Pediatric Hand Patients
Pediatric hand patients can span anywhere from birth to the age of 18. Most of my talk will focus on the younger pediatric patient, because teenage patients are very similar to adult patients, as far as how you are going to treat them and the protocols that you are going to use. However, the younger pediatric patients (infant to about age 12) are very different.
They are smaller and have a different body composition than adults. As you know, pediatric patients’ hands and forearms are pudgy which can greatly affect treatment and splints. They do not yet have their defined bony landmarks, so your evaluation is definitely altered. They have a limited attention span, if they have any attention span at all. They have limited understanding, so they are not going to follow directions the same way that an older child or an adult would. Most of all they are fearful. They are fearful of strangers. They are fearful of the unknown. They do not know what you are going to do. Your whole treatment approach is going to be different with this population.
Pediatric patients also do not sit still. You are always working with movement, which can make splinting, wound care, and exercises very difficult. However, the pediatric patient does not get as much resultant stiffness. They have a much higher rate of collagen in their body. You can immobilize them for four, five, to six weeks and they will still come out with great motion and without getting the stiffness that an older child or an adult would get. They also heal quickly.
With this population, you must deal with the parents or caretakers. A child is not going to follow your instructions. Their home setting is very important and to understand who is going to be taking care of them. Is it a parent? Do they go to daycare every day? Do you need to work with the daycare worker? Do they go to school? Who is responsible for that child?
They also have developing systems. You need to understand normal development for muscle, neurological, skeletal, cognitive, and language development. You need to have a great grasp of this population. You need to know their cognitive and language level in order to communicate effectively with the child.