SCOLIOSIS

Our spine is naturally curved in order to distribute the weight of the body. A side-view X ray of a soldier standing rigidly at attention would show the cervical spine in his neck arched slightly forward. The twelve thoracic vertebrae curve gently to the rear. Then the lumbar spine, which bears most of our upper-body weight, arches forward as it nears the pelvis. 

About one in twenty-five adolescent girls and one in two hundred teenage boys develop scoliosis. Captured on an X-ray, their spines form, to varying degrees, a more pronounced S shape. When imaged from the back, a normal spine exhibits no curvature. A youngster is said to have scoliosis if her curvature is greater than ten degrees. 

The condition can occur as a complication of polio, muscular dystrophy and other central nervous system disorders, but four in five cases among teenage girls are idiopathic—that is, of unknown cause. Very often, though, a family member will also have had scoliosis. 

Symptoms Suggestive of Scoliosis May Include: 

• Conspicuous curving of the upper body 
• Uneven, rounded shoulders 
• Sunken chest 
• Leaning to one side 
• Back pain (rare) 

Scoliosis can develop quietly for months to years so it may only be picked up by the pediatrician during an examination of the teen’s back. Progression may occur quickly during the teen’s growth spurt. One in seven young people with scoliosis have such severe curvature that they require treatment. 

How Scoliosis Is Diagnosed 

• Physical examination and thorough medical history 
• X-rays 

How Scoliosis Is Treated 

• Bracing: Many such cases never progress to the point that treatment is necessary. Follow-up visits are scheduled approximately every six months for those diagnosed with curves between fifteen and twenty degrees. 

Curvature above twenty-five degrees may call for bracing. There are two main types of orthopedic back braces. The Milwaukee brace has a neck ring and can correct curves anywhere in the spine; the thoracolumbosacral orthosis (TLSO for short, thankfully) is for deformities involving the vertebrae of the thoracic spine and below. The device fits under the arm and wraps around the ribs, hips and lower back. 

Scoliosis patients can expect to wear the brace all but a few hours a day until their spinal bone growth is complete; usually that’s about ages seventeen to eighteen for girls, and eighteen to nineteen for boys. The braces are more cosmetically appealing than they used to be and can be hidden easily under clothing. Having to wear an orthopedic brace interferes only minimally with physical activity. Only contact sports and trampolining are off-limits for the time being. 

• Surgery: Posterior spinal fusion and instrumentation, the operation to surgically correct scoliosis, is typically recommended when the spine’s curvature is fifty degrees or more. The surgical procedure fuses the affected vertebrae using metal rods and screws to stabilize that part of the spine until it has fused together completely. On average, this takes about twelve months. Although teenagers who have the surgery still face some restrictions on physical activity, they can say good-bye to the brace. 

Helping Teens Help Themselves 

Only about 50 percent of young scoliosis patients wear their braces. Parents need to convey the importance of complying with the doctor’s instructions. At the same time, they should be sensitive to the tremendous impact the condition can inflict on a teenager’s body image, which at this age is inextricably entwined with self-identity and self-confidence. You might want to consider asking your pediatrician or orthopedist for a referral to a mental-health professional experienced in counseling children with chronic medical problems. A patient support group, like those run by the Scoliosis Association may also be helpful.

Source - 11/21/2015

Caring for Your Teenager (Copyright © 2003 American Academy of Pediatrics)

HIP DYSPLASIA DETECTION IN KIDS

Why does my pediatrician check my baby's hips at each check-up?

Hip dysplasia (developmental dysplasia of the hip) is a condition in which a child's upper thighbone is dislocated from the hip socket. It can be present at birth or develop during a child's first year of life. 

No one is sure why hip dysplasia occurs (or why the left hip dislocates more often than the right hip). One reason may have to do with the hormones a baby is exposed to before birth. While these hormones serve to relax muscles in the pregnant mother's body, in some cases they also may cause a baby's joints to become too relaxed and prone to dislocation. 

Factors that may increase the risk of hip dysplasia include 

• Sex - more frequent in girls 
• Family history - more likely when other family members have had hip dysplasia 
• Birth position - more common in infants born in the breech position 
• Birth order - firstborn children most at risk for hip dysplasia 

Detecting Hip Dysplasia 

Your pediatrician will check your newborn for hip dysplasia right after birth and at every well-child exam until your child is walking normally. 

During the exam, your child's pediatrician will carefully flex and rotate your child's legs to see if the thighbones are properly positioned in the hip sockets. This does not require a great deal of force and will not hurt your baby. 

Your child's pediatrician also will look for other signs that may suggest a problem, including 

• Limited range of motion in either leg 
• One leg is shorter than the other 
• Thigh or buttock creases appear uneven or lopsided 

If you live in the state of Kansas as opposed to Missouri, you can visit a physical therapist like our own Hope Hillyard at Champion Performance and Physical Therapy for an assessment of possible hip dysplasia. If special tests are found positive, at that point it may be beneficial to schedule an appointment with your Pediatric physician for further imaging or testing. If your child's pediatrician suspects a problem with your child's hip, you may be referred to a pediatric orthopedic specialist who has experience treating hip dysplasia. 

Hip dysplasia is rare and in spite of careful screening during regular well-child exams, a number of children with hip dysplasia are not diagnosed until after they are 1 year old.

Source - 11/21/2015

Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)

PIGEON TOES IN YOUR TOT

Pigeon Toes (Intoeing)

Children who walk with their feet turned in are described as being “pigeon-toed” or having “intoeing.” This is a very common condition that may involve one or both feet, and it occurs for a variety of reasons. 

Intoeing During Infancy 

Infants are sometimes born with their feet turning in. This turning occurs from the front part of their foot, and is called metatarsus adductus. It most commonly is due to being positioned in a crowded space inside the uterus before the baby is born. 

You can suspect that metatarsus adductus may be present if: 

• The front portion of your infant’s foot at rest turns inward. 
• The outer side of the child’s foot is curved like a half- moon. This condition is usually mild and will resolve before your infant’s first birthday. Sometimes it is more severe, or is accompanied by other foot deformities that result in a problem called clubfoot. 

This condition requires a consultation with a pediatric orthopedist and treatment with early casting or splinting. 

Intoeing In Later Childhood 

When a child is intoeing during her second year, this is most likely due to inward twisting of the shinbone (tibia). This condition is called internal tibial torsion. When a child between ages three and ten has intoeing, it is probably due to an inward turning of the thighbone (femur), a condition called medial femoral torsion. Both of these conditions tend to run in families. 

Treatment 

Some experts feel no treatment is necessary for intoeing in an infant under six months of age. For severe metatarsus adductus in infancy, early casting may be useful. 

Studies show that most infants who have metatarsus adductus in early infancy will outgrow it with no treatment necessary. If your baby’s intoeing persists after six months, or if it is rigid and difficult to straighten out, your doctor may refer you to a pediatric orthopedist who may recommend a series of casts applied over a period of three to six weeks. The main goal is to correct the condition before your child starts walking. 

Intoeing in early childhood often corrects itself over time, and usually requires no treatment. But if your child has trouble walking, discuss the condition with your pediatrician who may refer you to an orthopedist. A night brace (special shoes with connecting bars) was used in the past for this problem, but it hasn’t proven to be an effective treatment. Because intoeing often corrects itself over time, it is very important to avoid nonprescribed “treatments” such as corrective shoes, twister cables, daytime bracing, exercises, shoe inserts, or back manipulations. These do not correct the problem and may be harmful because they interfere with normal play or walking. Furthermore, a child wearing these braces may face unnecessary emotional strain from her peers. 

Nevertheless, if a child’s intoeing remains by the age of nine or ten years old, surgery may be required to correct it.

Source - 11/21/2015

Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)