Children Just Don't Understand

I am currently on placement at PMH doing both inpatient and outpatient orthopaedics. Prior to this placement I have also completed an inpatient orthopaedics placement at Hollywood Private Hospital. It has become apparent already that the approach to dealing with a child in pain after an orthopaedic procedure is VASTLY different to that of an adult.

This week I have been treating a young boy who fractured his femur whilst skateboarding in a country town. He was flown down to Perth with the RFDS and had to wait three days before having surgery to place Nancy nails up his femur. I expected that he would be quick to recover because of how active he was before the injury and because of his age. When I saw him for the first time post-surgery, however, I realised that his recovery would be very different to what I had expected.

After his surgery he was extremely anxious about moving his affected leg. Any slight movement of his leg caused him to cry and hyperventilate. On questioning he said that it was more "scary" than sore. He also had distinct crepitus that could be felt through his thigh when the hip and knee were flexed. He would cry out every time a "clunk" was felt in his leg. This crepitus is normal and often occurs with Nancy nails as they have some give in them so the bony segments can move with leg mvts. This fear avoidance behaviour that he was showing made it extremely difficult to progress quickly with his rehabilitation.

With adults it is easy to overcome this fear avoidance behaviour as an adult is better able to comprehend explanations of things such as crepitus and the fact that it is safe to move the leg. With young children, however, other techniques to reassure them need to be thought of, as opposed to simply explaining things to them.

In this situation my supervising PT and I used a lot of distracting techniques, such as talking about his favourite things, about his school and friends back home, etc... We also made sure we involved his mother as much as possible to be hands on, i.e. holding his leg during transfers and helping him wiht active assisted exercises. It was important that any gains we made be continued when he goes home, which meant him being comfortable and not scared with his mum helping him instead of the physiotherapists. We also tried to create fun goals for him after he completed his treatment sessions, such as going to the Starlight room iafter transfering to a wheelchair for us.

This different approach to patients is a very important lesson for me to have learned during my first week of a paediatric patient and one that I will have to use throughout my time at PMH.