As the song goes, ‘Treat them well and let them lead the way…….’ (Masser and Creed, 1977). Sadly, even in the 21st Century, with all the medical and technological advances made in the last 100 years, there are still many circumstances in which children are being born with issues that will impact upon their lives – some through childhood, and some well beyond into their adult lives. It is the worst and best part of being in any kind of healthcare or medical profession, in that you see the pain and anguish of a poorly child, but you also get to experience the absolute elation that is assisting a child to overcome some of the real issues that they face every day of their young lives. There are, of course, many such illnesses and conditions that can effect children, and it would be impossible for me to tackle all of these in this forum, but I do want to examine just a few of the more frequent cases here, and then to look at just how an orthotist can assist in reducing pain, increasing mobility, and providing the stability for a growing child as they go forward into adulthood.
One of the better know conditions is Cerebral Palsy (CP), which literally means paralysis of or in the brain. This is damage that will not be cured, and is therefore persistent. As Hinchcliffe (2003) notes however, good positioning and handling can improve some of the issues related to posture and movement in children with CP, and conversely, poor handling can worsen movement for example. Often, children with CP have high muscle tone, which in basic terms means that their muscles are tense, and this also in turn prevents muscles from developing normally, which then goes on to cause further problems regarding mobility. CP is a once-only event, and it doesn’t reoccur and is not progressive, thus children who respond well to treatment, can show significant improvement in their stability and mobility, but more on how this can be achieved later. There are several ’causes’ for CP, but in most cases, the cause is not identifiable. Similarly, the problems associated with having CP is not the same for all children. There are often sensory issues, which may include sight, hearing and touch, and one quite common feature, is that the child has an issue with locating their limbs in relation to their bodies, thus becoming increasingly relying upon their sight in order to move around. This is something that has to be seriously considered when treating a child with CP, as you cannot rely upon the presence of touch or sensation, whilst at the same time having to factor in falls and bumps during movement.
Congenital Talipes Equinovarus, or club foot as it is often called, is another issue that manifests itself in babies. The definition of Talipes is quite complex, but put simply, it is where the foot is inclined inwards, axially rotated outwards and pointing downwards. Whilst the condition isn’t painful for babies, if it goes untreated, it becomes very painful for the toddler, and causes significant issues with walking as the child gets older still. Treatment usually involves a level of manipulation of the foot or feet, as in many cases, both feet are affected, and then it is often down to the Orthotist to ensure that the positioning of the feet is correct, in order to ensure a normal gait pattern, and to prevent issues with footwear in later life.
I’ve already examined the issues surrounding hypermobility in a previous blog post, but by way of a reminder…… A large number of children who live with hypermobile joints, experience pain, and can also present with a number of other, seemingly unconnected symptoms. ‘Joint Hypermobility Syndrome’, or sometimes ‘Benign Joint Hypermobility Syndrome’ as it is known, can be associated with joint pain and movement difficulty, but can also be linked to fibromyalgia, anxiety, low blood pressure, and even Urinary Tract Infections. Much of the joint pain happens after engaging in activities, or at the end of the day, and can be present within the hypermobile joint itself, or can manifest itself in other areas. Sometimes, hypermobile joints are susceptible to ‘cracking’ or ‘clicking’, but it is not normal for this to create further damage or to restrict mobility.
The NHS, as always, are fabulous in treating these, and other conditions common in children; The issue however, as in so many cases, is the level of time and funding that is made available through our wonderful health service. Splints prescribed for children with CP for example, may not be the best for their care, and whilst they may provide a level of support, they may not always be the most comfortable to wear, or allow for more everyday childhood activities. Your Orthotist working outside of the NHS has a whole different set of options available for you, but these do obviously come at a cost. These include a variety of FFOs and AFOs, lycra suits, bespoke footwear, and in certain cases, even devices such as the Paediatric F.E.S, which provides active muscle contraction for children with foot drop, not uncommon in CP sufferers.
In short, whilst some of these childhood issues are likely to impact upon their lives into their teens and beyond, the best treatment can certainly work to improve mobility – often unaided, reduce pain, possibly reduce the need for surgery, and certainly work to improve quality of life. So if your child has any of these issues, then make an appointment to see your Orthotist as soon as possible, as this will certainly count as ‘treating them well’.