Category: blog

Lockdown as poised a challenge for parents/caregivers in looking after the children.  Due to lockdown, children are spending most of their time at home. Above all, the children are adventurous and certainly not have an understanding of the consequences of their activities.  So children are more susceptible to injuries. However, most of the injuries can be anticipated and avoidable. So it is essential to have a safe home environment to reduce the probability, possibility, occurrence, and brutality of injuries.

Causes of injury –

The most common causes of injury are falls, jammed fingers, poisoning, burns, and near-drowning.  In children aged one to two years, injuries at home are most common.  After two years of age the injury rate decreases.

The common situations interconnected to injuries include:

• Poor visual contact between the play areas and work areas

• Poor lighting, floor surface or tripping hazards

• Lack of supervision when parents or caregivers are busy or distracted.

Prevention of injuries –

The most essential safety precaution is supervision. Especially, when children are on balconies should be supervised all the time.

In the living area, provide safe play space.

Make sure dangerous items (medicines, matches, or lighters) are inaccessible.

Mount barriers to stop entry to dangerous areas.

Use safety products like electrical outlet plugs, window stops, and furniture straps.

While cooking, children are kept away from the kitchen.

In the bathroom, always remain within arm’s reach of your baby

Never reverse your car, until you know all children are safe

For more information –

https://www.cdc.gov/parents/children/safety.html

https://kidshealth.org/en/parents/household-checklist.html

Bacteria and viruses are spread from children to children simply through touch and through the air. Infections occur due to the spread of bacteria and viruses. So it is important to stop the spreading of bacteria and viruses.

To stop the spreading of bacteria and viruses, good hygiene practices are important. Good hygienic practices are washing hands, encouraging children to cough or sneeze into their elbow, and not sharing the cups, cutlery, or personal items.

Washing hands –

Why? –

When the bacteria and viruses come in contact with hands, it is easily transmitted on touch. Once the bacteria and virus are on hands, they can get inside the body on touching the eyes, nose, or mouth. So to prevent the spread of bacteria and viruses, washing hands is an important good hygienic practice.

When? –

Washing your children’s hands and your hands are the best things to do to stop the spread of bacteria and viruses. Washing hands should be done before eating food, before feeding a child, before giving medications to a child, and before touching or holding a sick child. And also washing hands should be done after changing a nappy, after helping a child use the toilet, after wiping your child’s nose, after touching or holding a sick child, and after touching the pets or other animals.

How? –

First, wet the hands

Apply soap or hand wash and rub for at least 20 seconds

Make sure to rub in between the fingers, under fingernails, around the thumb, bank of hands and wrists

Rinse the hand and dry

Others –

Follow other good hygienic practices like encouraging the child to cough or sneeze into their elbow and to use tissues instead of hankies.

Key points to remember –

It is important to hand wash regularly to prevent the spread of infection

Wash hands for at least 20 seconds

Follow other good hygienic practices

More information –

https://www.aboutkidshealth.ca/article?contentid=1981&language=english

https://kidshealth.org/en/parents/hand-washing.html

https://www.childrens.com/health-wellness/importance-of-hand-washing-for-kids-infographic

https://www.rch.org.au/kidsinfo/fact_sheets/Hand_Hygiene_why_is_it_so_important/

The plaster cast is given to your child to treat an injury or after surgery to provide rest to the limb. Therefore the role of a plaster cast is to keep the arm/leg in a certain position and to protect the operated area while it heals. The most important and essential part of orthopaedic home management is cast care.

Cast care

Cast usually dries completely in 48 hours. Allow the cast to dry naturally.

Keep the plaster cast dry and clean at all times

Carefully check the cast, it should not be tight. Ideally, there should be a gap between the cast and skin.

Don’t bump or hit the cast

The cast can be decorated with a marker; however, do not paint the cast. This will close the pores of the plaster.

Check your child’s skin condition at the plaster edges every day. Look for skin irritation, rashes or ulcers.

Usually, children complain of itching under the plaster cast. Use a hairdryer on a cool setting at the opening of the cast.

Don’t put anything between the cast and skin as this can irritate the skin and cause an infection.

Around the cast, don’t use powder, lotions, or oils under or around the cast.

Elevate the limb above the heart level. It will reduce the swelling.

Encourage the child to keep moving the finger or toes while in plaster cast so that blood flow will be good.

Never immerse the plaster cast in water. Seal the cast in a water-proof plastic bag with tape, while showering or bathing.

See your doctor

When a child is having severe pain

When the skin may look pale or bluish in colour

When fingers or toes are cool or hot to touch

When a child says, they have pins and needles or numbness

When the child is not able to move the fingers or toes

When you notice any problem such as cast is broken or bad smell is coming from the cast

Key points to remember

Keep the plaster cast clean and dry.

Elevate the limb above the heart level.

Encourage the child to move the finger and toes.

More information

https://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/cast-care/art-20047159

https://www.texaschildrens.org/sites/default/files/Cast-Care.pdf

https://kidshealth.org/en/parents/casts.html

Transient synovitis of the hip is the most common cause of abnormal walking in children. In other words, it is also called toxic synovitis and irritable hip. It is usually seen after a recent viral infection like a common cold. Although it can happen at any age, it is most often seen between 3 to 10 years of age.  Boys are more commonly affected. However, there is nothing to panic, it recovers with rest over some time.

The exact cause is not known. It may be caused by the substances produced by the body’s immune system which fight against the recent viral infection.

It usually presents with sudden onset abnormal walking patterns or difficulty in crawling or difficulty in standing. Most often one side is affected. Older children complain of pain in the groin, hip, thigh or knee. In addition, children feel unpleasant and refuse to walk. However, children are fine with a nontoxic look.

Transient synovitis of the hip will get better with rest. Mild non-steroidal anti-inflammatory drugs such as ibuprofen or acetaminophen are enough to aid in the recovery.

Unsettling for the parents – Visit Paediatric Orthopaedic Surgeon

Parents should consult a Paediatric Orthopaedic Surgeon if the following red flags signs are present –

                If the child develops a high-grade fever

                If the child is not moving the limb at all

                If the child is not allowing even the parents to touch the limbs

                If the child is not standing or walking

                If there is a rest pain or persistent pain that is not relieved by mild analgesic

                If the condition is not showing improvement in three days

                If the condition has not recovered fully in two weeks

Key points to settle the parent’s concern –

Transient synovitis of the hip is the mild condition. After that, it will get better on its own. However, a vigilant watch is needed to avoid the unwanted.

Know more –

http://bengalurukidsortho.in/health-info/transient-synovitis-of-the-hip-or-irritable-

hip/https://www.rch.org.au/kidsinfo/fact_sheets/Transient_synovitis/

https://posna.org/Physician-Education/Study-Guide/Transient-Synovitis-of-the-Hip

Introduction –

Club foot is a treatable congenital foot deformity. The cause of the club foot is unknown. Club foot treatment should be started as early as possible after the delivery. The standard accepted treatment protocol is the Ponseti method of club foot manipulation and casting. Club foot manipulation and casting are painless procedures.

Cast application won’t deter the normal development of the baby and immunization can be continued as per the schedule.

The child’s foot is manipulated and placed in a cast to correct the inwardly- turned deformity of the foot. The cast extends from the toes to mid-thigh i.e. long leg cast. The foot is placed in the manipulated position for 4 to 7 days. So that the muscles and ligaments will stretch enough to help further correction is possible in the next cast. After the cast removal, the same process of gentle manipulation and casting is done in a much-corrected position. Casting is repeated for 5-6 times approximately depending on the age of baby and rigidity of the deformity. Just before the complete correction, the heel cord is cut in about 75-85% of the babies. This is done before the application of the last or last but two casts. The heel cord reattaches within 2-3 weeks and without any weakness.

Care about for each cast application –

First 24 hours after each cast application, the baby will be little fussy/ restless. This is usually due to discomfort and not due to pain. The baby should be comfortable after 24 hours.

The cast should be placed on the soft surface for 24 hours, as the cast takes about 24 hours to dry completely.  When the baby is on his/her back, place a rolled towel to elevate the limb with heel extends beyond the towel roll. This prevents the pressure sore on the heel.

Check the circulation in the foot every hour for the first 6-8 hours after application of the cast. After 8 hours, circulation is checked 4 times a day. Circulation is checked by pinching the toes, and then watches the return of color in the toes. Toes will turn white while pinching and then quickly return pink if the blood flow to the foot is good. If the toes are white, cold and don’t turn from white to pink on pinching, it indicates foot circulation is hampered. This may be due to tight cast. If this occurs, call your doctor immediately.

Top of the toes should be exposed. If toes are not visible, then it means the cast has sipped and correct reduction is not maintained. If this happens, call your doctor immediately.

Use disposable diapers always and frequent change of diaper is needed to prevent cast soiling. Apply the diaper above the top end of the cast, so that it prevents urine from getting inside the cast.

Observe at the skin condition at the edges of the cast.

Keep the cast clean and dry. The cast may be wiped with a slightly dampened cloth if it gets soiled.

Contact immediately –

When

                Toes are pale or swollen

                The cast is slipped and toes are sunken inside the cast

                Any foul smelling odor is coming from the cast

                Skin is red, sore or irritated at the edges of the cast

                Any drainage on the cast

                A child has an increased temperature of 101.3 degrees F or higher without a reason

Instruction before next cast application –

A new cast is applied every 4 to 7 days.

The cast can be removed at the clinic or home.

If removal is planned at home, then put the baby in a tub containing warm water and make sure that is inside the water for approximately 10-15 minutes. Then unwind the plaster and remove the cast. However, do not soak or remove the cast the day before the appointment.

Give the baby shower before every cast application.

Feed the baby and burp the baby before manipulation and cast application.

Bracing after the last cast application –

Club foot correction is maintained by a special foot abduction brace. Foot abduction brace includes shoes attached to a metal bar. Strict adherence to bracing protocol is important to prevent relapse.  A brace should be worn 23 hours a day for 3months, then bracing duration is reduced tonight and during naps by 1 year of age. By 1 year of age, the baby will start to walk. Walking on barefoot maintains the correction and helps in foot development. Bracing is continued at night and naps for an additional 3 to 4 years. The baby may be uncomfortable during the first and second night of brace wear. Usually, the baby adapts and tolerates the brace well after the second night of brace use.

Follow up visits are scheduled at one week, one month and three-monthly, till one year of age. The second-year, follow up visits are scheduled at six-monthly intervals.  Always bring the child’s brace at every visit. Thereafter yearly till skeletal maturity. Relapse will almost always occur if the shoes with the metal bare are not worn.

Know more –

http://bengalurukidsortho.in/health-info/congenital-talipes-equinovarus-ctev-or-club-foot/

https://orthoinfo.aaos.org/en/diseases–conditions/clubfoot/

http://orthokids.org/Condition/Clubfoot

http://www.ponseti.info/casting-care-instructions.html

https://kidshealth.org/en/parents/ponseti-casting.html

Baby walkers or infant walkers consist of a wheeled base supporting a rigid frame that holds a fabric seat with legs opening and usually a plastic tray. These devices are designed to assist the babies, with feet on the floor and to allow mobility while they are learning to walk. Baby walkers are commonly used between 5 and 15 months of age.

Various reasons for using baby walkers are – to keep the infant quiet and happy, to encourage mobility and promote walking, to provide exercise, to hold the infant during feeding and walkers would keep their infant safe.

Common types of baby walker related injuries – 

• Trip and fall over

• Roll down stairs

• Get into dangerous places, which are otherwise difficult to reach

• Child in a baby walker can move more than 3 feet in 1 second, so walkers are never safe, even with an adult close by.

Baby walker may cause delay in motor development –

Baby walkers are not only unsafe but may also slow the motor development. This is because walkers give an infant the sensation of walking on their own. And thereby, baby walkers eliminate the desire to crawl or to walk. So baby walkers are not a boon to the child’s development.

Recommendations –

American Academy of Paediatric recommends a ban on the manufacture and sale of mobile baby walkers.

Don’t use a baby walker for your baby and don’t allow other care givers to use baby walkers.

Efforts should be made, through media campaigns, warning labels to educate parent about the hazards and lack of benefits of baby walkers.

Safest walker is one without wheels, stationary activity centers should be promoted as a safer alternative to mobile baby walkers.

Conclusion –

Baby walkers are not safe and not a boon to the development of child. One way to keep baby safe and help in baby’s development is to throw away your baby walker.

References –

https://pediatrics.aappublications.org/content/108/3/790

https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/expert-answers/baby-walkers/faq-20058263

https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Baby-Walkers-A-Dangerous-Choice.aspx

In bowed legs, the knee appears to bow out from the body and does not touch, however, the feet do. All babies are born with bowed legs. However, parents notice bowed legs when children begin to walk at around 12 months. The bowed legs tend to straighten with age between 18 and 24 months.  So it is normal for infants to be born with bowed legs.  The bowed leg in children which gets corrected with age is called physiological bow legs.

Cause of physiological bowed legs –

Bowed legs in the newborn are because of the folded position of the foetus in the uterus. This actually increases until the age of 18 months, and then the legs straighten as the child grows.

Treatment of physiological bowed legs –

Physiological bow legs corrects naturally so special shoes, braces or exercises are not recommended. If parents are concerned about the shape of the child’s leg, then it may be helpful to take photographs every six months. Photographs should be taken with the child standing with knees facing forwards.

When to visit Paediatric Orthopaedic Surgeon (Red flag signs) –

• Your child’s bowed legs are severe

• Bowed legs persist after age three

• Only one leg is affected

• Your child has pain or a limp

• Your child is unusually short for their age

Paediatric Orthopaedic Surgeon examination –

The examination begins with a brief history of the child’s development, nutrition habits and any family history of skeletal dysplasia. The doctor will observe the child’s walking pattern, look for any lateral thrust at the knee. Then will evaluate the ligamentous laxity and torsional profile of the limb. Many times, especially in younger toddlers, a thorough physical exam is all that is needed. In some cases, with red flag signs, a radiograph and blood test are recommended.

Conclusion –

Bowed legs in a child less than 18 months is normal and usually straighten by 24 months. Any bowed legs after three years are pathological, which needs evaluation and treatment.

Know more –

http://orthokids.org/Condition/Bowed-Legs-Knock-Knees

https://www.rch.org.au/uploadedFiles/Main/Content/ortho/factsheets/BOWLEGS.pdf

https://kidshealth.org/en/parents/bow-legs.html

https://www.ucsfbenioffchildrens.org/conditions/bow_legs_and_knock_knees/

https://www.columbiadoctors.org/condition/bowlegs-knock-knees-pediatric

Backpacks are a practical and popular way for children and adolescents to carry school books and supplies.  If backpacks are used correctly, can be a good way to carry the necessities of the school days. And backpacks are designed to distribute the weight of the load among some of the body’s strongest muscles. However, when backpacks are too heavy or worn incorrectly can cause problems for children and teenagers.

Problems backpacks can pose –

When a heavy backpack is placed on the shoulder, the weight forces can pull a child backward. To compensate, that child will bend forward at the hips or arches the back. This compresses the spine unnaturally, leading pain at the shoulder, neck, and back.

Pack with narrow tight straps digs into the shoulder and can interfere with circulation and compress the nerve. These can lead to tingling, numbness, weakness in the arms and hands.

And also, the bulky or heavy backpack can hit others while turning around; children can trip over, pack falls on them and increases the risk of falling due to off-balance.

Finding a safe backpack –

• The most important thing to consider is an appropriate size backpack. An ideal backpack should not be wider than the child’s torso and should not hang more than 2 inches below the waist.
• Lightweight backpack – Pack should not add much weight to the load so avoid leather pack.
• Use pack with two wide, padded shoulder straps, which help to distribute the weight on children back without digging into shoulder.
• Use a backpack with padded back. It provides increased comfort and also protects kids from being poked by a sharp object or edges {pencils, rulers, notebooks, etc.} inside the pack.
• Use backpacks with multiple compartment and compressive straps, which help to distribute the weight throughout the pack.
• Use backpacks with waist straps, which help distribute the weight of the pack more evenly across the children’s back and also holds the pack close to the body.

Safe and sensible usage of the backpack –

• Pack light – Backpack should not weigh more than 10 to 15 percent of the child’s body weight.
• Make sure children use both shoulder straps when carrying the pack and use the waist strap. Adjust straps to fit snugly.
• Encourage children to bring only necessary books and material.
• Organize the pack, put the heaviest items low and near the center of the back.
• Do not bend over at the waist when wearing or lifting a heavy pack, instead bend using both knees.
• At last and most important, learn back strengthening exercises to build up the muscles used to carry a pack.

References

https://www.nsc.org/home-safety/safety-topics/child-safety/backpacks https://orthoinfo.aaos.org/en/staying-healthy/backpack-safety/ https://www.safety.com/backpack-safety https://kidshealth.org/en/parents/backpack.html?WT.ac=ctg

Introduction –

Wrapping or swaddling a newborn can help the baby to feel more secure and comfortable. This may assist the baby to settle and establish regular sleep patterns. However, improper wrapping or swaddling baby tightly with legs straight can hinder the normal growth and development of the child’s hips.  So improper wrapping or swaddling can result in DDH.

Van Sleuwen BE, et al, in a systematic review of swaddling noted that developmental dysplasia of the hip is more prevalent when the legs are bound so they are not free to move. Similarly, Yamamuro et al noted a decrease in the incidence of DDH from 1.5-3.5% to 0.2%, following the implementation of the national programs to eliminate swaddling with hips and knees in an extended position.

In contrast, cultures that carry their children in the straddle or jokey position, have very low rates of hip dislocation compared to cultures that wrap their children tightly with the legs together and extended.

In the mother’s womb, babies generally lie with their hips in an outward position. This position helps the hip joint to develop normally. In some babies, the ligaments around the hip joint are loose, which in most gets corrected during the first few months of life. So, incorrect swaddling or wrapping can have an effect on the growing hip joint and cause the hip to become unstable and dislocate.

That’s why all parents and caregivers need to know how to wrap a baby correctly to minimize the chance of hip dysplasia. So, safe wrapping or swaddling is most important during the first three months of life.

Safe wrapping or swaddling –

Any safe wrapping or swaddling methods like diamond method, square method or using a pouch can be followed. But it is recommended to leave enough rooms for legs to move freely.

International Hip Dysplasia Institute and POSNA, has issued the following statement. “It is the recommendation that the infant hips should be positioned in slight flexion and abduction during swaddling. The knees should also be maintained in slight flexion. Additional free movement in the direction of hip flexion and abduction may have some benefit. Avoidance of forced or sustained passive hip extension and adduction in the first few months of life is essential for proper hip development.”

To conclude, when wrapping or swaddling, “Always remember to leave the baby’s legs free to move”.

Know more –

http://bengalurukidsortho.in/health-info/developmental-dysplasia-of-hip/

https://www.rch.org.au/uploadedFiles/Main/Content/kidsinfo/safe-wrapping-for-hip-dysplasia.pdf

https://www.aaos.org/uploadedFiles/PreProduction/About/Opinion_Statements/position/1186%20Swaddling%20and%20Developmental%20Hip%20Dysplasia(1).pdf

Pulled elbow is a common injury in children under the age of five.  Pulled elbow is usually caused by a sudden pull on the child’s forearm or wrist like lifting the child up by one arm. It can also happen when a child falls. Pulled elbow also called nursemaid’s elbow. It is unusual for children over five years old to get a pulled elbow, as their joints are a lot stronger.

Pathoanatomy –

There is strong, flexible band called annular ligament normally holds the radius head in place, but with fall or sudden pull, this ligament can be overstretched and bone partially slips out from underneath the ligament.

Clinical features –

In most cases, children with pulled elbow will cry immediately after the sudden pull, and after that child won’t use the injured limb. Affected arm hang will lay by the side.

An X-ray is not necessary for the diagnosis, clear history and observation of the child is needed to make the diagnosis.

Treatment –

Pulled elbow will be reduced on manipulation by your Paediatric Orthopaedic Surgeon. This procedure is painful, but it lasts only for a short moment and radial head popping back into the normal place will be felt. With successful reduction, analgesia is rarely needed. Just observe the child for short period after the manipulation, to see return to the normal activities in the affected limb. If your child is not moving the arm fully by the next day, take them back to the doctor so that their arm can be evaluated again.

Prognosis and counselling –

A pulled elbow usually will not cause any long-term damage to your child if treated promptly and appropriately.

However some children are more prone, for instance in children who have particularly loose joints.

Prevention is better than cure, so make sure you don’t pick your child up by the forearms or wrists and lift them up using their armpits instead. Teach others who care for your child, such as grandparents and child care workers, the correct way to pick up your child.

References-

• https://www.rch.org.au/kidsinfo/fact_sheets/pulled_elbow/
• https://orthoinfo.aaos.org/en/diseases–conditions/nursemaids-elbow