Our expert - pediatrician Anna Mikhailova.
Risk factors
Experts call this condition osteopenia, which means that the bone mineral density is below normal. According to various studies, violations of this kind are found in every third teenager aged 11-17.
There are four main risk factors:- Deficiency of calcium, the main "building material" for bone tissue.
- Wrong nutrition. In addition to calcium, bones need protein, phosphorus, iron, copper, zinc and manganese, vitamins (from autumn to summer it is necessary to take vitamin-mineral complexes). And all these useful substances, as a rule, are present in those products that children like the least.
- Hypodynamia - for the growth of bone mass, movement is necessary that loads and trains the bones.
- "Hormonal storm": calcium metabolism in the body is under the strict control of the hormonal system, and during puberty, disturbances in its work are not uncommon.
Many chronic diseases also “interfere” with the normal absorption of calcium: the gastrointestinal tract, respiratory tract, liver, kidneys, thyroid gland ...
Cunning of the Invisible
Loss of bone density develops slowly and gradually, it is impossible to notice it by eye. But there are five indirect signs that should alert parents.
- The child has caries.
- "For some reason" hair splits,.
- From time to time there are pains in the legs, especially in the legs.
- The student stoops more and more, his back gets tired after a long sitting at the lessons or the computer.
- Your child is allergic, because of this he has dietary restrictions, he does not eat dairy products and fish.
Even one such symptom is a signal that the child needs to be examined and find out if he really lacks calcium.
Norm and deviations
First of all, the pediatrician will prescribe biochemical blood and urine tests, which can be used to understand whether phosphorus-calcium metabolism is disturbed. These partner minerals are involved in many vital metabolic processes and work hand in hand: the body cannot absorb calcium if there is not enough phosphorus, but if there is an excess of the latter, calcium is excreted from the body. That is why it is so important to keep them in balance. Comparing the data with the norms of indicators for a certain age and finding deviations, one can suspect the initial stage of osteopenia.
To clarify the diagnosis, densitometry is performed: assessment of bone tissue (often using the ultrasound method). Unlike adults, children analyze only the so-called Z-criterion - that is, deviations from the norm depending on the age and gender of the young patient, which are calculated using a special computer program.
Will we fix everything?
The process of healthy bone formation can be corrected as the child grows. For treatment, drugs containing calcium are prescribed.
The choice is large: for example, for the sake of prevention and with a slight deviation from the norm, calcium preparations with vitamin D are prescribed. If a deficiency of not only calcium, but also some trace elements is detected, complex preparations are used (they also include manganese, boron, copper, zinc, magnesium ).Since some chronic diseases affect the absorption of calcium, children who have them are selected with special drugs, for example, for gastritis with high acidity, those that “protect” the process of its absorption from the aggression of gastric juice. The course of continuation of treatment is individual.
But drugs alone are not enough. The diet should reinforce the treatment: cottage cheese, cheese, kefir or yogurts, fish (salmon, sardines), meat, eggs, broccoli, bananas, legume dishes are recommended.
And of course, you need to make time for sports: at least for regular visits to the pool or fitness room. It is regular, and not from case to case. And if the child has posture disorders, flat feet - it is necessary to undergo treatment under the supervision of a pediatric orthopedic surgeon.
Sooner or later, almost any child, and hence his parents, also faces the problem of a fracture. In order to correctly assess the severity of the situation and seek qualified help in time, one should be guided in the features of fractures in children. Often parents underestimate the severity of the condition because some children are not very sensitive to pain; other adults consider this almost the norm, explaining the mobility of the child. Is everything so simple?
Relevance of the issue
As is known from medical statistics, fractures in children are about 15% of all injuries and injuries with which they seek qualified medical help. The problem is due to the peculiarity of the structure of the human body: the biological mechanics, anatomy and even the physiology of a minor are very different from those inherent in an adult, since the body is actively growing and developing. Injuries accompanied by fractures, including violation of the integrity of the epiphysis, are an urgent problem of modern medicine. Updated approaches to refined diagnostics are being developed, treatment strategies are being formed that would fully satisfy the characteristics of the case.
A key feature of fractures in children is the structure of bone tissue. The musculoskeletal system contains not only cartilaginous tissue in a fairly large amount, but is also distinguished by the presence of end plates, which are not normally present in an adult. Such areas are called areas of growth. Children's bones are distinguished by increased strength and have a reliable periosteum, which forms a callus in a short time. The study of biomechanics has shown the ability to absorb large amounts of energy. Scientists explained this by the porosity of the elements and low mineral density. The abundance of bone tissue pores is associated with numerous large Haversian canals, due to which the elastic modulus decreases, strength decreases. Growth and maturation are accompanied by a decrease in porosity and a thickening of the cortical block, which makes the skeletal system stronger.
Anatomy and trauma
Another feature of fractures in children is due to the attachment of ligament blocks to the bone epiphyses. Therefore, trauma to the limb can damage the site of bone growth. The strength of the elements is ensured by the interweaving of ring blocks and mastoid bodies, but in any case, the growth area is characterized by relatively low strength. This is noticeable if we compare the anatomical features and qualities of the metaphysis, ligamentous fibers, growth zones. Such areas are relatively resistant to stretching, but are subject to the negative influence of torsion forces. From statistics it is known that the violation of the integrity of the growth plate is most often due to angular impact or rotation.
Another feature of a fracture in children is the possibility of a displaced format, and the probability directly depends on the quality and parameters of the periosteum. The thicker this block, the lower the risk of closed reduction. After changing the position, it is she who is responsible for maintaining the fragments in the correct and stable state.
healing process
Fractures in children are accompanied by bone remodeling. The process is provided by resorption by the periosteum, accompanied by the generation of new bone tissue. Anatomical reduction is needed only in a limited number of cases. Many traumatized children do not need such an event at all. The regeneration process depends on several factors: age, localization of the injury relative to the joint, and the presence of obstacles to its activity. Remodeling is due to the potential ability of the bone to grow, and the possibilities are higher the lower the age.
If the injury is localized near the growth block, recovery will require minimal time, especially in the case when the deformity coincides with the articular axis of movement. in which the areas have shifted, overgrows more slowly. It takes a lot of time to restore the diaphysis. Possible rotational injury or leading to deterioration of articular motility. These heal more slowly than others.
Bones: do they grow in moderation?
One of the features of bone fractures in children is the risk of excessive bone growth. With regard to long bones, this is due to the effect on growth areas - in this area, the blood flow is activated, which is necessary for the restoration of damaged tissues. It is noted that a fracture of the femur in a child under the age of ten is often accompanied by a lengthening of the bone by several centimeters in the next couple of years. To minimize the undesirable consequences of rehabilitation, it is necessary to combine bone fragments in a bayonet-like manner. For patients older than the specified age, excessive development is less dangerous, the process is relatively weakly expressed. If a fracture occurs, it is necessary to help by making a simple reposition of the blocks.
About the nuances
A feature of bone fractures in children known to doctors is the progress of the deformity. Sometimes the injury is accompanied by damage to the epiphysis. As a result, the site may be closed for a few percent or completely. This leads to angular deformation, which can provoke a shortening of the bone element. Both types of complications are likely. The level of deformation depends on the specifics of the bone and is determined by the ability of the bone tissue to grow.
Studies have shown that fractures heal faster in children than in adult trauma patients. The reason for this is the ability of the child's skeletal system to grow rapidly and increase the thickness of individual blocks. The periosteum of a minor is the area of localization of active metabolic processes. The older the person, the lower the healing rate.
Do you need help?
Sooner or later, bone fractures in children become a problem for almost any family. The more restless the child, the higher the risk of serious injury. Parents should be guided in the manifestations of the problem, know how to provide first aid to the victim. In many ways, the speed and quality of the rehabilitation period depend on it. Determine what kind of help is needed at first, based on the cause of the fracture and the factors that determine the specifics of the situation. However, the general tactics for all cases is the same.
From statistical observations it is known that the fracture of the arm in a child is most often disturbing; the incidence of leg fractures is half that. If the injury is severe, it is immediately clear what happened, but more often children suffer minor injuries, and only a qualified doctor can diagnose correctly. Some do not pay enough attention to the situation, since the functionality of the affected limb, although impaired, is weak. You can easily confuse a fracture, bruise, dislocation. The first in the upper limbs are more often localized in the forearm, elbow joint.
Closed fracture
If a fracture in a child (arm, leg or other part of the body) is observed in this form, it is necessary to give the victim peace and ensure immobility. This step is the first step in providing emergency care immediately after an injury. Parents should put the patient to bed, then calm down, because chaotic panic actions will only hurt the baby. Apply a cold compress to the affected area. This relieves the condition and helps to ease internal bleeding. The next step is immobilization. The term denotes measures to prevent movement of the diseased area. The limb must be kept elevated. The patient is then given an analgesic. Doctors recommend using drugs containing ibuprofen, paracetamol. Other medicines are prohibited until the arrival of the doctor.
Fracture open
Treatment of open fractures in children should be provided to a doctor. The task of those near the victim is to provide first aid. A distinctive feature of the injury is an open wound, which means that it is necessary to treat it as soon as possible and prevent large-scale blood loss. To stop bleeding, the damaged area is covered with a tight bandage. If the area is dirty, clean it with soapy water. Next, apply a cold compress, provide immobility to the victim, if necessary, give an analgesic.
About commit
Taking into account the features of bone fractures in children described briefly above, the importance of providing correct first aid becomes clear, since unsuccessful measures and the lack of suitable treatment can adversely affect a person’s future, lead to skeletal asymmetry and other complications. A key measure of assistance is the immobilization of the affected area. For this, a tire is applied. Any car owner's first aid kit is equipped with such a product. It must be at the disposal of the ambulance crew. Parents, providing first aid to an injured child, should prepare a splint from improvised means. It is not difficult to find something suitable - it is enough to use a dense material to which the injured part of the body is attached.
As with a fracture accompanied by a displacement in a child, and without such a complication, the task of providing first aid is to find means suitable for immobilization. You can use thick cardboard or plywood. If you have a small plank or stick handy, these items will also work. If a very small baby has suffered, it is better to use cardboard, wrapping it with cotton wool. A bandage is used to fix the diseased area. It is necessary to stabilize the position of the joints above and below the affected area. You don't need to take off your clothes and shoes. It is advisable to take wide objects for splinting - they are more reliable than narrow ones. If a limb is injured, it is necessary to fix it in the current position, without adjusting it to a more familiar or seemingly comfortable, correct one. It is strictly forbidden to set the affected block of the support system - this will be done by the doctor.
First aid: nuances
If a fracture with displacement occurs in a child, if the injury is not accompanied by displacement, it is necessary to call a doctor as soon as possible. If the situation occurred when the family was in a village where it is possible to call an ambulance, it is possible not to immobilize the limb. Parents need to urgently seek medical support, and while waiting for the car with the doctors, guarantee the victim peace and immobility. Do not touch the affected area.
There is such a situation when a child is injured, but the elders do not have anything suitable for splinting at hand. It is necessary to attach the diseased area to a healthy part of the body.
Strictly prohibited
One of the features of the treatment of fractures in children is a strict ban on heating and rubbing the diseased area. Parents should monitor the behavior of the victim: he should not move. In no case should you force the injured person to move or encourage movement. It will be dangerous to attempt to correct the zone on your own. Do not treat the area with gels, ointments.
The rules for providing primary care for both upper and lower limb injuries are almost the same. If the hand is injured, it should additionally be fixed with a scarf bandage. If the injury is localized in the leg, such measures are not required. If damage to the femur or injury involving the pelvic blocks is suspected, four joints are immobilized instead of two.
Subtleties of the question
Doctors, finding out the features of fractures in children and adults, have established: with the application of equal force, an older person is more likely to be injured than a child. The support system in childhood has a high elasticity, the elements that form it are flexible. To some extent, a fracture is similar to a broken branch of a tree. Fragments do not move, which means that regeneration requires a minimum of time. It is most difficult to clarify the case if the fracture is localized in the growth area. When examining a part of the body in x-rays, cartilage cannot be seen, so it is problematic to specify a fracture.
Known high ability to regenerate inherent in the child's body. The callus changes to the corresponding tissue in the shortest possible time. Comparing the features of fractures in children and adults, it was found that the former are much less likely to develop areas of scarring. It was found that in children with a fracture, it is possible to maintain an insignificant displacement - it will disappear on its own as the body grows.
Fractures: forms
It is customary to divide all cases into pathological and trauma-related. In everyday life, the latter are usually observed. In a child, fractures of the collarbone, limbs, and other parts of the body are provoked by blows, falls, and jumps. They are not uncommon during games, can be explained by twisting the leg or a long run. Pathological cases are provoked by diseases. These are observed in dysplasia, bone tuberculosis, may indicate the incorrect formation of bone tissue at the embryonic stage of development. A possible reason is a lack of calcium. Sometimes a fracture indicates an inflammatory process localized in the bone tissue.
All cases of injuries are divided into open, closed (the general rules for first aid are discussed above). The dangers of the open form should not be underestimated, since damage to the skin is accompanied by the danger of infection of the body. In a child, a fracture of the clavicle, limb, rib, or any other block of the supporting system is accompanied by ruptures, and the dimensions of the damage vary from case to case. Sometimes they are small, in others they are large, leading to the destruction of soft tissue. In addition to introducing dirt, there is a danger of tissue crushing. Cases of an open fracture are divided into those accompanied by displacement and without it. The first involves the movement of bone fragments to the sides, the second option is characterized by a stable position of the fragments in the original localization. Displaced fractures can be incomplete or complete. The connection of the fragments is partially broken, while the bone integrity is preserved - these are the features of an incomplete fracture. The second option involves the complete separation of the elements.
The main percentage of cases falls on an isolated injury, in which one segment is damaged. Less common are multiple, combined cases affecting several areas of the body.
How to notice?
The task of parents is to know the symptoms of a fracture in a child in order to call a doctor in time and provide first aid. There are common signs that are inherent in any injury of this type, regardless of location. All manifestations are divided into probable, reliable. The first category includes skin swelling, hematoma, pain accompanying movement, palpation. The mobility of the hand, foot, finger is impaired. Reliable manifestations include deformation of the site, crepitus. The term refers to the crunch heard due to the appearance of bone fragments.
It's curious: injuries and celiac disease
Not so long ago, the medical community became interested in the case of a child who often suffered fractures. In just a couple of years, a seven-year-old child received three fractures of the upper limbs, which were not accompanied by preliminary pressure. The doctors failed to detect prerequisites for bone fragility, the patient ate well and led an active life. Laboratory studies have shown adequate concentrations of trace elements, minerals in the blood. The only doubtful result of the study was the level of antibodies, which allows one to suspect celiac disease. The diagnosis was confirmed by gastroenterologists.
As studies have shown, in a child, fractures of the radius, collarbone and other parts of the body on the background of celiac disease are more likely than in the absence of this disease, since it affects the mineral density. A curious reliable study was organized in 2011. It turned out that about a quarter of all people who received a diagnosis of celiac disease had suffered a fracture shortly before.
Why is this happening?
Celiac disease is a pathological condition in which the functioning of the intestinal villi is disrupted. The absorption function of the tract is inhibited, the body does not receive the necessary components. This leads to deficiency of iron, vitamin compounds, folic acid. One of the features of fractures of tubular bones in children (as well as any other elements of the supporting system) is low density, which is provoked by a lack of nutrients. Accordingly, celiac disease leads to a decrease in bone strength. In parallel, the level of inflammation also increases, which also negatively affects the health of the musculoskeletal system.
Finding out the features of fractures in children of the jaws, limbs and other parts of the body against the background of celiac disease, doctors considered that the only reliable method of prevention is proper nutrition. It is necessary to completely eliminate gluten from the patient's diet. As the researchers of the case mentioned above noted, such a measure in relation to the child made it possible to do without fractures in the next 3.5 years (exactly after how many parents brought the child to the clinic for a preventive examination). It is noted that the restructuring of a new nutrition system for children is not easy, but the results are worth it.
Causes and consequences
If we do not touch on the topic of rare congenital and hereditary diseases, we will have to admit that the main percentage of fractures in minors is due to industrial society and the peculiarities of social interaction. It is not easy for children to learn to follow household rules, to behave correctly in transport, which means that the risk of injury is growing. Doctors involved in the diagnosis and treatment of fractures in children note that about 70% of all cases are due to cycling, skateboards, scooters, and rollerblading. Many children ride where it is forbidden, jump in dangerous places, fall. Even vehicles do not cause injuries to minors as often as they do due to domestic causes. On average, the likelihood of injuries due to transport in an adult is higher than in a child, but the severity of injuries usually dominates in the latter. Studies have shown that, on average, per thousand children, there are 248 people with bruises, 30 with dislocations and about 57 with bone fractures.
To understand how to distinguish these cases, it is necessary to consider their features, at least in general terms.
About terms and situations
A bruise is a closed injury in which organs and tissues suffer, but the structure remains intact. The sections do not come off, do not break, but the integrity of the blood vessels is possible. The result is hematomas, bruises. Bruising is visually visible as purple spots, the hue of which gradually transforms to green and yellow. Usually the cause is a collision, a fall, a blow. The mobility of the diseased part of the body is preserved, but the area responds with soreness. To help the victim, a cold compress is applied to the area and rest is provided.
As studies show, it is possible to get a fracture in an infant, but ligamentous sprains appear in people only older than three years of age. The classic localization is the ankle joint. The child makes an awkward movement, the foot is twisted. This is possible when a person runs, walks. The risk is especially high when running up stairs. Stretching indicates acute pain, followed by swelling of the affected area. The shade of the skin sometimes changes to cyanotic, palpation brings pain. Movements in the joint are possible, but the victim tries to spare the diseased limb, so he practically does not rely on it.
Parents should put ice on the affected area, fix it with an elastic bandage and show the injured doctor for an X-ray examination. The risk of a bone crack is high, the symptoms are similar to sprains. X-ray is the only way to clarify the condition.
Dislocation: what is it?
The word denotes an injury in which the articular contour is disturbed. The most common reason is a fall. The movements of the diseased area are limited, the pain becomes stronger, the ability to move is inhibited. The limb affected by the fall becomes longer or shorter than the pair. There is a possibility of deformation.
Parents should provide the patient with peace, fix the affected area with a splint, bandage. You need to seek help from a qualified doctor. Do not correct the dislocation on your own.
Subluxation is very common in practice, and the typical area is the elbow joint. This is most often seen in children in the age group from one to three. An adult holds the child tightly by the hand, but the child stumbles, suddenly slips or falls, and this leads to injury. The moment is sometimes accompanied by a specific crunch.
With subluxation, the affected area responds with pain, the child does not move the limb, pulls it along the body, sometimes bends it slightly. If you rotate your forearm or elbow, the pain becomes especially severe. Parents should provide peace to the affected area and take the patient to the pediatric traumatology.
Crack
Considering the features of bone fractures in newborns, infants, older children, one cannot ignore the cracks. This term refers to partial damage to bone tissue, a fracture that has not ended. It is not easy to identify him, as young children are not able to formulate complaints. From the outside, there is a general concern of the child. The likelihood of injury is especially high due to the small weight of the child. If the child falls, the soft tissues somewhat weaken the aggressive influence, so the likelihood of a crack is greater than a fracture.
An older child can describe the manifestations of the situation. The injured area is disturbed by pain, especially severe on movement, on palpation, on pressure. If you provide rest to the affected area, the pain becomes dull, the area pulsates, in some it tingles. The tissues swell, and the symptom can progress rapidly. Puffiness will subside a day after receiving a crack or later. Often the area is marked by a hematoma. Noticeable limited mobility of the victim, due to pain, swelling.
The spine suffers
A relatively common diagnosis is a compression fracture. In a child (as well as an adult), this is due to the compression of the elements of the spinal column. This is possible when falling, due to a blow to the back, somersault, gymnastic practice. It is known that in children the muscles are sometimes stronger than the skeletal system. When they are intensely reduced, a compression effect is formed that affects the individual blocks of the column in the lateral projection. Functionality, sensitivity are not violated, since there is no spinal injury, but the structure of the column is disturbed. The clinical symptoms of the condition are often blurred. At the moment of injury, he catches his breath, his back gives off a slight soreness, while the child does not even pay attention to the manifestations and continues his games and activities.
Without adequate treatment, a compression fracture leads to complications. These are more common after years. The consequences of the situation are sciatica, osteochondrosis, vertebral destruction and other similar pathological processes. To prevent the consequences, it is necessary to take the victim to the trauma department of the clinic at the slightest back injury, where they will take an x-ray, assess the danger of the condition and select a therapeutic program. Inpatient treatment is often indicated. Rehabilitation is accompanied by a special daily routine aimed at unloading the spinal column. Such treatment is quite long in time.
To correct a compression fracture, it is necessary to do therapeutic exercises. Swimming is recommended from the age of three. Without adequate body support, as you grow older and gain weight, the risk of a hernia of the affected area increases.
For the full development of the child's body, a sufficient intake of not only vitamins, but also other minerals, the lack of which affects health, is necessary. Increasingly, children under one year of age are diagnosed with hypocalcemia, a lack of calcium in the body. Calcium for children up to 1-1.5 years old is one of the important minerals, the norm of which should be ingested 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, takes care of the formation of teeth and bones. In order for calcium to be absorbed, it is important that a sufficient amount of vitamin D enters the body. What is the best drug to choose? After the examination, the doctor will prescribe the necessary medications.
The Importance of Calcium for Children
Already from birth, calcium plays a role in the formation of bones and teeth, is responsible for processes such as the contraction of muscle fibers and the functioning of the nervous system. Calcium ions directly affect blood clotting, improve the functioning of the endocrine system. Sufficient intake of calcium protects children from the occurrence of allergic reactions, and also protects against inflammatory processes.
If a child is not getting 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 tubercles on the crown of the head and in the forehead area;
- the back of the head may become flat, and the skull may become asymmetric;
- brittle and bad teeth;
- weak bones, which leads to frequent fractures.
This is a partial 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, not yet strong organism that it contains 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, and turning into a more serious condition, provokes frequent bone fractures.
Causes of insufficient intake of calcium in the child's body
Normally, every day the child should receive 500-1000 mg of calcium. Since babies under 1-2 years old most often feed on breast milk, the mother needs to eat right, as well as take calcium gluconate (Calcium D3 Nycomed) and other vitamins to make up for the deficiency during the feeding period. It is worth remembering: if the rate of calcium in the blood of a nursing mother is underestimated, this adversely affects the health of the child.
There are cases when a sufficient amount of calcium enters the body, but it is not absorbed due to a lack of vitamin D. Proper foods will not be able to fully compensate for the deficiency in children under 2 years old, so doctors recommend, in addition to changing the diet, taking calcium gluconate preparations (Complivit, Calcium D3 Nycomed), with which other vitamins most often go in addition. It is worth knowing that in the summer, vitamins in the child's body are synthesized in sufficient quantities, including vitamin D, so you should not take additional vitamins at this time of the year, because. excess can lead to hypervitaminosis. Vitamins, the norm of which is too high, can provoke colitis and other intestinal diseases in a child.
The child's body should receive the daily intake of calcium in the following dosage:
- 400-500 mg - the norm at the age of 0 to six months;
- 500-700 mg - the norm at the age of six months to a year.
- 700 mg and above should be ingested by a child from 1 year old.
Unlike other vitamins, an excess of calcium in the blood does not affect the baby's health in any way; up to 1-2 years, the excess comes out through urine and feces. If we talk about the excess calcium in the blood coming through drugs along with other trace elements (Complivit, calcium D3 Nycomed), for example, vitamins B and D, then this can lead to salt deposits in the kidneys. To the drugs in the instructions for use, you can find out about side effects.
Symptoms and signs of a lack of substance in a child
It is problematic to determine the lack of calcium in the blood of a child under one year old, since he does not walk yet, and only a specialist can detect hypocalcemia. The main symptoms, when the rate of calcium gluconate in the blood is underestimated, are manifested in the following:
- during crying, you can notice the trembling of the chin;
- increased sweating in the back of the head;
- in the places of the head, where the child most often comes into contact with the pillow, hair erasure is noticeable;
- from loud sounds the child shudders.
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 the nails. Products and vitamins in preparations (Calcium D3 Nycomed) help to compensate for the lack of trace elements in the body, after which the symptoms and signs gradually disappear, and the child gets better.
Treatment of hypocalcemia
Since the absorption of calcium in the blood of an infant directly depends on the mother, she should first of all review food and take drugs (for example, Aufbaukalk, Complivit D3 Nycomed). To the preparations in the instructions for use it is indicated which vitamins are in addition.
- cottage cheese;
- cheeses;
- chicken eggs;
- liver;
- butter;
- dairy and dairy products;
- chocolate.
Also, when it will be possible for the child to introduce complementary foods, and these products should be present in his diet. Reviews of many mothers who changed their diet and food indicate that some symptoms went away immediately, the child often stopped being capricious and crying.
If food products have not helped to compensate for the lack of calcium in children under 2 years old, then the doctor may prescribe medications. What is the best drug for use in children and adults? Medications 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 old. 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 six months of the child. Aufbaukalk has a release in 2 jars, from which you need to give the drug in the morning and evening. Aufbaukalk should be taken as directed.
Calcium gluconate. 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 under one year old, in this combination the symptoms disappear after 2 days. Instructions for use: take 2 g 3 times a day.
Which is better to give the drug to a child, the doctor must decide, depending on how low the level of calcium in the body is. How to take the drug, you can find out in the instructions for use.
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 for this age.
It is known that young children often fall during outdoor games, but they rarely have bone fractures. This is due to the lower body weight and well-developed cover of the soft tissues of the child, and consequently, the weakening of the impact force during a fall. Children's bones are thinner and less durable, but they are more elastic than the bones of an adult. Elasticity and flexibility depend on the smaller amount of mineral salts in the bones of the child, as well as on the structure of the periosteum, which in children is thicker and richly supplied with blood. The periosteum forms, as it were, a case around the bone, which gives it greater flexibility and protects it in case of injury. The preservation of the integrity of the bone is facilitated by the presence of epiphyses at the ends of the tubular bones, connected to the metaphyses by a 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 of childhood: fractures, subperiosteal fractures, epiphysiolysis, osteoepiphysiolysis and apophyseolysis.
Fractures and fractures like a green branch or a wicker rod 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 undergo a fracture, and on the concave side they retain a normal structure.
Pathogenesis (what happens?) during a bone fracture in children:
Subperiosteal fractures characterized by the fact that the broken bone remains covered by the periosteum, the integrity of which is preserved. These injuries occur under the action of a force along the longitudinal axis of the bone. Most often, subperiosteal fractures are observed on the forearm and lower leg; displacement of the bone in such cases is absent or is very slight.
Epiphysiolysis and osteoepiphysiolysis- traumatic detachment and displacement of the epiphysis from the metaphysis or with a part of the metaphysis along the line of the growth epiphyseal cartilage. They occur only in children and adolescents before the end of the ossification process.
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 childhood. This is due to the anatomical features of the bones and the ligamentous apparatus of the joints, and the place of attachment of the articular capsule to the articular ends of the bone is essential. Epiphysiolysis and osteoepiphysiolysis are observed where the articular bursa attaches to the epiphyseal cartilage of the bone: for example, the wrist and ankle joints, the distal epiphysis of the femur. In places where the bag 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), epiphyseolysis does not occur. This position is confirmed by the example of the knee joint. Here, in case of injury, epiphysiolysis of the femur occurs, but there is no displacement of the proximal epiphysis of the tibia along the epiphyseal cartilage.
Apophysiolysis - detachment of the apophysis along the line of the growth cartilage. Apophyses, unlike epiphyses, are located outside the joints, have a rough surface and serve to attach muscles and ligaments. An example of this type of damage is the displacement of the medial or lateral epicondyle of the humerus.
Symptoms of a 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, epiphyseolysis and osteoepiphyseolysis, movements can be preserved to a certain extent without displacement, there is no pathological mobility, the contours of the injured limb, which the child spares, remain unchanged, and only when palpated, pain is 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 the absorption of the contents of the hematoma.
Diagnosis of bone fracture in children:
In children, it is difficult to diagnose subperiosteal fractures, epiphysiolysis, and osteoepiphysiolysis without displacement. Difficulty in establishing a diagnosis also arises with epiphyseolysis in newborns and infants, since even radiography does not always clarify 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 nucleus of ossification gives a shadow in the form of a small point. Only when compared with a healthy limb on radiographs in two projections, it is possible to establish the displacement of the ossification nucleus in relation to the bone diaphysis. Similar difficulties arise during birth epiphyseolysis of the heads of the humerus and femur, the distal epiphysis of the humerus, etc. At the same time, in older children, osteoepiphyseolysis without displacement is easier to diagnose, since the separation of the bone fragment of the metaphysis of the tubular bone is noted on radiographs.
Misdiagnosis is more common in fractures in young children. Lack of history, well-defined subcutaneous tissue, which makes palpation difficult, and the absence of displacement of fragments in subperiosteal fractures make it difficult to recognize. Often, in the presence of a fracture, a bruise is diagnosed. As a result of improper treatment in such cases, limb curvature and impaired function are observed. In some cases, repeated x-ray examination, performed on the 7-10th day after the injury, helps to clarify the diagnosis, which becomes possible due to the appearance of initial signs of fracture consolidation.
Treatment of bone fracture in children:
The leading principle is a conservative method of treatment (94%). In most cases, a fixing bandage is applied. Immobilization is carried out with a plaster splint, as a rule, 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 limb necrosis).
In the process of treatment, periodic X-ray control (once a week) is necessary for the position of bone fragments, since secondary displacement of bone fragments is possible.
Traction is used for fractures of the humerus, lower leg 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 older than 3 years. Thanks to traction, the displacement of fragments is eliminated, a gradual reposition is carried out, and the bone fragments are held in a reduced position.
In case of bone fractures with displacement of fragments, one-stage closed reposition is recommended as soon as possible after the injury. In especially difficult cases, reposition is performed under periodic X-ray control with radiation protection of the patient and medical personnel. Maximum shielding and minimum exposure allow visually guided repositioning.
Of no small importance is the choice of method of anesthesia. 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 a hospital setting. In outpatient practice, reposition is performed under local or conduction anesthesia. Anesthesia is carried out by introducing a 1% or 2% novocaine solution into the hematoma at the fracture site (at the rate of 1 ml per one year of a child's life).
When choosing a method of treating children and establishing indications for repeated closed or open reposition, the possibility of self-correction of some types of remaining displacements in the growth process is taken into account. The degree of correction of the damaged segment of the limb 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 (with epiphyseolysis), as the child grows, a deformity may be revealed that was not present during the treatment period, which should always be remembered when evaluating the prognosis.
Spontaneous correction of the remaining deformity is the better, the younger the patient's age. The leveling of displaced bone fragments in newborns is especially pronounced. In children under 7 years of age, displacements in diaphyseal fractures are permissible in length from 1 to 2 cm, in width - almost to the diameter of the bone and at an angle of not more than 10 °. At the same time, rotational displacements are not corrected during growth and should be eliminated. In children of the older age group, more accurate adaptation of bone fragments is necessary and the elimination of deflections and rotational displacements is mandatory. With intra-articular and periarticular fractures of the bones of the extremities, an exact reposition is required with the elimination of all types of displacements, since the unrepaired 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 axis of the limb.
Surgery for bone fractures in children is indicated in the following cases:
- with intra-articular and periarticular fractures with displacement and rotation of the bone fragment;
- with a two or three attempts at a closed reposition, if the remaining displacement is classified as unacceptable;
- with interposition of soft tissues between fragments;
- with open fractures with significant soft tissue damage;
- with incorrectly fused fractures, if the remaining displacement threatens with permanent deformation, curvature or stiffness of the joint;
- with pathological fractures.
Open reposition 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. More often than others, a Kirschner wire is used for osteosynthesis, which, even with transepiphyseal conduction, does not have a significant effect on bone growth in length. Bogdanov's rod, CITO, Sokolov's nails can damage the epiphyseal growth cartilage and are therefore used for osteosynthesis in diaphyseal fractures of large bones. In case of incorrectly fused and incorrectly fused bone fractures, false joints of post-traumatic etiology, the compression-distraction devices of Ilizarov, Volkov-Oganesyan, Kalnberz, etc. are widely used.
The timing of fracture consolidation in healthy children is shorter than in adults. In debilitated children suffering from rickets, hypovitaminosis, tuberculosis, as well as with open injuries, the periods of immobilization are lengthened, since the reparative processes in these cases are slowed down.
With insufficient duration of fixation and early loading, secondary displacement of bone fragments and a repeated fracture are possible. Ununited fractures and false joints in childhood are an exception and usually do not occur with proper treatment. Delayed consolidation of the fracture area can be observed with insufficient contact between fragments, soft tissue interposition, 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-articular and periarticular fractures, especially when movements are limited in the elbow joint. Physiotherapy exercises should be moderate, gentle and painless. Massage near the fracture site, especially with intra-articular and periarticular injuries, is contraindicated, as this procedure promotes the formation of excess bone callus and can lead to myositis ossificans and partial ossification of the joint capsule.
Children who have suffered damage near the epimetaphyseal zone need long-term dispensary observation (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 axis of the limb, shortening of the segment, etc.).
Which doctors should be consulted if you have Fractures of bones in children:
- Traumatologist
- Surgeon
- Orthopedist
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Other diseases from the group Injuries, poisoning and some other consequences of external causes:
| Arrhythmias and heart block in cardiotropic poisoning |
| Depressed skull fractures |
| Intra- and periarticular fractures of the femur and tibia |
| Congenital muscular torticollis |
| Congenital malformations of the skeleton. Dysplasia |
| Dislocation of the semilunar bone |
| Dislocation of the lunate and proximal half of the scaphoid (de Quervain's fracture dislocation) |
| dislocation of the tooth |
| Dislocation of the scaphoid |
| Dislocations of the upper limb |
| Dislocations of the upper limb |
| Dislocations and subluxations of the head of the radius |
| Dislocations of the hand |
| Dislocations of the bones of the foot |
| Shoulder dislocations |
| Dislocations of the vertebrae |
| Dislocations of the forearm |
| Dislocations of the metacarpal bones |
| Dislocations of the foot in Chopart's joint |
| Dislocations of the phalanges of the toes |
| Diaphyseal fractures of the leg bones |
| Diaphyseal fractures of the leg bones |
| Chronic dislocations and subluxations of the forearm |
| Isolated fracture of the diaphysis of the ulna |
| Deviated septum |
| tick paralysis |
| Combined damage |
| Bone forms of torticollis |
| Posture disorders |
| Instability of the knee joint |
| Gunshot fractures in combination with soft tissue defects of the limb |
| Gunshot injuries to bones and joints |
| Gunshot injuries to the pelvis |
| Gunshot injuries to the pelvis |
| Gunshot wounds of the upper limb |
| Gunshot wounds of the lower limb |
| Gunshot wounds of the joints |
| gunshot wounds |
| Burns from contact with a Portuguese man-of-war and a jellyfish |
| Complicated fractures of the thoracic and lumbar spine |
| Open damage to the diaphysis of the leg |
| Open damage to the diaphysis of the leg |
| Open injuries of the bones of the hand and fingers |
| Open injuries of the bones of the hand and fingers |
| Open injuries of the elbow joint |
| Open injuries of the foot |
| Open injuries of the foot |
| Frostbite |
| Aconite poisoning |
| Aniline poisoning |
| Poisoning with antihistamines |
| Poisoning with antimuscarinic drugs |
| Acetaminophen poisoning |
| Acetone poisoning |
| Poisoning with benzene, toluene |
| Pale toadstool poisoning |
| Poisoning with a poisonous milestone (hemlock) |
| Halogenated hydrocarbon poisoning |
| Glycol poisoning |
| mushroom poisoning |
| dichloroethane poisoning |
| smoke poisoning |
| iron poisoning |
| Isopropyl alcohol poisoning |
| Insecticide poisoning |
| Iodine poisoning |
| cadmium poisoning |
| acid poisoning |
| cocaine poisoning |
| Poisoning with belladonna, henbane, dope, cross, mandrake |
| Magnesium poisoning |
| Methanol poisoning |
| Methyl alcohol poisoning |
| Arsenic poisoning |
| Indian hemp drug poisoning |
| Hellebore tincture poisoning |
| nicotine poisoning |
| Carbon monoxide poisoning |
| Paraquat poisoning |
| Smoke poisoning from concentrated acids and alkalis |
| Poisoning by oil distillation products |
| Poisoning with antidepressant drugs |
| Salicylates poisoning |
| lead poisoning |
| Hydrogen sulfide poisoning |
| Carbon disulfide poisoning |
| Poisoning with sleeping pills (barbiturates) |
| Fluorine salt poisoning |
| Poisoning by stimulants of the central nervous system |
| Strychnine poisoning |
| Tobacco smoke poisoning |
| Thallium poisoning |
| Tranquilizer poisoning |
| Acetic acid poisoning |
| Phenol poisoning |
| Phenothiazine poisoning |
| Phosphorus poisoning |
| Poisoning with chlorine-containing insecticides |
| Poisoning with chlorine-containing insecticides |
| cyanide poisoning |
| Ethylene glycol poisoning |
| Ethylene glycol ether poisoning |
| Poisoning by calcium ion antagonists |
| Barbiturate poisoning |
| Poisoning with beta-blockers |
| Poisoning with methemoglobin formers |
| Poisoning by opiates and narcotic analgesics |
| Poisoning with quinidine drugs |
| pathological fractures |
| Fracture of the upper jaw |
| Fracture of the distal radius |
| Tooth fracture |
| Fracture of the bones of the nose |
| Fracture of the scaphoid |
| Fracture of the radius in the lower third and dislocation in the distal radioulnar joint (Galeazzi injury) |
| Fracture of the lower jaw |
| Fracture of the base of the skull |
| Fracture of the proximal femur |
| Fracture of the calvaria |
| jaw fracture |
| Fracture of the jaw in the region of the alveolar process |
| skull fracture |
| Fracture dislocations in the Lisfranc joint |
| Fracture and dislocation of the talus |
| Fractured dislocations of the cervical vertebrae |
| Fractures II-V metacarpal bones |
| Hip fractures in the knee joint |
| Fractures of the femur |
| Fractures in the trochanteric region |
| Fractures of the coronoid process of the ulna |
| Fractures of the acetabulum |
| Fractures of the acetabulum |
| Fractures of the head and neck of the radius |
| Fractures of the sternum |
| Fractures of the diaphysis of the femur |
| Fractures of the diaphysis of the humerus |
| Fractures of the diaphysis of both bones of the forearm |
| Fractures of the diaphysis of both bones of the forearm |
| Fractures of the distal end of the humerus |
| Clavicle fractures |
| bone fractures |
| Fractures of the leg bones |
| Fractures of the bones of the hindfoot |
| Fractures of the bones of the hand |
| Fractures of the bones of the forefoot |
| Fractures of the bones of the forearm |
| Fractures of the bones of the midfoot |
| Fractures of the bones of the midfoot |
| Fractures of the bones of the foot and toes |
| Pelvic fractures |
| Fractures of the olecranon of the ulna |
| Fractures of the scapula |
| Fractures of the condyle of the shoulder |
| Patella fractures |
| Fractures of the base of the I metacarpal bone |
| Humerus fractures |
| Metatarsal fractures |
| Spinal fractures |
| Fractures of the proximal end of the tibia |
