Frequent fractures in children, what tests to take. Features of various types of fractures in children: associated symptoms, diagnosis and treatment, causes of frequent bone injuries
Children rarely have bone fractures, despite frequent falls during outdoor games; however, in addition to the usual fractures observed in adults, some types of fractures appear that are characteristic only of childhood, which is explained by the peculiarities of the anatomical structure of the skeletal system and its physiological properties in children.Typical fractures
Bone fractures in children - diagnosis
metaphysis of the tubular bone
General principles of treatment
See also Fracture
ICD
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Young children often fall during outdoor games. In this case, you have to deal with various injuries (cuts and bruises). Fractures in young patients are diagnosed much less frequently. This is due to the low weight of the body, and therefore the insignificant impact force when falling. In addition, the bones of babies are more flexible than those of adults. At the same time, children may be diagnosed with fractures that are characteristic only of a younger age.
The most common injuries in young patients are injuries to the arms and legs. At the same time, about 5% are injuries to the hands and fingers. Most often, such injuries occur in children who are just beginning to take their first steps. Damage to the upper limbs can be caused by a bad fall.
A child may get a fracture during active play
Injuries in children of the first year of life are quite rare. If a child who does not yet walk or even sit is often diagnosed with fractures, it is possible that he had to deal with congenital osteoporosis.
Some babies may be diagnosed with birth injuries. Most often you have to deal with a fractured collarbone in a newborn due to the mother’s narrow pelvis. Malpresentation of the fetus is also a risk factor. Therefore, monitoring the woman and the condition of the baby in the last stages of pregnancy plays a very important role.
Children have a special bone structure. In this regard, in a child who is fully developing and does not have chronic diseases, the likelihood of getting a fracture is minimized. Even if a young patient is diagnosed with an injury, the rehabilitation period is much faster than for an adult. Often in children of the first years of life, fractures of the bone outgrowths to which the muscles are attached are detected. These are tears of ligaments and muscles with bone elements.
Clavicle fracture is a common injury in newborns.
A fracture in children of the younger and middle group often occurs in the growth zone of bone tissue, located in close proximity to the joints. Such injuries are fraught with premature closure of the growth zone and subsequent bone deformation. At the same time, in most patients, self-correction of residual bone displacements resulting from the fracture occurs. The reason is the continued development of the bone apparatus. However, in some cases, self-correction does not occur, and the question of surgical intervention arises.
Types of fractures in young patients
Depending on the structure and strength of the patient’s bone, the following forms of fractures are distinguished:
- Traumatic. Damage develops due to strong mechanical impact on the bone (fall, blow).
- Pathological. Such fractures can develop even with weak physical impact and are a consequence of a certain disease.
Based on the condition of the epidermis, fractures in children can be:
- closed (the integrity of the epidermis is not compromised);
- open (elements of the damaged bone violate the integrity of the skin).
Closed fractures are not infected. Open fractures have primary microbial contamination. Therefore, first aid for different types of injury differs significantly.
The fracture can be closed or open
Depending on the type of separation of individual bone elements, fractures with and without displacement are distinguished. For young and middle-aged children, subperiosteal “green stick” fractures are most common. The peculiarity is that the damaged area does not lose the integrity of the periosteum. In most cases there is no displacement. This injury often develops in the lower leg or forearm.
Depending on the direction of the fracture line, the following types of injury are distinguished:
- star-shaped;
- transverse;
- longitudinal;
- oblique;
- helical;
- V-shaped;
- T-shaped.
Types of fractures according to location - table
Causes of injuries in children
The main reason for violating the integrity of bone tissue is a strong mechanical impact - impact. However, the same fall can cause different injuries in children. One child will get away with a bruise, and the other will spend a good amount of time healing a fracture. The main risk factors that contribute to a decrease in bone strength include:
- Calcium deficiency. This substance is the main building material for bone. Therefore, children need to consume more foods containing calcium (milk, kefir, cottage cheese, meat, etc.).
- Sedentary lifestyle. To keep bones strong, a child must be physically active.
- Hormonal disorders. In this regard, the largest number of fractures is observed in children who have entered puberty.
Refusal of fermented milk products is one of the reasons for frequent fractures
Some chronic diseases can also interfere with the normal absorption of calcium. It is necessary to consult a pediatrician if your child’s hair begins to grow dull and fall out, caries develops rapidly, and the back gets tired quickly.
How to recognize a fracture
It is not difficult to suspect a fracture in a child. Immediately after the injury, the baby feels sharp pain and cries. The site of injury rapidly swells and acquires a bluish tint. A characteristic sign of a limb fracture is its deformation. In addition, the child may become pale, sticky sweat appears, and body temperature rises to low-grade levels.
Nonspecific symptoms may occur with greenstick fractures. The child can maintain physical activity and there will be virtually no pain. Often, it is possible to determine the presence of a fracture only with the help of hardware diagnostics in a hospital.
Sharp pain when falling is one of the signs of a fracture
With serious damage to the bones of the skull and spine, other symptoms may additionally be present. You should immediately call an ambulance if:
- the child lost consciousness, even briefly;
- body temperature rose rapidly;
- the patient is vomiting;
- the child behaves strangely (sleepy, refuses to eat, pale);
- neurological disorders appeared (the patient cannot walk smoothly, sees and speaks poorly).
The sooner an injury is detected, the less chance of serious complications developing.
Diagnostics
To determine the type of injury and location of the fracture, a specialist can use the following techniques:
- Interview with the patient or his parents. It is important to find out under what circumstances the fracture occurred and whether the patient often encounters injuries of this kind.
- Examination of the patient. The doctor can guess the location and type of fracture by visually examining the damaged area. For injuries to the spine and skull, the specialist checks the patient’s reflexes and skin sensitivity.
- Radiography. The procedure makes it possible to make a final diagnosis. Using the technique, the location and shape of the fracture is determined.
X-rays help doctors accurately diagnose
In case of dangerous injuries, when the patient is unconscious, differential diagnosis is carried out with consultation of related specialists (neurosurgeon, vascular surgeon).
Treatment
If a fracture is detected in a child, it is strictly forbidden to self-medicate. Therapy should only be prescribed by a qualified specialist. At the same time, parents should know how to provide assistance to the victim before the ambulance arrives. The algorithm of actions should be as follows:
- Immobilize the damaged area using a splint. Any hard means at hand will do - a ruler, a board, a stick. As a last resort, you can roll up a magazine. If the tire turns out to be quite rough, wrap it in a bandage or towel before applying it. If a rib is fractured, a pressure bandage is applied.
- It is necessary to ensure that the splint is applied above and below the fracture joints.
- The splint should be carefully secured using a bandage. The bandage should not be too tight.
- To relieve pain, the child can be given a drug based on ibuprofen or paracetamol.
In case of an open fracture, before immobilizing the damaged area, it is necessary to treat it with an antiseptic and stop the bleeding. It is advisable to carefully remove clothing from the area of injury (it is better to cut it off).
In case of an open fracture, the doctor must clarify whether the patient has previously been vaccinated against tetanus.
If the skull bones are damaged, the child should be in a horizontal position. The maximum that can be done before the ambulance arrives is to apply ice to the damaged area. No further actions should be performed.
If a spinal fracture is suspected, the child’s entire body must be immobilized. An ambulance should be called immediately. Under no circumstances should you transport the victim yourself! Any actions can aggravate the situation. First aid should not include taking medications (with the exception of painkillers described above).
Conservative treatment
For simple fractures, treatment is carried out at home. Hospitalization is required only for complex bone injuries (if it is necessary to compare the fragments) or in cases where surgical intervention is indicated.
A pediatric traumatologist can prescribe the correct treatment
Simple fractures without displacement or splinters are treated with a plaster cast or splint (the plaster covers only part of the limb). The child will have to visit a traumatologist once a week. An indicator that the bandage is applied correctly is the subsidence of pain and the preservation of sensitivity in the fingers.
For simple fractures of the spine, pelvic bones or ribs, a bandage may be applied or a bandage may be used. The doctor secures the damaged area to prevent mobility of the bone elements. In case of a jaw fracture, fixation is performed using special dental splints.
If the bones of the skull are fractured, the patient is prescribed bed rest. In the most difficult cases, surgery is performed.
With displaced fractures, it can be difficult to fix the necessary position of the damaged bone. In this case, the skeletal traction technique is used. Reduction of fragments is performed using weights. The damaged area is held in the correct position until a callus forms.
It is possible to speed up the process of restoring the integrity of bone tissue with the help of medications. Therapy may include the following groups of drugs:
- Painkillers. Children may be prescribed medications Nurofen, Ibuprofen, Paracetamol, Panadol.
- Medicines that accelerate the process of building cartilage tissue. The patient may be prescribed Chondroitin sulfate.
- Vitamin complexes. It is worth paying attention to drugs that contain calcium. Pediatric traumatologists often prescribe Complivit.
No medications should be given to a child without a prescription from a specialist.
Medicines for fractures in children - gallery
Complex fractures often require surgery
For unstable fractures, plates and pins can be installed to more securely fix the bone elements. Titanium products are most often used. The advantage of the material is that it can remain in the human body for more than 20 years without interfering with the functionality of organs and systems. Each area of the child’s skeleton uses its own method of installing plates or wires.
Features of the rehabilitation period
The length of time it takes for bone to recover may depend on the type and location of the fracture. In preschool-age patients, the rehabilitation process is faster. Damage to the arms and legs heals within 1–2 months. For the pelvic bones, rehabilitation is longer (up to 3 months). With compression fractures of the spine, complete recovery may occur only after several years.
Exercise therapy is an effective method of rehabilitation after a fracture
Active restorative procedures are prescribed to a small patient after the fixing bandage (plaster or bandage) is removed. It is important to develop the muscles in the damaged area and normalize the functioning of the joints. If a limb is injured, it is necessary to restore its supporting ability. Good results can be achieved with the help of physical therapy. A set of exercises is developed by the doctor in each specific case.
Physiotherapeutic procedures also help speed up the rehabilitation process:
- UHF. The procedure allows you to get rid of pain and swelling in a short time.
- Magnetotherapy. The procedure is carried out by exposing the damaged area to a constant magnetic field. The technique accelerates tissue restoration.
Good results can also be achieved with the help of therapeutic massage.
Video - gymnastics after compression fractures
Proper nutrition during the recovery period is of great importance. In order for a child’s bones to heal faster, the diet must contain sufficient amounts of calcium, protein and vitamins. D. It is recommended to drink a glass of kefir daily and eat 150 g of cottage cheese.
Calcium is also found in large quantities in some plant foods, such as:
- sesame seeds;
- parsley leaves;
- cabbage;
- flax seeds.
To ensure that calcium is well absorbed, it is recommended to consume daily foods high in vitamin D (fatty fish, cod liver). One of the building materials of bone is protein. A child will be able to recover faster if his diet includes eggs, low-fat cheese, and poultry.
Proper nutrition will reduce the risk of fractures
If the affected child is breastfed, the foods described above should be included in the mother's diet.
During the rehabilitation period, to accelerate bone fusion and relieve pain attacks, you can resort to traditional medicine recipes. However, the possibility of their use should be discussed with your doctor. Mumiyo shows good results. It is necessary to consume 200 mg of the product 3 times a day.
In ancient times, boiled onions were consumed in unlimited quantities to speed up bone healing.
It will be possible to restore bone functionality faster and increase the body's defenses if you use rosehip decoction. Pour a tablespoon of fruit into two glasses of boiling water and cook over low heat for 15 minutes. Then the product should be infused in a dark place for 24 hours. It is recommended to give children 50 g of medication 2 times a day.
Treatment prognosis and prevention
For simple fractures without displacement, the prognosis of therapy is usually favorable. Children's bones heal quickly and their function is restored. The rehabilitation period in most cases does not exceed 3 months.
Displaced bone injuries require longer rehabilitation. It is often necessary to perform multiple surgeries to restore normal functionality to the injured area. The following complications are possible:
- injuries to nerves, ligaments and tendons;
- addition of a bacterial infection;
- improper fusion of bone, which leads to disruption of its functionality.
In most cases, if qualified assistance is provided in a timely manner, the child’s health condition is completely restored. However, unpleasant consequences of fractures are also possible. The most common complication is premature closure of the growth plate, resulting in deformed bone.
It is not always possible to protect a child from falls and injuries. But you can significantly reduce the likelihood of fractures if you monitor your baby’s diet. Food should be healthy and varied.
Physical activity is also of great importance. The child should regularly spend time in the fresh air and experience moderate physical activity.
Video: how to properly help a child return to an active life after a fracture
A fracture is a dangerous pathology. But proper first aid and qualified therapy will help the child recover faster in the future.
The main reason for violating the integrity of bone tissue is a strong mechanical impact - impact. However, the same fall can cause different injuries in children. One child will get away with a bruise, and the other will spend a good amount of time healing a fracture. The main risk factors that contribute to a decrease in bone strength include:
- Calcium deficiency. This substance is the main building material for bone. Therefore, children need to consume more foods containing calcium (milk, kefir, cottage cheese, meat, etc.).
- Sedentary lifestyle. To keep bones strong, a child must be physically active.
- Hormonal disorders. In this regard, the largest number of fractures is observed in children who have entered puberty.
Some chronic diseases can also interfere with the normal absorption of calcium. It is necessary to consult a pediatrician if your child’s hair begins to grow dull and fall out, caries develops rapidly, and the back gets tired quickly.
Injuries in children differ from those in adults. For a child, a “green stick” bone injury is typical, in which the fragments are held in place by strong periosteum that has maintained its integrity.
Damage to the joints in children is fraught with damage to the cartilage of the growth zone, and therefore the lengthening of the limb after injury may stop. In general, healing occurs faster in a child than in an adult.
This process is accompanied by the migration of cells into the pathological focus, forming a section of new bone tissue (callus) at the site of a post-traumatic hematoma. In addition, when localized in the area of the cartilaginous growth zone, necrosis of the bone tissue of the epiphysis develops in children (traumatic epiphysiolysis).
Skull fractures are most often the result of a fall from a height or a traffic accident. Both the arch and the base may be involved in the pathological process.
Clinical picture
The clinical picture of a fracture is characterized by the following signs:
A skull fracture is characterized by the following symptoms:
Doctor Komarovsky about fractures in children - video
Types of fractures depending on location
Fractures in a child are usually very different from fractures in young and old people. If the baby falls or hits himself, the following types of fractures are most often observed:
- Subperiosteal fracture;
- Epiphysiolysis;
- Osteoepiphysiolysis;
- Apophysiolysis;
- Fracture of the periosteum.
Depending on the structure and strength of the patient’s bone, the following forms of fractures are distinguished:
- Traumatic. Damage develops due to strong mechanical impact on the bone (fall, blow).
- Pathological. Such fractures can develop even with weak physical impact and are a consequence of a certain disease.
Based on the condition of the epidermis, fractures in children can be:
- closed (the integrity of the epidermis is not compromised);
- open (elements of the damaged bone violate the integrity of the skin).
Closed fractures are not infected. Open fractures have primary microbial contamination. Therefore, first aid for different types of injury differs significantly.
Depending on the type of separation of individual bone elements, fractures with and without displacement are distinguished. For young and middle-aged children, subperiosteal “green stick” fractures are most common. The peculiarity is that the damaged area does not lose the integrity of the periosteum. In most cases there is no displacement. This injury often develops in the lower leg or forearm.
Depending on the direction of the fracture line, the following types of injury are distinguished:
- star-shaped;
- transverse;
- longitudinal;
- oblique;
- helical;
- V-shaped;
- T-shaped.
Types of fractures according to location - table
According to the nature of the injury in children, fractures of the vertebral bodies are distinguished (compression, crushed, splintered), isolated fractures of the arches; transverse, spinous and articular processes of the vertebrae.
Causes of injuries in children
The most common injuries in young patients are injuries to the arms and legs. At the same time, about 5% are injuries to the hands and fingers. Most often, such injuries occur in children who are just beginning to take their first steps. Damage to the upper limbs can be caused by a bad fall.
Injuries in children of the first year of life are quite rare. If a child who does not yet walk or even sit is often diagnosed with fractures, it is possible that he had to deal with congenital osteoporosis.
Some babies may be diagnosed with birth injuries. Most often you have to deal with a fractured collarbone in a newborn due to the mother’s narrow pelvis. Malpresentation of the fetus is also a risk factor. Therefore, monitoring the woman and the condition of the baby in the last stages of pregnancy plays a very important role.
Children have a special bone structure. In this regard, in a child who is fully developing and does not have chronic diseases, the likelihood of getting a fracture is minimized.
Even if a young patient is diagnosed with an injury, the rehabilitation period is much faster than for an adult. Often in children of the first years of life, fractures of the bone outgrowths to which the muscles are attached are detected.
These are tears of ligaments and muscles with bone elements.
Treatment of fractures in children is complex and is carried out under the guidance of a pediatric traumatologist with the possible involvement of a neurologist and neurosurgeon. Uncomplicated cases are subject to treatment on an outpatient basis; if complications develop, hospitalization in a specialized hospital department is required.
First aid
If a child is injured, it is necessary to quickly and competently provide him with first aid. The following procedure must be followed:
Common mistakes when providing first aid
Children rarely have bone fractures, despite frequent falls during outdoor games; however, in addition to the usual fractures observed in adults, some types of fractures appear that are characteristic only of childhood, which is explained by the peculiarities of the anatomical structure of the skeletal system and its physiological properties in children.
Typical fractures
metaphysis of the tubular bone
General principles of treatment
See also Fracture
Such fractures are a consequence of obstetric care for foot or pelvic presentation of the fetus. Typical localization is in the middle third of the diaphysis of the tubular bone; along the plane, the fracture runs in a transverse or oblique direction.
Traumatic epiphysiolysis of the proximal and distal ends of the humerus and femur are rare. This circumstance, as well as the fact that X-ray diagnostics are difficult due to the absence of ossification nuclei, often lead to untimely diagnosis of these injuries.
In diaphyseal fractures of the humerus and femur with complete displacement of bone fragments, pathological mobility at the level of the fracture, deformation, traumatic swelling and crepitus are noted. Any manipulation causes pain to the child.
Fractures of the femur are characterized by a number of features: the leg is in the typical position of flexion in the knee and hip joints for a newborn and is brought to the abdomen due to physiological hypertension of the flexor muscles.
Radiography clarifies the diagnosis.
.
There are several treatment options for newborns with diaphyseal fractures of the humerus and femur.
In case of a fracture of the humerus, the limb is immobilized for a period of 10-14 days. The arm is fixed with a plaster splint from the edge of the healthy scapula to the hand in the average physiological position or with a cardboard U-shaped splint in the position of shoulder abduction to 90°.
How to recognize a fracture
It is not difficult to suspect a fracture in a child. Immediately after the injury, the baby feels sharp pain and cries. The site of injury rapidly swells and acquires a bluish tint. A characteristic sign of a limb fracture is its deformation. In addition, the child may become pale, sticky sweat appears, and body temperature rises to low-grade levels.
Nonspecific symptoms may occur with greenstick fractures. The child can maintain physical activity and there will be virtually no pain. Often, it is possible to determine the presence of a fracture only with the help of hardware diagnostics in a hospital.
Symptoms
Diagnostic methods
To establish a correct diagnosis, the following methods are used:
Differential diagnosis is carried out with the following diseases:
Treatment
If a fracture is detected in a child, it is strictly forbidden to self-medicate. Therapy should only be prescribed by a qualified specialist. At the same time, parents should know how to provide assistance to the victim before the ambulance arrives. The algorithm of actions should be as follows:
- Immobilize the damaged area using a splint. Any hard means at hand will do - a ruler, a board, a stick. As a last resort, you can roll up a magazine. If the tire turns out to be quite rough, wrap it in a bandage or towel before applying it. If a rib is fractured, a pressure bandage is applied.
- It is necessary to ensure that the splint is applied above and below the fracture joints.
- The splint should be carefully secured using a bandage. The bandage should not be too tight.
- To relieve pain, the child can be given a drug based on ibuprofen or paracetamol.
In case of an open fracture, before immobilizing the damaged area, it is necessary to treat it with an antiseptic and stop the bleeding. It is advisable to carefully remove clothing from the area of injury (it is better to cut it off).
In case of an open fracture, the doctor must clarify whether the patient has previously been vaccinated against tetanus.
For simple fractures without displacement, the prognosis of therapy is usually favorable. Children's bones heal quickly and their function is restored. The rehabilitation period in most cases does not exceed 3 months.
Displaced bone injuries require longer rehabilitation. It is often necessary to perform multiple surgeries to restore normal functionality to the injured area. The following complications are possible:
- injuries to nerves, ligaments and tendons;
- addition of a bacterial infection;
- improper fusion of bone, which leads to disruption of its functionality.
In most cases, if qualified assistance is provided in a timely manner, the child’s health condition is completely restored. However, unpleasant consequences of fractures are also possible. The most common complication is premature closure of the growth plate, resulting in deformed bone.
It is not always possible to protect a child from falls and injuries. But you can significantly reduce the likelihood of fractures if you monitor your baby’s diet. Food should be healthy and varied.
Physical activity is also of great importance. The child should regularly spend time in the fresh air and experience moderate physical activity.
Complications
The prognosis for treatment of fractures in children largely depends on the nature of the injury. Multiple injuries, crushed bones with complete loss of some areas complicate the situation. In severe cases, the following complications may develop:
- systemic reaction of the body to damage - traumatic shock;
- the body's systemic reaction to blood loss is hemorrhagic shock;
- wound suppuration;
- post-traumatic purulent inflammation of the bone - osteomyelitis;
- non-union of the fracture with the formation of pathological mobility of the bone area (false joint);
- formation of joint stiffness;
- limb deformity;
- shortening of the limb with the formation of lameness;
- death.
Prevention
It is necessary to explain to children the rules of safe behavior on the street, at home in child care institutions, and in transport. Young children require supervision.
There should be no dangerous objects that could cause injury in the room where the child is located. Small children must be transported in a car using a special restraint device.
Parents should feed their baby foods rich in calcium and phosphorus, as well as foods high in vitamins and minerals.
megan92 2 weeks ago
Tell me, how does anyone deal with joint pain? My knees hurt terribly ((I take painkillers, but I understand that I’m fighting the effect, not the cause... They don’t help at all!
Daria 2 weeks ago
I struggled with my painful joints for several years until I read this article by some Chinese doctor. And I forgot about “incurable” joints a long time ago. That's how things are
megan92 13 days ago
Daria 12 days ago
megan92, that’s what I wrote in my first comment) Well, I’ll duplicate it, it’s not difficult for me, catch it - link to professor's article.
Sonya 10 days ago
Isn't this a scam? Why do they sell on the Internet?
Yulek26 10 days ago
Sonya, what country do you live in?.. They sell it on the Internet because stores and pharmacies charge a brutal markup. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. And now everything is sold on the Internet - from clothes to TVs, furniture and cars
Editor's response 10 days ago
Sonya, hello. This drug for the treatment of joints is indeed not sold through the pharmacy chain in order to avoid inflated prices. Currently you can only order from Official website. Be healthy!
Sonya 10 days ago
I apologize, I didn’t notice the information about cash on delivery at first. Then, it's OK! Everything is fine - for sure, if payment is made upon receipt. Thanks a lot!!))
Margo 8 days ago
Has anyone tried traditional methods of treating joints? Grandma doesn’t trust pills, the poor thing has been suffering from pain for many years...
Andrey A week ago
No matter what folk remedies I tried, nothing helped, it only got worse...
Ekaterina A week ago
I tried drinking a decoction of bay leaves, it didn’t do any good, I just ruined my stomach!! I no longer believe in these folk methods - complete nonsense!!
Maria 5 days ago
I recently watched a program on Channel One, it was also about this Federal program to combat joint diseases talked. It is also headed by some famous Chinese professor. They say that they have found a way to permanently cure joints and back, and the state fully finances the treatment for each patient
Elena (rheumatologist) 6 days ago
Yes, indeed, a program is currently underway in which every resident of the Russian Federation and the CIS will be able to completely cure diseased joints. And yes, the program is personally supervised by Professor Park.
For the full development of a child’s body, a sufficient supply of not only vitamins, but also other minerals is necessary, the lack of which affects health. Increasingly, hypocalcemia is detected in children under one year of age, a lack of calcium in the body. Calcium for children under 1-1.5 years old is one of the important minerals, the norm of which should be supplied to the body daily. It is necessary for the health of bones, teeth, heart, as well as the general formation of the body.
Calcium helps in the absorption of many substances, including iron, and is also responsible for the functioning of the nervous system. Calcium, together with magnesium, ensures the functioning of the cardiovascular system, and in combination with phosphorus, it takes care of the formation of teeth and bones. In order for calcium to be absorbed, it is important that the body receives a sufficient amount of vitamin D. What is the best drug to choose? After the examination, the doctor will prescribe the necessary medications.
Importance of calcium for children
Already from birth, calcium plays a role in the formation of bones and teeth, and is responsible for processes such as the contraction of muscle fibers and the functioning of the nervous system. Calcium ions directly affect blood clotting and improve the functioning of the endocrine system. Sufficient calcium intake protects children from allergic reactions and also protects against inflammatory processes.
If a child does not receive enough calcium from birth, this can lead to the following problems:
- rickets;
- osteoporosis;
- deformation of the lower extremities (O- and X-shaped type);
- the edges of the crown may soften;
- the appearance of bumps on the crown and forehead;
- the back of the head may become flat and the skull may become asymmetrical;
- brittle and bad teeth;
- weak bones, which leads to frequent fractures.
This is not a complete list of calcium deficiency problems.
The occurrence of rickets is associated not only with a lack of calcium in the blood, but also with vitamin D and phosphorus, which help it to be absorbed. It is very important for a small, immature body to have all the necessary vitamins. Also, a lack of calcium in the body of children under 1-2 years of age leads to osteoporosis, which may not manifest itself for a long time, but when it becomes more severe, it provokes frequent bone fractures.
Causes of insufficient calcium intake in children's bodies
Normally, a child should receive 500-1000 mg of calcium every day. Since babies under 1-2 years of age most often feed on breast milk, the mother needs to eat properly and also take calcium gluconate (Calcium D3 Nycomed) and other vitamins to compensate for the deficiency during the feeding period. It is worth remembering: if the level of calcium in the blood of a nursing mother is underestimated, this has a detrimental effect on the child’s health.
There are cases when a sufficient amount of calcium enters the body, but it is not absorbed due to a lack of vitamin D. The right foods cannot completely compensate for the deficiency in children under 2 years of age, so doctors recommend, in addition to changing the diet, taking calcium gluconate preparations (Complivit, Calcium D3 Nycomed), which most often comes in addition to other vitamins. It is worth knowing that in the summer, vitamins are synthesized in sufficient quantities in the child’s body, including vitamin D, so at this time of year it is not worth taking additional vitamins, because Exceeding the norm can lead to hypervitaminosis. Vitamins whose norm is too high can cause colitis and other intestinal diseases in a child.
The child’s body should receive the daily calcium intake in the following dosage:
- 400-500 mg is the norm for ages from 0 to six months;
- 500-700 mg is the norm for ages from six months to a year.
- 700 mg and above should enter the body of a child from 1 year of age.
Unlike other vitamins, an excess amount of calcium in the blood does not affect the baby’s health in any way; up to 1-2 years of age, the excess is excreted through urine and feces. If we talk about excess calcium in the blood, which comes through drugs along with other microelements (Complivit, calcium D3 Nycomed), for example, vitamins B and D, then this can lead to salt deposits in the kidneys. You can find out about side effects of the drugs in the instructions for use.
Symptoms and signs of substance deficiency in a child
Determining the lack of calcium in the blood of a child under one year old is problematic, since he does not walk yet, and only a specialist can identify hypocalcemia. The main symptoms when the level of calcium gluconate in the blood is underestimated are as follows:
- when crying, you may notice a trembling of the chin;
- increased sweating in the back of the head;
- in the areas of the head where the child most often comes into contact with the pillow, hair abrasion is noticeable;
- Loud noises make the child flinch.
Also, a lack of calcium in the body of a child under 2 years old can be determined by cracked corners of the mouth, anemia, cramps and poor condition of nails. Products and vitamins in preparations (Calcium D3 Nycomed) help compensate for the lack of microelements in the body, after which the symptoms and signs gradually disappear and the child feels better.
Treatment of hypocalcemia
Since the absorption of calcium in the blood of an infant directly depends on the mother, she should first review the food and take medications (for example, Aufbaukalk, Complivit D3 Nycomed). The instructions for use of the drugs indicate which vitamins are included in the supplement.
- cottage cheese;
- cheeses;
- chicken eggs;
- liver;
- butter;
- dairy and fermented milk products;
- chocolate.
Also, when the child can be introduced to complementary foods, these products should be present in his diet. Reviews from many mothers who changed their diet and food products indicate that some symptoms went away immediately, the child stopped frequently being capricious and crying.
If food does not help compensate for calcium deficiency in children under 2 years of age, the doctor may prescribe medications. Which drug is best suited for use in children and adults? Medicines that have proven themselves and have positive reviews:
- Complivit Calcium D3 Nycomed.
Complivit calcium D3 Nycomed is designed specifically for children under 1-2 years of age. Complivit also includes vitamin D for better absorption. Suspension Complivit D3 Nycomed has a sweetish taste, which will not cause problems for the mother while taking the medicine. Instructions for use: dilute the powder in ½ glass of water, shake before giving. Complivit calcium D3 Nycomed has contraindications.
Aufbaukalk. A natural preparation containing calcium gluconate, which can be used from a six-month-old child. Aufbaukalk comes in 2 jars, from which you need to give the drug in the morning and evening. Aufbaukalk should be taken as directed.
Calcium gluconate. A very cheap drug, produced in its pure form. Calcium gluconate is prescribed to the mother during lactation. Calcium gluconate in combination with Aquadetrim should be given to children up to one year old; in this combination, the symptoms disappear after 2 days. Instructions for use: take 2 g 3 times a day.
The doctor must decide which drug is best to give to the child, depending on how low the level of calcium in the body is. How to take the drug can be found in the instructions for use.
- Which doctors should you contact if you have bone fractures in children?
What are bone fractures in children
The anatomical features of the structure of the skeletal system of children and its physiological properties determine the occurrence of certain types of fractures that are characteristic only of this age.
It is known that young children often fall during outdoor play, but they rarely experience bone fractures. This is explained by the child’s lower body weight and well-developed soft tissue cover, and therefore by a weakening of the impact force during a fall. Children's bones are thinner and less strong, but they are more elastic than adult bones. Elasticity and flexibility depend on the smaller amount of mineral salts in the child’s bones, as well as on the structure of the periosteum, which in children is thicker and richly supplied with blood. The periosteum forms a kind of sheath around the bone, which gives it greater flexibility and protects it from injury. The preservation of bone integrity is facilitated by the presence of epiphyses at the ends of the tubular bones, connected to the metaphyses by wide elastic growth cartilage, which weakens the force of impact. These anatomical features, on the one hand, prevent the occurrence of a bone fracture, on the other hand, in addition to the usual fractures observed in adults, they cause the following skeletal injuries typical for childhood: fractures, subperiosteal fractures, epiphysiolysis, osteoepiphysiolysis and apophysiolysis.
Breaks and fractures like a green branch or a willow twig are explained by the flexibility of bones in children. This type of fracture is observed especially often when the diaphysis of the forearm is damaged. In this case, the bone is slightly bent, on the convex side the outer layers are subject to fracture, and on the concave side they retain their normal structure.
Pathogenesis (what happens?) during bone fractures in children
Subperiosteal fractures characterized by the fact that the broken bone remains covered with periosteum, the integrity of which is preserved. These injuries occur when force is applied along the longitudinal axis of the bone. Most often, subperiosteal fractures are observed on the forearm and lower leg; In such cases, bone displacement is absent or very insignificant.
Epiphysiolysis and osteoepiphysiolysis- traumatic separation and displacement of the epiphysis from the metaphysis or with part of the metaphysis along the line of the germinal epiphyseal cartilage. They occur only in children and adolescents until the ossification process is complete.
Epiphysiolysis occurs more often as a result of the direct action of force on the epiphysis and, according to the mechanism of injury, is similar to dislocations in adults, which are rarely observed in children. This is explained by the anatomical features of the bones and ligamentous apparatus of the joints, and the place of attachment of the articular capsule to the articular ends of the bone is of significant importance. Epiphyseolysis and osteoepiphysiolysis are observed where the joint capsule is attached to the epiphyseal cartilage of the bone: for example, the wrist and ankle joints, the distal epiphysis of the femur. In places where the bursa is attached to the metaphysis so that the growth cartilage is covered by it and does not serve as a place for its attachment (for example, the hip joint), epiphysiolysis does not occur. This position is confirmed by the example of the knee joint. Here, during injury, epiphysiolysis of the femur occurs, but there is no displacement of the proximal epiphysis of the tibia along the epiphyseal cartilage.
Apophysiolysis is the separation of the apophysis along the line of the growth cartilage. Apophyses, unlike epiphyses, are located outside the joints, have a rough surface and serve for attachment of muscles and ligaments. An example of this type of injury is displacement of the medial or lateral epicondyle of the humeral csti.
Symptoms of Bone Fracture in Children
With complete fractures of the bones of the extremities with displacement of bone fragments, the clinical manifestations are practically no different from those in adults. At the same time, with fractures, subperiosteal fractures, epiphysiolysis and osteoepiphysiolysis without displacement, movements can be preserved to a certain extent, pathological mobility is absent, the contours of the injured limb that the child is sparing remain unchanged and only upon palpation is pain determined in a limited area corresponding to the fracture site. In such cases, only x-ray examination helps to make the correct diagnosis.
A feature of bone fractures in a child is an increase in body temperature in the first days after injury from 37 to 38°C, which is associated with absorption of the contents of the hematoma.
Diagnosis of bone fractures in children
In children, it is difficult to diagnose subperiosteal fractures, epiphysiolysis and osteoepiphysiolysis without displacement. Difficulty in establishing a diagnosis also arises with epiphysiolysis in newborns and infants, since even radiography does not always provide clarity due to the absence of ossification nuclei in the epiphyses. In young children, most of the epiphysis consists of cartilage and is passable for x-rays, and the ossification nucleus gives a shadow in the form of a small dot. Only when compared with a healthy limb on radiographs in two projections is it possible to establish the displacement of the ossification nucleus in relation to the diaphysis of the bone. Similar difficulties arise during birth epiphysiolysis of the heads of the humerus and femur, the distal epiphysis of the humerus, etc. At the same time, in older children, osteoepiphysiolysis without displacement is easier to diagnose, since radiographs show a separation of the bone fragment of the metaphysis of the tubular bone.
Errors in diagnosis are more often observed with fractures in young children. Insufficient medical history, well-defined subcutaneous tissue making palpation difficult, and the absence of displacement of fragments in subperiosteal fractures make recognition difficult. Often, in the presence of a fracture, a bruise is diagnosed. As a result of improper treatment in such cases, curvature of the limb and impairment of its function are observed. In some cases, repeated X-ray examination, performed on the 7-10th day after injury, helps to clarify the diagnosis, which becomes possible due to the appearance of initial signs of fracture consolidation.
Treatment of bone fractures in children
The leading principle is the conservative method of treatment (94%). In most cases, a fixing bandage is applied. Immobilization is carried out with a plaster splint, usually in the average physiological position, covering 2/3 of the circumference of the limb and fixing two adjacent joints. A circular plaster cast is not used for fresh fractures in children, since there is a risk of circulatory disorders due to increasing edema with all the ensuing consequences (Volkmann's ischemic contracture, bedsores and even necrosis of the limb).
During treatment, periodic x-ray monitoring (once a week) of the position of bone fragments is necessary, since secondary displacement of bone fragments is possible.
Traction is used for fractures of the humerus, shin bones and mainly for fractures of the femur. Depending on the age, location and nature of the fracture, adhesive plaster or skeletal traction is used. The latter is used in children over 3 years of age. Thanks to traction, displacement of the fragments is eliminated, gradual reposition is carried out and the bone fragments are held in the reduced position.
For bone fractures with displacement of fragments, one-stage closed reduction is recommended as early as possible after the injury. In particularly difficult cases, reposition is performed under periodic X-ray control with radiation protection for the patient and medical personnel. Maximum shielding and minimal exposure allows for repositioning under visual control.
The choice of pain relief method is of no small importance. Good anesthesia creates favorable conditions for repositioning, since the comparison of fragments should be done in a gentle way with minimal tissue trauma. These requirements are met by anesthesia, which is widely used in hospital settings. In outpatient practice, reposition is performed under local or regional anesthesia. Anesthesia is carried out by injecting a 1% or 2% novocaine solution into the hematoma at the fracture site (at the rate of 1 ml per one year of the child’s life).
When choosing a treatment method for children and establishing indications for repeated closed or open reduction, the possibility of self-correction of some types of remaining displacements during growth is taken into account. The degree of correction of the damaged limb segment depends both on the age of the child and on the location of the fracture, the degree and type of displacement of the fragments. At the same time, if the growth zone is damaged (during epiphysiolysis), as the child grows, a deformation may appear that was not there during the treatment period, which should always be remembered when assessing the prognosis.
Spontaneous correction of the remaining deformity occurs the better, the younger the patient is. The leveling of displaced bone fragments in newborns is especially pronounced. In children under 7 years of age, displacements for diaphyseal fractures are allowed in the length range from 1 to 2 cm, in width - almost the diameter of the bone and at an angle of no more than 10°. At the same time, rotational displacements cannot be corrected during growth and should be eliminated. In children of the older age group, more accurate adaptation of bone fragments is necessary and it is necessary to eliminate deflections and rotational displacements. For intra-articular and periarticular fractures of the bones of the extremities, accurate reduction is required with the elimination of all types of displacement, since unresolved displacement of even a small bone fragment during an intra-articular fracture can lead to blockade of the joint or cause varus or valgus deviation of the limb axis.
Surgical intervention for bone fractures in children is indicated in the following cases:
- with intra- and periarticular fractures with displacement and rotation of the bone fragment;
- with two or three attempts at closed reduction, if the remaining displacement is classified as unacceptable;
- with interposition of soft tissues between fragments;
- with open fractures with significant damage to soft tissues;
- in case of improperly healed fractures, if the remaining displacement threatens permanent deformation, curvature or stiffness of the joint;
- for pathological fractures.
Open reduction is performed with special care, gentle surgical access, with minimal trauma to soft tissues and bone fragments and is completed mainly by simple methods of osteosynthesis. Complex metal structures are rarely used in pediatric traumatology. Most often, a Kirschner wire is used for osteosynthesis, which, even when carried out transepiphyseally, does not have a significant effect on bone growth in length. The Bogdanov rod, CITO, Sokolov nails can damage the epiphyseal growth cartilage and are therefore used for osteosynthesis for diaphyseal fractures of large bones. For improperly fused and improperly fused bone fractures, false joints of post-traumatic etiology, compression-distraction devices of Ilizarov, Volkov-Oganesyan, Kalnberz, etc. are widely used.
The time frame for consolidation of fractures in healthy children is shorter than in adults. In weakened children suffering from rickets, hypovitaminosis, tuberculosis, as well as with open injuries, the periods of immobilization are extended, since the reparative processes in these cases are slowed down.
With insufficient duration of fixation and early loading, secondary displacement of bone fragments and re-fracture are possible. Ununited fractures and pseudarthrosis in childhood are an exception and, with proper treatment, usually do not occur. Delayed consolidation of the fracture area can be observed with insufficient contact between fragments, interposition of soft tissues, and with repeated fractures at the same level.
After the onset of consolidation and removal of the plaster splint, functional and physiotherapeutic treatment is indicated mainly for children with intra- and periarticular fractures, especially when movement in the elbow joint is limited. Physical therapy should be moderate, gentle and painless. Massage near the fracture site, especially with intra- and periarticular injuries, is contraindicated, since this procedure promotes the formation of excess callus and can lead to myositis ossificans and partial ossification of the joint capsule.
Children who have suffered injury near the epimetaphyseal zone require long-term follow-up (up to 1.5-2 years), since injury does not exclude the possibility of damage to the growth zone, which can subsequently lead to limb deformity (post-traumatic deformity of the Madelung type, varus or valgus deviation of the limb axis, segment shortening, etc.).