Children Orthopedic Problem

Pediatric Disabilities / Children Orthopedic Problem

There are number of pediatric disabilities and orthopedic problem which affect a person since childhood. Some of them are congenital and others are acquired. We can group them in following major parts—

1. Neuro-developmental disabilities (NDD): —-

• Congenital developmental disabilities (autism, intellectual disabilities, attention deficit disorder & learning disabilities,)
• Metabolic and genetic condition eg. Down syndrome ( Trisomy of 21)
• Vision loss & blindness
• Hearing loss
• Speech & language disorder
• Nerve & muscle disorder (eg. Muscular dystrophy, congenital neuropathies, spina bifida, polio )
• Neurological disorder due to brain insult- cerebral palsy

2. Congenital Musculo-skeletal disorders

• Congenital dislocation of hip (CDH)
• Congenital talipus equanovarus (CTEV) & vertical talus
• Congenital limb deficiency like PFFD, Tibial hemimelia , Fibular hemimelia, Radial club hand

 3. Acquired disorder- infection, trauma, Ricket & scurvy etc

Autism spectrum disorder: it is a developmental condition which affects individuals in two main areas. First thing, that they have impaired communication and social interaction and second, that they have restricted, repetitive patterns of behaviour, interest or activities. Cause of autism is not known but one thing is clear that it is not caused by parenting, or side effect of vaccination. This disorder arises most probably because of multiple factor including some genes, environmental impacts in early pregnancy. Two individuals with autism can be entirely different. Although there is no cure but with early intervention they can be helped to live lives with their full potential.
Pediatric Intellectual disabilities: Intellectual disability or learning disability was formerly known as mental retardation. It is generalized neuro-developmental disorder with significantly impaired intellectual and adaptive functioning defined as IQ level below 70. It affects about 2-3% of the general population and two third of them have only mild intellectual pediatric disability. Children with intellectual disability learn more slowly than others. The causes can be genetic. Down’s syndrome being the most common, problems during pregnancy like alcohol intake, rubella or other infection, birth hypoxia, exposure of infant to various diseases or toxins , iodine deficiency, malnutrition etc. Although currently there is no cure for established disability but most of the individuals can live socially acceptable life with appropriate teaching, training and support since early age.

Attention deficit hyperactivity disorder (ADHD)—– Attention deficit hyperactivity disorder is a neurodevelopmental psychiatric disorder in which there is significant problem in executing the work given to them that cause attention deficits along with hyperactivity which is not appropriate for a person’s age. This problem in school going children often results in poor school performance. Treatment in this problem involves some combination of counselling, life style changes & behavioural therapy.

Learning Disability- Learning disability is an umbrella term for variety of learning problem. Most common type of learning disability is problem in maths, reading, writing, reasoning, listening, time planning and speaking. Learning disability can impact relationship with family & friends. Before leveling learning disability, we should always rule out problem in hearing, vision & mental retardation. These children can come out from this problem with right approach of teaching, training and intervention.

Down’s syndrome (Trisomy of 21): Down’s syndrome or trisomy of 21 is a genetic disorder. It is associated with physical growth delays, characteristic facial features, and mild to moderate intellectual disability. The parents are typically normal. The parent’s diet or activity before and during pregnancy does not affect its occurrence. Although women of any age can have baby with Down’s syndrome but advance age mothers are at higher risk of it. Down’s syndrome can be identified during pregnancy with prenatal screening and pregnancy with final diagnosis of Down’s syndrome is terminated. People with Down’s syndrome may have small chin, slanted eyes, flat nasal bridge, a single palmer crease or protruding tongue. Usually face is flat and wide with short neck; there is extra space between first and second toe and short stature. Although the individuals with mild to moderate intellectual impairment, their understanding of language is better than ability to speak. Usually they are good at social interactions. Some of them also can have associated disorders like eyes, ear, epilepsy etc. Early diagnosis, screening for common problems and good family environment, education and proper care can give a good quality of life to the child and family.

Vision impairment / blindness: vision impairment may cause difficulty in recognizing the object clearly in activity of daily life. Impairment can be incomplete loss or complete loss of vision. Complete loss of vision in children occurs most commonly because of brain involvement, corneal opacity, cataract & retinopathy etc. Partial loss can occur because of strabismus, refractive error. Early recognition & early intervention helps the children in getting good outcome.

Hearing Loss: hearing loss can affect a Child ability to develop communication, language & social skill. Congenital hearing loss can occur because of genetic causes or some acquired causes like infection during pregnancy, trauma during birth. Acquired causes can occur because of recurrent ear infection & noise pollution. Early recognition & treatment of causes and hearing aid can helps these children in developing their skill. When a person has trouble understanding others (receptive language), or sharing thoughts, ideas, and feelings completely (expressive language), then he or she has a language disorder. A stroke can result in aphasia, or a language disorder.

Speech language disorder: Difficulty in pronouncing sounds, articulation disorder and stuttering are the example of speech problem. Difficulty in expressing thought, idea, need, information by language (expressive language) or trouble in understanding what others say (receptive language) are a few example of language disorder. Speech language pathologist helps these children by giving individualize treatment plan of rehabilitation.

Muscular Dystrophy : muscular dystrophy is a group of genetic disorder where abnormal gene (mutation) interfere with the production of protein required for muscle formation led to progressive weakening & loss of muscle mass. There is variety of muscular dystrophy in which some variety run in family and others caused by sporadic mutation of genes. It primarily affected boys. There is no treatment but still few medicines, exercise and brace helps in prolonging life of child. Stem cell treatment is in research phase but still it is not proven till date.

Hereditary Neuropathy: It is group of inherited disorder which affect peripheral nervous system (sensory, motor & autonomous system in different combination). Charcot Marie tooth disease is commonest one. Symptom can appear at birth or in late age to any age group. There is no standard treatment. Orthopaedic surgery is required in cases with foot or other skeletal deformity. Therapy and proper bracing helps in maintain correct posture.