Children Differ From Adults
pmm highlights important knowledge about musculoskeletal medicine in children and young people. This is very different to adult practice.
- Children are developing - physically, emotionally and psychologically - illness impacts them differently to adults.
- Normal variants in development of young children result in changes that can be mistaken as pathology.
- Patterns of pathology are different in children (compared to adults) and at different ages within childhood (e.g., causes of limp).
- Adolescents appear to be at greater risk of musculoskeletal injury during periods of rapid growth in early puberty.
- Communication with children takes patience and skill - the parent/caregivers often provide the history but it is still important to engage with and include the child (as appropriate to age).
We encourage you to watch the short video below which highlights how clinical assessment in children is different to adults.
The video shows a 22 month old girl whose her parents noticed her to be limping. While watching the video, ask yourself the following;
Do you think she is in pain ? Look out for verbal and non-verbal clues.
Which joints are affected ? Look at both her upper and lower limbs.
Key points from the video:
- This little girl has Juvenile Idiopathic Arthritis (involvement of ankles, knees, wrist).
- The child may not give any verbal history and this is often obtained from the parent / caregiver.
- The history may not tell you where the problem is (so you need to examine all joints as part of your general assessment).
- Children may not verbalise pain and non-verbal clues are important (e.g., facial expression, withdrawal and non-usage of a limb).
- Normal musculoskeletal development is important to know as there are different normal ranges of joint movement, differences in leg alignment at different ages and different motor milestones at various ages.
- It is important to know what is normal to be able to identify what is abnormal.