and the foot is moved a little closer to neutral. Another cast is placed on the lower leg. This procedure is repeated each week until the deformity is corrected.

When the final cast is removed, the child wears a special foot abduction brace. The brace continues to hold the foot and ankle in neutral alignment while the child grows and develops. At first, the brace is worn everyday, all day. It can be taken off to bathe and dress the child.

After about three months, the child can move freely during the day. The brace is only worn at night and during naptime. The treatment is very successful. All reports are that parents are very pleased with the results.

There are two possible problems to deal with. The first is getting the child used to the brace. Most parents report this takes a week or two at most. But it can mean having a fussy child. Many parents report no problems adjusting at all.

Parents are instructed to watch for any pressure sores or skin irritation. This is more likely to happen and is reported in up to 45 per cent of cases studied. The brace may need some slight adjustment to take care of the problem.

To date, there are no reported cases of human immunodeficiency virus (HIV) or cancer being passed to someone receiving a bone graft. There has always been some concern about passing along viruses and infections through donated bone grafts. In fact, it’s one of the main reasons more surgeons have not used a bone bank.

But some operations require far more bone than a single patient can donate for her own use. In the case of spinal fusion for scoliosis, there can be multiple levels fused. This requires quite a few bone chips. The natural next step is to consider using donated bone.

And according to a recent study from Harvard University, this method is safe. Over 100 children with congenital scoliosis deformity were treated with spinal fusion. All received bone grafts from a donor bank.

The infection rate was very low (less than one per cent). No one got HIV/AIDS. The failure rate was also very low (less than three per cent). Almost everyone had a successful fusion. Bone substitute from a donor bank were a safe and effective alternative to bone taken directly from the patient.

The gold standard test used to screen infants for developmental dysplasia of the hip (DDH) is called Ortolani’s maneuver. By carefully examining and testing the hips, the doctor or nurse can accurately identify DDH.

X-rays are not really used in young babies to avoid exposure to the radiation. An ultrasound would be a more likely choice. Ultrasound (US) imaging is not routinely ordered without a reason, though. Almost 80 per cent of any hip abnormalities seen on US disappear by the time the child is six months old. So US testing is not done routinely.

The doctor may consider additional testing if it’s indicated. But a competent examiner performing the Ortolani test is usually accurate. You can always ask for a second opinion. The physical exam is less expensive and less invasive for the infant compared with further imaging tests.

US testing is done more often when the physical examination is normal but there are risk factors to consider. Sometimes US is used to monitor the results of conservative treatment.

Screw misplacement and screw loosening are two well-known complications of this type of surgery. The surgeon may not do anything just yet. It depends on the location of the screw. If the patient is not having any symptoms, there may not be any urgency in this situation.

However, if the screw is close to a major blood vessel or nerve pathway, it may be necessary to operate again and remove or replace the screw. Sometimes the surgeon opts to replace the screw(s) with hooks instead of screws. Hooks have their own set of potential problems so none of these tools are risk-free.

If the patient is experiencing pain and other symptoms, then the loose or misplaced screw(s) are revised or removed. The greatest concern is if the screw is close to the aorta, a major blood vessel carrying blood away from the heart. In a case like this, the screw will be removed even if there are no symptoms.

Spinal fusion for scoliosis is an important and necessary operation for some patients. Scoliosis is an unnatural curvature of the spine. It can curve so much that the heart and lungs and other organs are pinched and pushed out of their natural position. Heart, lung, and stomach function can be severely compromised.

Pedicle screws can be used to help straighten and stabilize the spine. The surgeon removes a tiny portion of the vertebral arch. This is the curved part of the bone that goes around the outside of the spinal cord to protect it.

Using a tiny spatula-shaped tool, the surgeon is able reach around the inside of the curve and locate the right spot for the screws. Usually the screws are placed in the pedicles. The pedicles are the upright support column of the vertebral bone.

Drilling a tiny hole and inserting a screw in this part of the bone can cause a fracture. The surgeon must back the screw out of the hole and seal it up with bone wax. That site can no longer be used. Sometimes the pedicle is too small for screws. The surgeon may have to use a rod or hooks instead.

As with all fractures, healing takes at least six to eight weeks. The surgeon will advise your brother as to what he can and cannot go during that time. Further complications are rare but can happen.

Slipped capital femoral epiphysis (SCFE) is a condition that can affect older children and young adolescents. The capital epiphysis (growth plate) at the top of the femur (thighbone) slips.

The head of the femur should sit squarely on the femoral neck. When it slips, the hip can collapse and/or become deformed. This situation is considered unstable.

To prevent this from happening, surgery is often needed. The goal of surgery is to stop any further slippage of the capital femoral epiphysis. The less slip, the lower the risk of problems in the hip during the child’s life.

Until the surgery is done, the hip remains unstable. The child must use crutches and keep activities to a minimum. The method used most often to stop the epiphysis from slipping further is to place a large screw into the epiphysis to hold it in place. The child will continue to use crutches and may be able to put some weight on that side.

X-rays are used to monitor the stability of the hip. When it looks like the capital ephiphysis is starting to fuse, then the hip is stable, and the crutches are often discontinued.

Legg-Calvé-Perthes disease is a condition that first affects the hip in children between the ages of four and eight. The name is in honor of the three physicians who each separately described the disease.

In this condition, the blood supply to the growth center of the hip is disturbed. This area is called the capital femoral epiphysis. The loss of blood supply causes the bone in this area to die.

Blood eventually returns, and the bone heals. How the bone heals determines how much problem the condition will cause in later life. This condition can lead to serious problems in the hip joint later in life.

Most experts agree that treatment before the age of eight gives the best result. The goal is to keep the head of the femur in the acetabulum (hip socket) and to maintain a nice, round ball shape to this part of the bone.

But the few studies done on children who received treatment later in life have also shown some good results. The femoral head must be held in the joint socket as much as possible. This treatment is called containment.

It is better if the hip is allowed to move and is not held completely still in the acetabulum. Joint motion is necessary for nutrition of the cartilage and for healthy growth of the joint. The healing process can take several years.

Sometimes surgery is needed for children who are diagnosed with this disease later in life. Surgical treatment for containment usually consists of procedures that realign either the femur (thighbone), the acetabulum (hip socket), or both.

Once the child has been seen by an orthopedic surgeon, a plan of care can be established.

The ideal time to treat Legg-Calvé-Perthes Disease is before the head of the femur collapses from loss of blood supply. But knowing when this might happen requires a crystal ball. X-rays and other imaging studies don’t show this collapse and can’t predict it.

By the time the hip progresses to the point of collapse, it may be too late to preserve the shape of the femoral head. Treatment before the age of eight seems to get the best results. And treatment this early means non-operative care may be enough.

The goal of conservative care is to maintain motion, reduce inflammation, and keep the head of the femur in the socket. This can be done with anti-inflammatory medications, traction, and sometimes bracing. When these measures fail, surgery to correct the problem is possible.

There’s no reason not to try a course of nonoperative care wherever your location. It will take six months to see if this plan of action works anyway. Then you can have the surgeon at home review the case and plan the next step.

Children diagnosed with scoliosis (curvature of the spine) must be monitored for a change in the curve. If the curve gets worse, bracing may be needed. If the curve is large enough and changing quickly, then surgery may be needed to fuse the spine.

Full spine X-rays are used to establish a baseline and observe for changes. A measurement called the Cobb angle is used to measure the curve on the X-ray. X-rays must be repeated as the child grows. The Cobb angle is measured each time and compared with the last measurement. An increasing angle signals a scoliosis that is getting worse. With this method, children are exposed to repeated doses of radiation.

Researchers from the Children’s Hospital of Wisconsin (CHW) have found a way to monitor scoliosis without using X-rays. The tool used is called the Quantec system. This system is not invasive and does not use X-rays. It is a camera that takes a 3-D scan of the spine. Using the data collected with specific formulas, a Q-angle can be determined.

In this study, children with scoliosis had X-rays taken and then they were scanned by the Quantec system. The authors compared the Q-angles from the Quantec system against the Cobb angles from the X-rays.

They found that the Quantec system was useful and reliable in classifying patients in one of two groups. The groups were based on size of spinal curve (less than 20 degrees and 20 degrees or more). In fact, the Quantec system detected curve progression one year earlier than X-rays.

This is the first study of children with scoliosis using the Quantec system. Early results suggest it is a reliable and accurate tool used to monitor scoliosis. It works best with mild-to-moderate curves. Best of all, the child is not exposed to potentially harmful X-rays.

You are most likely referring to the Quantec System, which is indeed, a noninvasive, nonradiographic way to monitor changes in the spine for children with scoliosis. Studies show that the Q-angles measured by this system match closely to the Cobb angle on X-rays used to measure the curve.

You may be relieved to know that the Quantec System appears to be even more accurate in detecting curve progression than X-rays. A study done at the Children’s Hospital of Wisconsin showed Quantec detected curves getting worse a full year sooner than X-rays.

The Quantec System does not diagnose scoliosis. An X-ray is still needed for that. But it is reliable and accurate for mild-to-moderate curves of unknown cause.