Paediatric Lower Limb Flashcards
Head in baby
Developing brain
Fontanelles
Rudimentary viscerocranium
Larger neurocranium vs smaller viscerocranium
Facial development quite prompt
Straight eustacian tube with close relationship with adenoid
Glabella and supraciliary arches with mastoid processes are absent
Sutures of skull are open
Why is neurocranium relatively large
To accommodate developing brain
Why is neurocranium v flexible
allow it to pass through birth canal
What ensures flexibility of neurocranium
Fontanelles
Frontal fontanelle
Can show signs of high pressure, high CSF or be depressed if dehydrated
Allows ultrasound imaging of brain without exposing newborn to radiation
If sutures close too early
Can cause deformation of head and face
Big head baby complications
Babies are gravity dependant
Having heavy head on a short and not very mobile neck –> at first weight is shifted towards head
Structural deformity example
Talinthus equinavarus
Hip dysplasia
Position in womb and RFs are indicator to measure hip congruity for possible developmental hip dysplasia–> do X ray
why are airways obstruction risk in babies
Narrow airways
Large occiput and tongue
Smaller oral cavity
Flexed neck in lying
Epiglottis/larynx
C3/4
high at first
–> implications for feeding/breathing/oedema
Babies breath through
Nose
Thorax
Horizontally oriented ribs
Cartilage>bone
Relatively large organs- large heart, so hard for lungs to expand
Respiratory muscles
Type 1
Muscles lack tone/power/co-ordination
–> leads to fatigue
Lung development
Alveoli small in size and number –> small SA for gaseous exchange
Neck and spine
Different–> more elastic
Facet joints
Shallower and more horizontal in kids
Ligaments + joint capsule
More stretchable
Uncinate processes
Absent
Contribute to stability
Nuchal muscles
Weak
Contribute to flexibility
Vertebral bodies
Anterior wedging of vertebral bodies
Spinous process less developed
–> decrease the stabilising effects of paraspinal muscles
–> hypermobility of spine
Primary curves
Thoracic and sacral curvature formed during foetal development
Secondary curves
Develop after birth
Cervical curvature- 1st one- forms as result of lifting head
Lumbar curvature- 2nd one- forms as result of sitting and walking
Vertebral ossification centres
i.e. imaging of the odontoid
Spina bifida- due to non-fusion at back of head yet
Spinal growth
‘ascent’ of the spinal cord
Descent of viscera (larynx)
Phases
o Sit- 6 months o Crawl- 9 months o Walk with support- 1 year o Walk without- 15 months o Run- 18 months o Can skip stages and times vary
Walking
Walking base is wider Stride length + speed are lower Cycle time shorter No heel strike at initial contact- whole foot Limited stance phase knee flexion Whole leg is externally rotated in swing Swing is shorter No reciprocal arm swinging
Power generation
Youngest children use hip flexor and extensor muscles more than ankle power flexors for power generation
When toddlers walk, most of muscles activated through most of cycle- not very energy efficient
Theory that development is…
Proximal –> distal
Lower limb normal variants
Physiological genu varum (bow legs) –> straight –> physiological genu valgum (knock knees) –> straight
Flat feet
Not being able to wear footwear/uncomfortable
Skin breakage and blisters
If stand on tip toes and arch is reappearing- good sign- means flat feet are flexible
Immature bone characteristics
Significant osteopenic potential
Periosteum in paediatric bone is thicker- reduces displacement fractures and chance of open fractures
Growth plates
Physis- area of developing tissue near the end of the long bone- regulates and helps determine length and shape of bone
Weakest section of skeleton, and fractures happen
May have complications
Can stop growth or stimulate growth
Non-accidental fractures
e.g. spiral fractures of humerus or femur in toddler and younger children- strongly linked and should be careful history background examinations used to determine child at risk and safeguard
Slipped Captio Femoral Epiphysis (SUFI)
- 8 and 16 years
- thigh hip and knee pain
- hip pain can radiate to knee first or groin
- presents with limp or antalgic gait
- restricted internal rotation and obligatory external rotation during hip flexion, leg length discrepancy
- Management- surgical
Perthe’s
- avascular necrosis of proximal femoral epiphysis of hip
- initiated by disruption of blood flow to head of femur
- most common between 4-10 but can be 2-14
- child presents with knee or hip pain with limb
- restriction in Rom and leg length discrepancy
- can produce permanent deformity of femoral head which can lead to OA in future
Physical activity kids
Average 6 year old spends 2 hours a day watching TV secondary to playing/outdoor activities
Huge gap between boys and girls
Only 28% of kids achieved 1 hour at school and 22% achieved after school
F words
Function Fitness Friends Family Fun Future
