Common Medical Issues in Pediatric Rehabilitation-Part I

Posted by Nurse Linda in Life After Paralysis on December 23, 2020 # Health

There are many healthcare issues to consider for a child or adolescent with spinal cord injury. This will be a two-part blog to include the medical issues most often seen in children. This blog will start with issues and treatments for mental health, bladder, bowel, skin, and respiratory issues. These sections contain a quick overview of commonly seen issues. It is not inclusive of all concerns. children pushing each other's wheelchairs

As a parent or guardian, you will get to know your child the best. A change in their health status, behavior or temperament can be a guide that something is happening within or to their body. Children and teens do not always communicate effectively. The person who knows their child the best is also the best advocate for them. Some common issues for pediatric individuals are presented here.

Mental Health: The minute anyone says mental health, people tend to react. The status of mental health is something everyone protects however, keeping your mental health healthy is something we all work toward. It does not just happen. In life, there are upsets, sights, and disappointments as well as joys, happiness, and resilience.

An assessment of mental health can be performed simply at each medical exam through a series of questions. This provides a good baseline and a start to understanding your child’s mental health. Some children are too young to participate in questions and answers. Older children might want to put on a brave front for their parents. These are different personality types that can be sorted through an in-office test.

To gain an understanding of your child’s mental health, observe their behavior. If behavior changes for periods of time, a discussion about frustrations and upsets would be necessary or observe what is going on in their life. Everyone has days when they are tired of therapy or school or just whatever. However, longer periods of time indicate things are not as your child would wish.

Enlist the support of a professional to help your child and your family build the coping skills to deal with spinal cord injury. SCI affects the entire family. Having a safe place to vent as a parent is helpful, so your mental health stays healthy as well. You should not wait until you or your family is in crisis to seek support. A counselor, therapist, or educated clergy person will be able to support you and your child’s needs.

Bladder: Keep up with the bladder regiment that has been prescribed for your child. The bladder program intake of fluid and catheterization schedule will change as your child grows and develops. The child should become familiar with their technique as well as complications such as signs and symptoms of infection or how to get help if there is a problem.

Involve your child with what you are doing when you assist with bladder management. As the child enters school, many children will be able to perform simple bladder emptying skills. They should know the steps to their bladder program if hand control is an issue. More complicated bladder treatments may take a bit more time to master.

Children have a variety of bladder programs from suprapubic, ostomy, intermittent catheterization, and external catheters. Some children will be able to void spontaneously or by using triggers. Some will wear urine containing products (diapers). Make sure bladder needs are normalized for your child because this is their normal.

Keeping dry is dependent on the coordinated function of the bladder and sphincters. The contraction of the bladder wall should happen when the internal and external sphincters open to allow urine to flow out. If this process is out of sequence, urinary retention, urinary incontinence, or reflux of urine into the kidneys can occur. Be sure to have an annual urodynamic study performed to make sure this coordination process is happening. Early care and detection of bladder issues can avoid damage to the urinary system in the present as well as in later years.

Bowel: Children who have spinal cord injury have a neurogenic bowel, which is nerves affected that control bowel function. Constipation is hard stools that are difficult to pass caused by diet, poor fluid intake and slow bowel movement. A child can have constipation, which needs treatment, but constipation is not the issue causing the bowel problem after SCI. Neurogenic bowel, a nerve issue, is the problem after SCI. Treating constipation is important if that is an issue, but constipation treatment does not affect the nerves causing neurogenic bowel.

A bowel program is a method for removing stool from the body with neurogenic bowel. For children with an upper motor neuron spinal cord injury (cervical and thoracic levels), a suppository followed by digital stimulation is used. Children with a lower motor neuron injury (lumbar and sacral levels) have their bowel evacuated by digital removal of the stool. Providing healthy nutrition with fiber in the diet and fluids, mainly water, helps the bowel program. Some medications such as stool softeners help as well as fiber additives.

An effective bowel program is essential, especially for school-aged children. By the time the child enters school, they should have a good idea about how to perform a bowel program if they are not able to do it themselves. Again, make this process normal for your child as it is their normal.

Skin: Children’s skin appears resilient, and it is, but also more delicate than adult skin. Burns happen more often in children. Especially, burns are risky for individuals with decreased or absent sensation. Be sure to use sunscreen to avoid burns. A heating pad or hot pack burns happen without warning, which makes them not recommended. Care should be provided to make sure spilling of hot fluids or foods (think about popcorn bags right out of the microwave) does not happen.

A pressure injury, friction and shearing happen to children frequently. Be sure to turn your child, make sure they are doing pressure releases and guard against rashes. Also, check for proper fitting and applied anti-embolism stockings as a wrinkle can cause an injury to the skin or start a blood clot. Equipment such as splints and braces can also rub. Even if the equipment fit perfectly yesterday, a child can change practically overnight, making something not quite right. In all children but especially older children, the fashion of the day can cause constrictions. Too tight shoes or pants are the usual culprits, but styles change, so always be on the lookout.

Respiratory: Spinal cord injury at any level affects breathing. Practice deep breathing and coughing with your child four times a day. This is done by taking in three really deep breaths and letting the air out slowly. That should produce a cough. This action moves fluid and debris around in the lungs, making them easier to clear. An incentive spirometer can accomplish deep breathing. It is a device that has balls that go up a chamber when taking in air. This can become a game with your child. Clear lungs lead to fewer infections, colds, and pneumonia.

One of the primary causes of infection in the lung is choking on food. It can happen to anyone, but children with swallowing difficulty are at an increased risk. If food is inhaled that has been lingering in the mouth; bacteria has already formed in the food. After choking, the bacteria and the food can enter the lungs. Keeping the mouth clean after eating is one of the best preventions of pneumonia for individuals of all ages.

If your child uses an assistive device for breathing, make sure your use the sigh feature if it is not built into the mechanical ventilator program. Repositioning also moves the fluid in the lungs, as does the use of a cough assist, chest physical therapy, nebulizers and external chest supports (VEST).

Keep respiratory equipment impeccably clean. There are cleaning devices for some systems. Since there is moisture from the lungs and in the air inhaled into the lungs, bacteria are quick to grow. Cleaning is essential so as not to promote infection.

Next month, we will focus on preventions, issues and treatments in cardiovascular, metabolic, nervous systems and infections. In the meantime, if you have general questions, be sure to submit them on the Community site of the Christopher and Dana Reeve Paralysis Foundation website. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.