Topic 12: Pediatric

Transverse deficiency

• no skeletal elements below level of normal development

• resemble an amputation residual limb in which the limb has developed normally to a particular level beyond which no skeletal elements are present

Longitudinal deficiency

• reduction or absence of elements is present within the long axis with normal skeletal elements distal to affected bone

5 Stages of Child Development

• Newborn (0-3 months)

• Infant (3-12 months)

• Toddler (1-3 years)

• Preschool age (3-4 years)

• School age (4-5 years)

Staging of pediatric prostheses is based on a _ rather than _ alone

Staging of pediatric prostheses is based on a child’s developmental abilities rather than age alone

• Limb deficiency affects how a child performs motor skills, not when those skills emerge, and the sequence of development remains predictable.

• Gross motor milestones are therefore used to guide prosthetic treatment planning.

• When staging a prosthesis, the prosthetist considers developmental level, amputation level and etiology, activity and participation goals, and cosmetic needs.

• For children receiving a first prosthesis, readiness is determined by functional skills such as pulling to stand, cruising along furniture, standing with support, walking behind a push toy, or taking independent steps.

Age-Appropriate Communication and Appointment Considerations

• Avoid white coats

• Get on their level

• Be honest

• Use simple language. Use affirmative terms and avoid negative terms.

• Allow child to control some choices

• Appointment time

Pediatric Feet & Components

• 10cm – 22cm

• SACH to Dynamic Response

• Pylon = 22mm

• Requires pediatric adapters: tube clamps, pyramids, etc.

• Watch weight limit of components

Pediatrics Growth - Plan Ahead

• Longitudinal Growth is faster than circumferential growth

• Plan Ahead

  • Socket liners

  • Begin with socks and remove with growth

  • Flexible inner with frame

  • Distal end pads

How often do peds need now prosthesis (normally)

• Preschool age: at least 12 months

• Grade school age:12 – 18 months

• Teenage:18 – 24 months

Osseous Overgrowth

• Terminal bone spikes can cause pain, skin breakdown and difficulty wearing a prosthesis.

Osseous Overgrowth Etiology

• Appositional growth at the cut bone end, rather than physeal growth. Exact pathogenesis remains uncertain.

Revision Peds Rates Incidence

• by level

  • 50% Metaphyseal

  • 45% Diaphyseal

  • 0% Disarticulation

• by amputation cause

  • Traumatic 43%

  • congenital / intrauterine 30%

  • elective 20%

Other Peds Considerations

• Parental and Family Adjustment

• Grief, Loss, and Coping

• Marital Adjustment

• Psychological Adjustment