Children tend to have different injuries to adults, as their skeletal system is not fully matured. They have growth plates in their bones, which grow at different rates making them susceptible to injury at different ages.
The weakest point in children’s bones occurs at the growth plates or where tendons meet the growth plates. As opposed to adults, avulsion fractures and growth plate injuries are more common than ligament sprains.
Thus, it is advisable to X-ray a child’s joint/limb more frequently to that of an adult post injury. Inflammation or traction injuries can occur where tendons meet the growth plates causing pain, which may inhibit activity.
Apart from injuries, there are childhood conditions, which present at different ages. Many of the childhood conditions are more common in males than females.
There are varying degrees of each condition, which can help determine long-term outcomes. Conditions not to be missed are ones affecting the weight bearing bones and the surrounding cartilage, which protects the bones.
These are:
1.slipped upper capital femoral epiphysis (SUCFE) of the hip instability of the growth plate at the hip joint2.5 times more prevalent in males boys aged 10-16, girls aged 12-14
2. Perthes disease degeneration and death to the head of the femur at the hip joint 4 to 5 times more prevalent in males children aged below 10
3.Osteochondritis dissecans (OCD) of the knee affecting the weight bearing surface of the femur at the knee joint. It is a bony and cartilage injury potentially resulting in a detached fragment 2 to 3 times more prevalent in males children aged 5 to 15 The conditions described above require orthopaedic/medical review to determine management and long term outcomes.
More common and less serious conditions occur at the junction of tendons and growth plates. Commonly this is seen when children play more sport leading to overuse injuries. These include:
1.Osgood-Schlatter Disease presents as frontal knee pain affecting the growth plate below the knee cap at the attachment of the patella tendon. Often called jumper’s knee boys aged 10-15, girls aged 8-13
2.Sinding-Larson Johansson Disease presents as frontal knee pain but higher than Osgood-Schlatter. Much less common than Osgood-Schlatter disease affecting the growth plate at the base of the knee cap
3.Sever’s Disease presents as heel pain affecting the growth plate on the back of the heel at the attachment of the Achilles tendon commonly in children aged 10 or below
Management of these conditions/injuries is to modify the amount of activity the child does. Complete rest is often not necessary, as these conditions will resolve on their own at a later stage. It is important for the parent and child to understand this. Ice and stretching can help with pain. Improving the child’s biomechanics with advice on footwear and strengthening of weak areas may also be helpful.
Other less common conditions affecting the feet are Frieberg’s infraction affecting the 2nd toe and Kohler’s disease affecting a small but important bone in the foot called the navicular. Growing pains in children have been often described but poorly researched. There is sufficient anecdotal evidence to suggest that it is a phenomenon,. It often occurs at night; in both legs and there is no residual discomfort in the morning. Parents can be reassured that these pains will go away. They commonly occur in the younger age group between 3 and 7.
