Understanding Potential Causes of Back Pain in Younger and Older Children

 

Most adults experience back pain at some point during their lifetime. But there are many children who complain of back pain. The younger and older children experience back pain due to a variety of reasons – infection, injury and bone tumor. Some of the potential causes of child back pain can be serious. The child needs to be treated by a skilled orthopedic to alleviate back pain and heal quickly. Hence, it becomes essential for parents to understand the potential causes of back pain in children.

Potential Causes of Back Pain in Younger and Older Children

Muscular Back Pain

Most children experience severe back pain due to muscular injuries. Poor conditioning of muscles on the back, muscles overuse injury, muscle and ligament strains, and similar injuries often make a child experience back pain. The orthopedic identify muscular back pain through specific image study. The child can combat muscular back pain simply by taking adequate rest and changing his physical activities.

Spinal Stress Fractures

Often the stress fractures occurring in the spine make children experience severe back pain. But the children often failed to identify the injury in the early stages. Also, a child may suffer from various types of stress fractures. Specific stress fracture like spondylolisthesis can occur on both sides of the span and make the spinal column unstable. Often orthopedic treat spinal stress fractures through nonsurgical treatment. However, they have to perform surgery if the child back pain persists despite continuing nonsurgical treatment.

Disc Herniation of Spine

Disc herniation of spine is one of the serious causes of child back pain. It moves the disc material from its normal space and pushes the disc material against spinal cord and nerves. Hence, a child experiences back pain, along with bending and straightening his spine with difficulty. Often orthopedic perform surgery to relieve pressure on the spinal cord and nerves.  But some physicians try to treat disc herniation without surgery if the child does not experience severe and consistent back pain.

Spinal Infection

Some children experience back pain consistently due to infection of spinal discs or bone. The spinal infections can occur in both toddlers and adolescents. The orthopedic has to perform specific image tests to diagnose spinal infection and identify the exact location of the infection. They also treat the spinal infection initially with antibiotics. But the orthopedic have to perform surgery if the prescribed antibiotics fail to control the infection or the spinal structure is damaged due to the infection.

Abnormal Alignment of Spine

In addition to causing deformity, abnormal alignment of spine also makes children experience severe back pain. However, the spinal deformity may differ from one child to another. An orthopedic monitors the conditions of deformity continuously to determine the most appropriate way to treat abnormal alignment of spine. If the condition is not severe, they try to normalize spine alignment by making the child wear braces. But they have to perform surgery if the spine deformity is consistent and the deformity must be corrected permanently.

Spinal Tumor

Sometimes the tumors occurring in the spinal column cause severe child back pain. A variety of tumors can occur in the spinal column. Hence, the orthopedic can to decide the treatment plan according to each spinal tumor. But the parents can identify spinal tumors based on common symptoms like consistent back pain, night pain and weight loss. The orthopedic combine medication and surgery to treat the spinal tumors effectively.

Sometimes the physicians have to perform bone scanning to identify the exact cause of back pain in a child. Hence, the parents must consult a skilled orthopedic when the child complains of back pain consistently. The orthopedic will perform the required screening tests to identify the exact cause of child back pain and speed up the healing process.

 

Congenital Clubfoot: Symptoms And Causes

 

Clubfoot is one of the most common birth defects of the foot. Out of one thousand new-born babies, one to two have this deformity. This deformity affects a new-born’s muscles, tendons, and blood vessels. It is caused when the tissues that connect the muscles to the bone are not the usual size. In congenital clubfoot, one or both feet are rotated downward and inward. It is also known as congenital talipes equinovarus in medical terms, and the child born with this deformity can’t place their foot flat on the ground for walking. Clubfoot is not painful, but if this congenital disease is not treated on time, the foot will remain deformed forever. Mostly, clubfoot can be treated without surgery, but in severe cases, follow-up surgery is required later on.

 

Types of Clubfoot

Clubfoot can be divided into two major categories non-isolated clubfoot and Isolated (idiopathic) clubfoot. Isolated clubfoot is a common musculoskeletal birth defect. It generally occurs without any other medical problems. On the other hand, non-isolated clubfoot happens along with other serious medical problems, including arthrogryposis and spina bifida. Arthrogryposis is a joint problem, and spina bifida is a neural tube disorder. If anyone in your family has clubfoot, your baby will be at higher risk of congenital clubfoot. Also, boys are at a greater risk of developing clubfoot than girls. Babies also have a higher chance of developing clubfoot if they have another birth defect known as spina bifida. Women who had oligohydramnios during pregnancy are also at a higher risk of having a clubfoot baby.

 

Symptoms of Congenital Clubfoot

If your new-born baby has clubfoot, their foot will be twisted inward and downward. The affected foot or leg will also be slightly shorter. In some cases, the foot is so severely turned that it seems as if it is upside down. Clubfoot is a serious health concern that will not improve on its own without any treatment. A baby with untreated clubfoot will use the outer edge of their foot to walk, leading to painful calluses. But with proper treatment, clubfoot can be treated, and your baby can lead a normal life.

 

How can clubfoot affect your baby

Clubfoot will not affect your baby until your child starts to walk. Untreated club food can limit your baby’s daily activities. They might have difficulty walking, standing, and wearing their shoes. A child with clubfoot may walk on the top and side of their feet. Clubfoot can also lead to calluses which is a thick layer of skin that usually develops on the foot’s sole. It can also lead to arthritis, a disease that causes stiffness and painful inflammation of the joints.

 

Causes of clubfoot

The definite cause of clubfoot has still not been identified by the researchers. But according to a popular theory, clubfoot is caused due to environmental and genetic factors. Families with a history of clubfeet are at higher risk of this disease. If a pregnant woman has one child with clubfoot, their chance of having a second child with this deformity is 1 in 35. In some cases, clubfoot is also linked to spina bifida, a congenital deformity that mostly occurs when the spinal cord and spine have not formed properly. Sometimes it can be linked to a developmental dysplasia of the hip or a developmental hip condition called hip dysplasia. If one of the parents has clubfoot, there is a 1 in 30 chance that your baby will have it. In 20016, research was conducted in which it was shown for the first time that a gene variation that processes folate in the body might be the cause of clubfoot.

 

What Is Cerebral Palsy?

 

A number of disorders of the developing brain affecting body movement, posture and muscle coordination.

• Caused by damage to one or more specific areas of the brain, usually occurring during fetal development; before, during or shortly after birth; during infancy; or during early childhood.
• Not a disease, not progressive, nor communicable.

Types of Cerebral Palsy:

• Spastic Cerebral Palsy: characterized by muscle stiffness and permanent contractions
• Athetoid or Dyskinetic Cerebral Palsy: characterized by uncontrolled, slow, writhing movements
• Ataxic Cerebral Palsy: characterized by poor coordination and balance

Cerebral palsy (CP) is a term used to describe a problem with movement and posture that makes certain activities difficult. Even though someone who has Cerebral palsy has problems moving his or her muscles, this is not because there is something wrong with the muscles or nerves. These difficulties are caused because of problems in the brain. The child might have had an injury to the brain, or had a brain that did not develop properly. These problems can affect the way the brain controls movement and posture.

Simply stated, “cerebral” refers to the brain, and “palsy” refers to muscle weakness/poor control. Although the brain itself will not get worse, people who have cerebral palsy will usually change over time. Sometimes they will get better, and some patients will stay the same. Occasionally they will get worse, usually because of contracture of the joints or changes in the muscle tone.

There is currently no cure for cerebral palsy, however there are different treatment options for people who have cerebral palsy. These options include therapy, medications, surgery, education and support. By taking advantage of one or more of these options, people with cerebral palsy can learn to improve their function and the quality of their lives.

How is Cerebral Palsy Diagnosed?

Parents are often the first to notice that their infant is not developing normally. Infants with cerebral palsy are often slow to roll over, sit, crawl, or walk. When an infant develops more slowly than usual it is called developmental delay.

Some of the skills that infants should have include:

• Holding own head up when lying flat in a bed at 3 months
• Sitting and rolling over by 6 months
• Walking by 12-18 months
• Speaking simple sentences by 24 months

Most children with cerebral palsy are diagnosed by the time they are two years old. But if a child’s symptoms are mild, it can be hard for a doctor to make a true diagnosis before the child is four or five years old. If the doctor thinks a child has cerebral palsy, he or she will probably schedule an appointment to see the child and talk to the parents about their child’s physical and behavioral development.

Doctors diagnose cerebral palsy by obtaining a complete medical history of development and examining the child, paying special attention to the child’s movements. In addition to checking for the most common symptoms — such as slow development, abnormal muscle tone, and unusual posture — a doctor also has to make sure the child doesn’t have something else that could cause similar symptoms.

Some children have hypotonia, which means that their muscles are too relaxed. In this case, the baby may seem floppy. Other children have hypertonia which makes their muscles seems stiff. Sometimes a child can have hypotonia that later become hypertonia two to 24 months after birth. Children may also have unusual posture or favor one side of their body.

What’s most important to the doctor is making sure that the child’s condition is not getting worse. Although cerebral palsy symptoms may change over time, children with cerebral palsy do not usually lose function. That means, if a child does seem to be losing motor skills, the problem is probably not cerebral palsy. It more likely a genetic or muscle disease, a metabolism disorder, or tumors in the nervous system. A complete medical history, special medical tests, and, in some cases, repeated check-ups can help confirm whether or not the child has cerebral palsy for certain.

Once the diagnosis of cerebral palsy has been made based on medical history and physical examination, your doctor may order tests to try to figure out the cause of the cerebral palsy (Ashwal et al., 2004). Tests (like MRI scans), that allow doctors to look into the brain, can find problems that may be able to be treated. If it is cerebral palsy, an MRI scan can also show a doctor the location and type of injury to the brain.

Some other tests a doctor might order include:

Cranial ultrasound

This test is used for high-risk premature infants because it is the least intrusive of the imaging techniques. However, it is not as effective as the two methods described below at seeing small changes in “white matter” – which is the type of brain tissue that is effected in cerebral palsy.

Computed tomography (CT) scan.

This technique creates images that shows brain injury.

Magnetic resonance imaging (MRI) scan

This test uses a computer, a magnetic field, and radio waves to create a picture of the brain’s tissues and structures. Doctors prefer MRI imaging because it offers better detail and does not involve radiation.

Metabolic Disorders

On rare occasions, metabolic disorders can be mistaken as cerebral palsy and some children will require additional tests to rule them out.

Specialized Knowledge and Training

To confirm a diagnosis of cerebral palsy, a doctor may send a child to other doctors who have specialized knowledge and training or to specialty clinics where these doctors work with a team of health professionals who specialize in working with children with cerebral palsy and other developmental delays. These doctors might be child neurologists, developmental pediatricians, ophthalmologists (eye doctors), or otologists (ear doctors). Additional observations by these specialists can help the doctors make a more accurate diagnosis and begin to develop a specific plan for treatment.

Most Common Characteristics:

A person with cerebral palsy may exhibit one or more of the following effects:

• muscle tightness or spasticity
• disturbance in gait or mobility
• involuntary movement
• difficulty in swallowing and problems with speech

An individual with cerebral palsy may also exhibit:

• difficulty in feeding
• impairment of sight, hearing or speech
• abnormal sensation and perception
• seizures
• difficulty with bladder and bowel control
• mental retardation
• learning disabilities
• problems with breathing because of postural difficulties
• skin disorders because of pressure sores

Treating Cerebral Palsy:

At this time, there is no cure for the developmental brain damage that causes cerebral palsy. Training and therapy, however, can help improve muscle function and coordination. Studies have found that children who receive early intervention services are more likely to lead a typical life.

Although there is no cure, recent advancements in neurological studies have vastly expanded our knowledge of brain development, and are allowing researchers to explore new treatments focused on the protection and care of children with cerebral palsy and other developmental brain disorders that strike early in life.

Cerebral Palsy Treatment

Although cerebral palsy cannot be cured, treatment will often improve a child’s capabilities. Many children with cerebral palsy go on to enjoy productive adult lives if their disabilities are properly managed. In general, the earlier that treatment begins the better chance the child has to learn new ways to accomplish the tasks that challenge them.

There is no single therapy that works for every child who has cerebral palsy. A team of healthcare professionals and community-based providers can help identify specific needs and develop a plan to help improve your child’s quality of life.

Who is on the team?

Doctors may include:

• Neonatologists
• Pediatricians
• Developmental Pediatricians
• Neurologists
• Orthopedists
• Physiatrists (Physical Medicine and Rehabilitation)
• Ophthalmologists
• Neurosurgeons
• Gastroenterologists
• Urologists
• Otolaryngologists (Ear Nose and Throat physicians)

Other health care professionals may include:

• Physical Therapists
• Occupational Therapists
• Speech Language Pathologists
• Social Workers
• Nurses
• Audiologists
• Psychologists
• Nutritionists/Dietitians

About United Cerebral Palsy

Founded over 60 years ago by parents of children with cerebral palsy, today United Cerebral Palsy (UCP) is a leading service provider and advocate for children and adults with disabilities. The UCP mission is to advance the independence, productivity and full citizenship of people with disabilities through an affiliate network. This includes approximately 100 local service providers reaching over 176,000 individuals daily in the U.S., Canada, Scotland and Australia. The national office in Washington DC advocates on behalf of individuals with disabilities; advances federal disability public policy (Disability Policy Collaboration and develops forward-thinking programs.

Content Source: Parentingspecialneeds.org

 

 

Flat Feet Treatment Strategies for Children

You may have heard the term pes planus, flat feet, poor arch support, or overpronation… You may notice your child’s feet turning out significantly when standing or walking. You may even notice a more significant wear pattern on the inside of the child’s shoe. So what exactly does a flat footed presentation entail? Flat Feet (aka Pes Planus) Children who present with flat feet may have been late ambulators, may have been initially classified as toe walkers, or may have been diagnosed with hypotonia. When the child is standing, you will notice the entire foot contacting the weight bearing surface with the absence of an inner (medial) arch. The foot may also turn out, increasing the weight on the medial side, and making it appear even more flat. When assessing this child’s gait, you may notice audible “foot slap”, denoting a lack of true control as compared to more typical gait pattern (as weight shifts from heels to toes). Children with flat feet will experience overpronation or excessive pronation, which refers to a pattern in which the foot rolls too far in a medial direction causing the body weight to be distributed unevenly across the metatarsus and cause excessive strain on the ankle, the knee and the hip. A child who overpronates does not absorb shock efficiently, leading to poor lower extremity alignment and the potential for future orthopedic concerns. It is important to note that most children will appear with a flexible flat foot early on in their “walking career”. We anticipate early ambulators to display a flattened arch with forefoot pronation while weight bearing. Over time most children develop the musculature of their intrinsic foot and plantar arch. Intervention is not necessary if this presentation is not otherwise affecting function. Here are some fun treatment ideas to promote development of the arch muscles to encourage lower extremity alignment, fluidity of gait mechanics and prevent any potential long term musculoskeletal issues that may arise as a result of this presentation. All exercises should be done barefoot without sock or shoes, to encourage activation of the intrinsic muscles of the foot. We want child to experience both tactile and proprioceptive input through the soles of their feet. Treatment for Flat Feet Targets: • Arch Activation/Strength • Lower Extremity Strength & Alignment • Efficient and Fluid Motor Patterns • Biomechanics of Gait Intrinsic Plantar Muscle (Arch) Activation Gentle Foot Massage • Apply gentle pressure to bottom of child’s foot. • Use circular motion to activate muscles of medial foot. Vibration or Tactile Input Use vibrating node or tactile ball along arch of foot with child comfortably seated, to activate muscles of foot. Can do this before other more challenging activities to ensure arch is activated and ready to “work”. Scarf Lifts Using fun play scarves, start with material flat on floor. With child seated or standing, encourage child to place one foot on top and use muscles of foot to lift scarf up! Toe Basketball For increased challenge, have child pick up marbles or flat “chips” with toes and drop in small container, this requires greater control and prolongs muscle activation. Single Leg Balance With the standing on foam balance pad or firm cushion, practice balancing on each leg for 10 second intervals to challenge arch activation. Half Kneel Ball Toss • Pass ball back & forth while maintaining half kneel on balance pad. Dyna-Disc Balance Maintain balance on dyna disc during game of catch, balloon volleyball, Velcro ball, etc. Half Moon Balance Stand to squat on half moon foam roller – also great for arch activation! Tandem Stance • Standing with one foot in front of the other. Use colorful tape for helpful visual cue to promote alignment. Tactile footprints are great visual and tactile cues for foot placement to help engage foot musculature and promote development of arch! Scooter Adventure Seated floor scooter, forwards and back using heels to dig in and muscles of foot to initiate movement. Bridge Pose Push into dyna disc with both feet, lifting bottom for sustained hold or lift & lower for more dynamic activation. Crab Kicks Hold bridge position and perform alternate leg kicks while saying the ABCs. To increase challenge and to target muscles of the foot, place dyna disc under feet, while alternating leg kicks! Ball Marching With child seated on therapy ball, balance pad under feet, encourage alternating marching movement. Engaging lower body disassociation while promoting lower body and trunk engagement. Brick Kicks With child standing on balance pad or dyna disc encourage kicking down either soft blocks or cones to promote weight shifting and balance. Bear Walks Have child walk across the room like a bear to complete a puzzle. You can increase the challenge and provide sensory input by lining the floor with pillows or bubble wrap! Penguin Walks Encourage child to walk forward with heels on the ground and toes up! Shoe Suggestions for Children with Flat Feet The appropriate shoe or sneaker: • Provides Support • Offers Stability • Facilitates Weight Bearing • Promotes Lower Extremity Alignment • Encourages Fluidity and Efficiency in Motor Patterns Some great options include: • ASICS: ASICS Contend & ASICS Jolt • Saucony: Saucony Cohesion & Saucony Ride • Keen: Keen Newport Sneaker & Keen Newport Sandal • Pediped: Pediped Max & PediPed Flex Dakota • Stride Rite: Stride Rite Cannan & Stride Rite Racer For more information about shoe recommendations for common Pediatric gait presentations, check out our post on What a Difference a Shoe Makes! Content Source: Dinopt.com

Perthes’ Disease

Perthes’ disease affects children, most commonly boys aged between four and ten years old, but can also occasionally occur in younger children and teenagers. Tiredness and groin pain are two common symptoms, and they may have a noticeable limp.

Symptoms Symptoms of Perthes’ disease are usually on one side only and include: • Tiredness and pain in the groin, thigh, and sometimes in the knee • Pain in the knee only, even though the disease affects the hip • Stiffness and reduced range of motion at the hip joint • Walking with a limp • The affected leg may appear shorter than the other leg Diagnosis It is important a medical professional examines any knee or hip pain in children. An early diagnosis is important to avoid long-term complications. A doctor may X-ray the hip to help diagnose the cause of hip pain. However, in the early stages of the disease, X-rays may appear normal. Therefore, your doctor uses other investigations such as MRI or bone scans. What is Perthes’ disease? Perthes’ disease commonly affects children between the age of 4 and ten years old. But can also occasionally occur in older children and teenagers. Another name for Perthes’ disease is Legg–Calvé–Perthes disease. The exact cause of the disease is unknown. It affects the hip joint, where the top of the femur (thigh bone) meets the socket of the pelvis (acetabulum). The blood supply to the head of the femur is disrupted, resulting in necrosis. This is where the bone softens and begins to break down. Once the blood supply returns to normal, bone tissue is laid down and the femoral head reforms and hardens. This occurs over a period of 1 to 3 years. Due to the joint being a ball and socket, one of the main problems is that the re-growth may not form in a spherical shape as before. The severity of deformity of the head of the femur determines the degree of symptoms and if there are likely to be any future problems such as a permanently decreased range of motion at the joint and arthritis. Boys are far more likely to develop this condition than girls, although girls tend to suffer from more severe symptoms and future problems. Symptoms are usually only in one hip, although occasionally can affect both sides. Treatment and management of Perthes’ disease Depending on how severe the disease is will determine whether it requires conservative treatment or surgery. Treatment consists of rest from any aggravating activity or exercise and maintaining range of motion in the hip through mobility exercises. In particular, exercises to maintain abduction of the hip (moving the leg out sideways) and internal rotation of the hip. Treatment will depend on the age of the child and the severity of the condition but may include bed rest, crutches, traction, a plaster cast, leg brace, or surgery in extremely severe cases. Your surgeon performs arthroscopic (keyhole) surgery to remove loose bodies within the joint and repair damaged cartilage (chondroplasty). Perthes’ disease usually resolves over time as the athlete grows, as long as they manage it properly. Athletes can return to sport when they are free of symptoms. With competitive young athletes managing injuries and diseases is important. This may mean changing sporting activity for a while, or reducing the volume of training and focussing on quality. For example, a young soccer player may play once or twice a week and substitute other activities such as swimming, or light technical training. If Perthes’ disease is not managed correctly then long-term complications include arthritis because the surface of the joint is irregular, resulting in faster wear and tear. Content Source: Sportsinjuryclinic

Radial Club Hand Treatment & Management

“Radial Club Hand Syndrome” can be defined as the medical condition in which there are deficiencies in the extremities of the pre-axial and radial side of the arms. Although the deficiencies are confined to the extremities, forearm and hand, the deficiencies may stretch to the whole of the arm. Radial club hand syndrome is usually detected by the radio graphs that are performed on the patient or by the ultrasound imaging of the affected or suspected areas.

Classification: The radial club hand has various kinds of types which need to be handled in different manners. The disease is classified as follows: 1. Type N: Isolated thumb anomaly 2. Type 0: Carpal bone deficiency 3. Type I: Short distal radius 4. Type II: Miniature hypoplastic radius 5. Type III: Absence of distal radius 6. Type IV: Radius being completely absent 7. Type V: Complete absent radius along with proximal humerus manifestations Treatment: Just like stated above the different types of radial club hand requires various kinds of treatments to be rectified most of which usually involve surgical process for rectification. The most common treatments that are applied to children suffering from this condition are: Splinting and Stretching: Splinting and stretching is sufficient in cases where the disease is minimalist and confined to slight abnormality of the wrist. This should be followed by regular exercise which helps in fixing the extension of the wrist and relapse of the condition can be avoided. 1. Centralization: This treatment is usually applied in the severe cases where a notch is used as a replacement in the central position. Centralization is usually done to return the normal functionality of the hand by fixing the position of the ulna. The method is accomplished by the removal of the carpal bones to adjust the ulna which is followed by the wearing of a sling for an extended period of time to hold the position of the rectified bones. Although this method may cause certain damages to the ulna, this process usually cures situations like stiff elbow which helps the patient feed on her own. 2. Radialization: Radialization is a surgical treatment in which the extensors are added to the ulna and the metacarpal is pinned to it for proper movement of the hand. Usually, the ulna is overcorrected to prevent the relapse of the radial club hand syndrome. 3. Vascularized Metatarsophalangeal (MTP)-Joint Transfer: Vascularized metatarsophalangeal (MTP)-joint transfer is the method of transferring the second toe to the ulna on the radial side of the same to provide it with an extra platform which will help in the proper movement of the wrist. These treatment processes along with the proper exercises can help the patient keep radial club hand syndrome at bay and prevent it from relapsing again in the future. At Kids Orthopedics, special attention is given to the various types of radial club hand syndrome that may occur and the treatment and management is done accordingly to achieve the best possible end result.