Children have developing and growing bodies, and abnormal forces applied to their tissues often result in different injuries than those seen when similar forces are applied to the adult body. Below are some examples of how injuries to children can differ from those seen in the adult population.
“Growing pains” are used to describe specific aches and pains that occur in children as they experience growth spurts. These pains occur at the insertion of tendons onto bone. As children grow, the long bones of the body grow faster than the associated muscles. As a result, these extra forces cause an irritation at the insertion of the relatively shortened muscles onto the bones
The most common sites for these injuries are the tibial tubercle where the patella tendon inserts into the tibia (Osgood Slatters), and the calcaneum where the Achilles Tendon inserts into the calcaneum (Severs). However, these stress reactions can occur at other sites around the body wherever tendons join onto bones and growth occurs at a rapid or inconsistent rate. Another site is the anterior superior iliac spine (ASIS) where the quadratus femoris attaches.
Children’s growing bones are softer than fully formed adult bones. As a result, instead of a joint sprain resulting in ligament rupture (seen in adults), the ligament may avulse from the bone itself, leaving the ligament intact, or the bone itself will fracture. Examples most commonly seen are avulsions of the superior attachment of the ACL or fracture of the distal tibial growth plate with a severe lateral ankle sprain.
The uncovertebral joints in the cervical spine do not form until around 8 years of age. This means that young children have a more unstable neck, as well as a larger head compared to body size, than adults. Trauma to the neck which results in an acute wry neck (such as a fall onto the head) can be a sign that quite severe damage has occurred to the upper cervical spinal joints. An x-ray is highly recommended in this situation. Cervical manipulation is contra-indicated in children under about 12 years of age for this very reason.
Children experience Greenstick fractures rather than complete bone breaks (bone snaps like a green stick pulled from a tree). Instead of fracturing all the way through the bone, it will splinter and split on one side. The bone can be deformed but often the child can move the limb better than one would expect with a fracture.
The child often presents with either severe acute knee pain or severe acute groin pain, and is unable to weight bear on the leg. Immediate x-ray is essential and if positive, hospitalization is required. If the x-ray is clear, the diagnosis is the less severe Irritable Hip Syndrome, which responds to a couple of days rest followed by physiotherapy treatment for mobility and strengthening.