Children Differ From Adults
pmm highlights important knowledge about musculoskeletal medicine in children and young people. This is very different to adult practice.
- Children are developing - physically, emotionally and psychologically - illness impacts on them differently to adults.
- Normal variants in development in young children results in changes that can be mistaken as pathology.
- Patterns of pathology are different in children and at different ages (e.g. causes of limp).
- Communication with children takes patience and skill - the parent/carer often provide the history but it is still important to engage with and include the child (as appropriate to age).
We encourage you to watch the short video below which highlights why clinical assessment in children is different to adults.
The video shows a 22 month old girl and her parents noticed her to be limping. Whilst watching the video, ask yourself the following;
Do you think she is in pain ? Look out for verbal and non-verbal clues.
Which joints are affected ? Look at both her upper and lower limbs.
Key points from the video:
- This little girl has Juvenile Idiopathic Arthritis (involvement of ankles, knees, wrist).
- The child may not give any verbal history and this is often obtained from the parent / carer.
- The history may not tell you where the problems are (so need to examine all joints as part of your general assessment).
- Children may not verbalise pain and non-verbal clues are important (e.g facial expression, withdrawal and non-usage of a limb).
- Normal musculoskeletal development is important to know as there are different normal ranges of joint movement, differences in leg alignment at different ages and motor milestones change with age. So you need to know what is normal to be able to identify what is abnormal.