FAQ Category: Child

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.

By asking your daughter to bend over at the waist, your daughter’s doctor is doing an initial screening for scoliosis, or curvature of the spine. This particular exam is called the Adam’s Forward Bend test. This allows the doctor, or other healthcare professional, to see if your daughter’s shoulder blades are even. However, chances are, your daughter’s doctor is also looking for other signs as well, such as:

• When your daughter is standing straight, are both shoulders at the same height? Is her waist even?
• Is your daughter’s straight over the center of her body?
• Does your daughter lean to one side?
• Are both hips at the same level?

Scoliosis can be caused by certain disabilities, such as cerebral palsy, spina bifida, and muscular dystrophy, to name a few. However, 80 percent of patients who have scoliosis, or curvature of the spine, don’t have an identifiable cause. Approximately 2 percent of women and 0.5 percent of men who don’t have any predisposing disorders or disease, have scoliosis. If someone in your family has scoliosis, you have a higher chance of having it yourself.

Scoliosis treatments are changing and have changed a lot over the past couple of generations.

The medical community is concerned about the weight of the backpacks that some students are carrying around. They are recommending that parents be sure that their children have good, well-made backpacks with proper straps, including one that goes around the waist, to help distribute the pack’s weight evenly. The children have to learn good habits that include using both shoulder straps, instead of just one, and using the waist strap. Another alternative would be to use the backpacks with the wheels.

If possible, children should be discouraged from bringing too many books back and forth to school. Perhaps parents can get together and discuss this with the school’s administration and teachers. Some parents have resorted to buying a second copy of the text books so that their children will not have to bring one home.

Elbow injuries in children and adolescent athletes are very common. In fact, more than four million participated in softball or baseball alone. Children between the ages of five and 14 were affected the most.

There are several reasons for this — some can be changed or modified, others are nonmodifiable. For example, the area damaged is often the cartilage at the end of the bones. This cartilage will eventually harden into bone. Until it does, repetitive movements at high velocity (like pitching) can cause fragments of cartilage and bone to break away.

We can’t really do much about the developing elbow in children and teens. But what we can do is monitor their playing time. Parents, coaches, and even the team members can help keep track of pitch counts, breaking pitches, and pitch speed.

The USA Baseball Medical and Safety Advisory make the following recommendations for young pitchers:

CRPS, or complex regional pain syndrome, most often happens after an injury of some sort – but not always. The injury doesn’t have to be severe; it could be a sprain. The pain seems out of proportion to the injury and can get worse if the area is touched, however lightly. There can be swelling, excess sweating, and the skin color can seem bluish or quite red.

Clubfeet is one of the more common birth defects. Latest numbers show that it happens in about 1 out of every 1,000 births, with boys having them more often than girls.

Since doctors don’t really know what causes clubfeet, there isn’t much that we can do to prevent them. The only thing that they have realized is that clubfeet do tend to run in families, so if there are people with clubfeet in your family, you do have a higher chance of having a child with clubfeet.

The best way to treat clubfeet is to begin as soon as possible to push the bones and muscles to grow in the proper direction. This means beginning the casting and bracing early. By bracing the feet and legs for 23 hours per day, every day – with cast changes regularly – the foot and leg begin to adapt in most cases. Surgery is done if the bracing doesn’t work.

Fragments of cartilage or bone that have come loose in a joint are sometimes called joint mice. This name comes from the fact that the joint makes a squeaking sound as these pieces crunch against each other or rub against the bone.

The most common cause of joint mice is osteochondritis dissecans (OCD). OCD is a painful condition within a joint. The loose fragments inside the joint set up an inflammatory response that can be very painful.

Children and adolescents between the ages of five and 14 are affected most often. Overuse, repetitive use, and trauma are the usual underlying causes of the problem. The elbow in baseball pitchers and gymnasts is affected most often.

A clubfoot is a relatively common birth defect; about half the time, both feet are affected. A child with clubfeet will have his feet turned inwards to the point that if he could stand, he would be standing on his outside ankles. Clubfeet are more common in boys than in girls.

Some children have no other problems beside the clubfeet while others may have disorders like spina bifida, or “hole in the spine.” Although doctors don’t really know what causes clubfeet, it does seem to run in families.

If a child with clubfeet isn’t treated, his walking will be affected and could develop a host of other problems with his legs and hips. As well, the outside of the foot isn’t meant for that type of weight-bearing so injuries to the ankles would be a concern.

The best treatment for clubfoot is the use of braces to keep the foot in proper alignment, forcing the muscles and bones to grow in a certain way. The process is slow, but the braces manipulate the legs into the desired position.

That being said, sometimes surgery is necessary. Most surgeries won’t be done before the child is six months old. The surgery involves lengthening the tendons that connect muscle to bone. Usually, pins are put into place to keep everything set correctly and then the foot is casted. Surgery does not always mean that there will be no bracing. Often children still need to be braced post-operatively.

The cuboid nutcracker fracture isn’t a common fracture but it is serious because of how the bone is broken. It’s been found in girls who fall while horseback riding. As their horse falls on them and their foot remains caught in the stirrup, the foot is forced away from the center of the bone, as it is usually aligned, and then there is a sort of fulcrum or pivot that causes the bone to snap. As well, there is usually more injury to the bone than just the fracture.

What makes it serious is that it needs to be treated properly to prevent long-term disabilities, allowing the patient to regain full use of the foot.

In a recent study, researchers found four girls who had cuboid nutcracker fractures following horseback riding accidents. Two underwent surgery, two did not. The two girls who had surgery recovered well and went back to their previous levels of activity, including playing sports again. Of the other two girls, one continued to have stiffness in her foot and although she resumed her previous level of activity, she could only play non-strenuous sports. The other girl continued to have pain and stiffness to the point that she could not participate in any sports and her pain affected her daily activities.

CRPS, or complex regional pain syndrome, was once considered rare in children so doctors often did not look for it. HOwever, now that it is known that children do get CRPS, the medical community is more aware. Unfortunately, what doctors knew about CRPS with adults can’t always be transferred to children because they seem to a different presentation.

The problem with CRPS is that there are no definitive tests that can tell a doctor that this is what is happening. According to a recent study, most children who have CRPS end up being seen by anywhere from one to six specialists and that the average time to diagnosis is about three months. This is better than just 10 years ago, when it took as much as a year, on average, for the diagnosis.

Each surgeon prescribes for his or her patients a course of post-operative care. You should have been given instructions before leaving the hospital or clinic about what you can and can’t do.

For example, some surgeons use a short leg splint for two or three weeks. The patient is given crutches and shown how to use them safely by a physical therapist. Most often, if the fracture is considered unstable, the patient isn’t allowed to put any weight on that foot.

Weight-bearing can begin with a toe touch to the floor when the surgeon approves it. This may be two to six weeks after surgery. The goal is to maintain a stable environment for the fracture to heal.

Any disruption before the bone is ready could cause further problems. Avoiding displacement of the rod and/or shortening of the fracture site are two important goals in remaining non weight-bearing.

Follow your doctor’s instructions carefully. Ask if you have any questions. At some point, the nail may be removed. At the right time in the healing process, you will be allowed to resume most of your activities. This is done as tolerated, meaning you go at your own pace based on how you feel. As you regain motion and strength, your confidence will increase.

That’s a very good question. Bracing for scoliosis (curvature of the spine) is used until X-rays show the child has reached skeletal maturity. This means the bones have stopped growing.

For the normal, healthy child, the scoliosis is unlikely to progress or get worse once skeletal maturity is reached. The scoliosis may not be stopped if the child has some other developmental or neurologic condition.

Many children finish with orthodontic braces before growth is complete. A retainer is worn until the roots of the teeth are firmly implanted in the jaw. There’s no danger that they might continue to move or migrate back. The dentist uses both the age of the child and the X-rays to make this decision.

Scoliosis bracing is not stopped or discontinued until the growth plates are fully closed. The phase of rapid growth when scoliosis is most likely to get worse is now over.

A retainer is not needed but further follow-up is required. The orthopedic surgeon will continue to follow your son for at least another two years. It’s important to keep these appointments to insure maximum success from the program.

Comminuted refers to bones that are broken into two or more pieces. Sometimes the bone is shattered into many tiny little pieces. Unstable refers to the fact that the bone fragments can shift and cause poor bone alignment while healing.

Sometimes this type of fracture requires surgery to pin or wire it in place while it heals. In other cases, the arm or leg is placed in a cast. Usually, the patient is not allowed to put any weight through the foot. The idea is to prevent shortening or other deformity of the bone. The hope is for good healing without the need for further surgery.

For children, there is always a concern that growth might be slowed on one side (the fractured side) compared to the other. This is most likely to be a problem if the bone near the growth plate has been fractured. Your surgeon will make every effort to prevent disturbances in growth, alignment problems, or deformities.

Surgery is often needed in unstable fractures. When the femur (thigh) is involved, it may be necessary to insert a long rod called a nail down into the shaft of the bone.

Most likely your daughter will not be allowed to put any weight on that leg until healing occurs. In some cases, the type of nail used might allow up to 40 per cent of body weight even when it’s a comminuted fracture. Your surgeon will let you know what your daughter can and cannot do over the next few weeks until healing takes place.

Follow-up after an unstable femoral (thigh bone) fracture is very important. There is a risk of silent complications. The patient doesn’t have any signs or symptoms of a problem until it progresses too far. In children, there can be injury to the growth plate. In all patients, there is always a concern about infection.

Your worry about exposure to radiation is understandable. It doesn’t hurt to discuss your hesitation with the surgeon. X-rays are a very useful tool in cases like this. They show alignment of the bone. Any shortening across the fracture site can be seen and measured. The X-rays can also be used to look for any growth disturbance or infection.

Experts suggest it is very wise to follow up these patients for at least two years after the injury.

Leg length differences can occur after a fracture anywhere in the limb. Many times fractures heal without any noticeable difference in the length of the bone. Shortening or lengthening of the leg are both possible problems after fracture healing. The difference can occur for a number of different reasons.

Sometimes the fracture is close enough to the growth plate to either stimulate or reduce bone growth. In other cases, the bone can be broken in such a way that it is distracted or pulled apart. It may not be possible to bring the bone fragments close enough together to prevent the leg from healing in a lengthened position.

According to a recent study of tibial fractures in children, there are times when a discrepancy occurs in the bone that has nothing to do with the fracture.

If the difference is small, an insert in the shoe may be all that’s needed. If X-rays and exam show the difference is significant, surgery may be needed. The surgeon can staple the growth plate on the longer side until the other leg catches up. When the legs are even again, the staple can be removed and the bone resumes growth.

You heard right. The United States Preventive Health Task Force has made the recommendation to stop school screening. School screening has been done for many years to identify children at increased risk for scoliosis. But studies have not been able to prove that it is cost effective.

There is not enough evidence to show that treating early cases of mild scoliosis makes a difference. Even so, it’s still possible that without early detection, diagnosis will come later and the result will be more severe spinal curves.

Without the screening process, it may be too late to keep the curves from getting worse (progression). In order to change this policy, researchers must prove that bracing is a significantly effective treatment for mild, but progressive curves.

New guidelines from the Scoliosis Research Society (SRS) may be helpful. The SRS Committee on Bracing has set up ways to collect and report data so that one study can be compared to another. The number of subjects tested can be combined making the results more significant.

The first two studies on bracing using this criteria have now been published. The children included were the same age with the same degree of spinal curvature. three different braces were used and the results compared. It remains to be seen if these children were braced soon enough to avoid surgery.

If children aren’t identified early enough through school screening, then they may not have a chance to try bracing. They may have to have surgery first. And surgery gets more complex with more advanced cases of scoliosis. Until further studies are completed, debate may continue on this topic for some years to come.