Pediatric orthopedics is dedicated to treating musculoskeletal problems in children (problems that affect bones, muscles and joints). A pediatric orthopedist is a doctor who specializes in treating orthopedic issues in children, ranging from newborns to adolescents. Children’s bodies are constantly growing, which makes their joint, muscle and bone makeup very different from those of adults. Your child’s pediatrician can refer to a pediatric orthopedist, if the child ever faces a musculoskeletal issue.

Common musculoskeletal problems in children

Pediatric orthopedic surgeons diagnose, treat, and manage the full range of musculoskeletal problems in children, including but not limited to:

1. Limb and spine deformities: Children may suffer from musculoskeletal problems originating at birth or developing later in life.

• Clubfoot is a congenital foot abnormality (present at birth), in which the baby's foot is twisted out of shape or position. Depending on the condition, doctors treat clubfoot without surgery, or at times, a therapy followed up with a surgery.
• Scoliosis is a curvature of the spine that affects mostly adolescents. Most cases of scoliosis are mild, but some curves worsen as children grow. Children who have mild scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In more severe cases, children need to wear a brace to stop the curve from worsening. Others may need surgery to straighten severe curves.

2. Gait abnormalities:

• The most common types of gait abnormalities in children are in-toeing and out-toeing. Intoeing is walking with the feet turned inward. Out toeing is walking with the feet turned outward.
• Other common issues are bowlegs (outward curve of the legs at the knees) and knock knees (inward curve of the legs at the knees). Both are common stages of development and usually self-correct as a child grows.

3. Fractures: Fractures fall into several categories with different treatments required for different kinds of fractures and the site of fracture. A simple break may be treated with a sling, ice and rest, but a complicated break might require surgery to realign the broken bone and to implant wires, plates, nails or screws to maintain proper alignment during healing.

4. Sprains and strains: Children who play contact sports are more susceptible to sprains and strains as compared to other children. A majority of sports injuries are caused by minor trauma involving muscles, ligaments, and/or tendons, including contusions (bruises), sprains and strains.

5. Bone, joint and muscle infections: Children can develop infections in their bones (osteomyelitis), joints (septic arthritis), muscles (pyomyositis) and abscess (isolated pockets of infection with pus). Your child’s orthopedic surgeon or doctor may advise the use of antibiotics to resolve mild infections. Serious infections will need surgery to remove infected material (pus) from the area of infection.

Complex musculoskeletal issues

Pediatric orthopedic surgeons may work with doctors from other specialties as part of a medical-surgical team to treat complicated conditions such as:

Cerebral palsy: Cerebral palsy (CP) is a disorder that affects a child's ability to control their muscles. It is caused by damage or abnormalities in the parts of the brain that are involved with movement and coordination. Early treatment, such as physical therapy, medication, braces, and other assistive devices, can significantly help children improve their functional capabilities.

Juvenile arthritis: Joint pain in children can be caused by a variety of things. However, if a child's joints are swollen for 6 weeks in a row or longer, they may have juvenile arthritis which is a long-lasting, chronic disease.

Muscular dystrophy: Muscular dystrophy (MD) is a rare disease that causes muscles to weaken and deteriorate. MD is a progressive disease, meaning that it worsens over time. Although there is currently no cure for MD, there are medications that may slow the rate of muscle degeneration, as well as other treatment options to improve function and assist in activities of daily living.

Symptoms

Most orthopedic issues have distinct symptoms, and some of the most common symptoms of a musculoskeletal injury/condition are:

• Weakness
• Aching and stiffness
• Burning sensations in the muscles
• Fatigue
• Muscle twitches
• Pain that worsens with movement
• Decreased range of motion
• Sleep disturbances

Additionally, inflammation can result from many different musculoskeletal disorders, such as autoimmune disorders (for example, arthritis) and infections.

Diagnosing a musculoskeletal condition

If you visit a pediatric orthopedic doctor, your child may have to undergo a medical evaluation. Parents are expected to provide details on the type and duration of any symptoms. A pediatric orthopedic surgeon will likely review information about the child’s birth, development, medical history and family medical history. A physical examination will also be carried out to help diagnose the problem. The physical examination is an important diagnostic tool, apart from which a doctor may need to use:

• Various types of imaging tests can help doctors diagnose musculoskeletal disorders like X-ray, CT scan, MRI scan, or an ultrasound.
• Laboratory tests are often helpful in making the diagnosis of a musculoskeletal disorder. Blood may be drawn for laboratory tests like erythrocyte sedimentation rate (ESR), which is a test that indicates the presence of inflammation.

Treatments

Many musculoskeletal issues can be treated without any surgery. When surgery is necessary, a pediatric surgeon uses his specialized training with implants and techniques to treat the child’s growing body, such as guided growth for limb length differences or deformities. Medical treatment of some disorders consists of drug therapy such as painkillers or anti-inflammatory medications.

Additionally, physiotherapy treatments can reduce pain and decrease the healing time in some musculoskeletal injuries, so that the child can recover and return to normal function. Due to the varying nature of musculoskeletal problems, there are many different treatments that can be considered for your child. The appropriate treatment for each child depends on the nature of their condition, their age and other relevant factors.

Preventing musculoskeletal issues

Musculoskeletal injuries and disorders have different causes and risk factors. Although, some chronic or congenital issues such as cerebral palsy may not be preventable, most injuries and other issues can be avoided with proper care for good musculoskeletal health, like:

Good diet: A diet rich in calcium helps build bone mass, and appropriate levels of vitamins D and C allow the body to absorb calcium and create strong connective tissue.

Avoid obesity: Overweight children have a harder time getting adequate physical exercise that is needed to build bone mass. Since growth plates are made of cartilage or tissue, they easily can be damaged or deformed by excess body weight if the child is obese.

Develop an active lifestyle early on: Make physical activity a part of a child's schedule for at least 30 to 60 minutes per day, and reinforce the message that exercise is fun. Choose games and gifts that involve activity.

Minimize risk of sports injuries: Children who play on more than one sports team are at increased risk for overuse injuries. A well-balanced fitness program includes a wide variety of activities and sports, using different muscles.

Warm up: Make sure children take the time to warm up before exercising. Research studies have shown that cold muscles are more prone to injury.

At Dr. Soliman Fakeeh Hospital, Jeddah, we provide quality care for conditions that affect the muscles, tendons, joints and bones of children and adolescents. The hospital has a dedicated team of surgeons, anesthesiologists, nurses, physiotherapists, and other medical professionals who use modern methods, research and technology to deliver world-class care that is tailored to fit your child’s needs.