Treating Children Like Children

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By Andrea Spridgen
Andrea Spridgen

As any parent who has ever tried to explain to a five-year-old why he or she cannot wear a favorite pair of shorts when it's snowing outside can attest, children are not small adults; they do not comprehend the world with the same cognitive reasoning skills, and they are as different physically as they are mentally. So, we must approach the situations they are confronted with-including physical challenges-differently than we would if they were adults. We cannot simply shrink adult-size solutions and apply them to children. The features in this issue confront these problems and provide insight into possible solutions to help treat pediatric patients on their own terms-as children.

"Prosthetic Management of Rotationplasty in Children" examines a rare procedure that requires parents and the entire healthcare team to find ways to explain the impact of the surgery to the child in order to engage him or her in the process in an age-appropriate way. It is the kind of life-changing decision adults generally shield children from who are not yet fully emotionally and cognitively mature. Because of the unusual appearance that results from rotationplasty, Mike Gozola, CP, mentions the need for a strong peer network for those who do undergo it. Shanna Decker shares her recollections as a seven-year-old making the decision to have the surgery. With guidance from her parents, and while surprised by the concept of having a foot facing backward, she nevertheless was convinced that being able to do all the things she had always done in her young life would be worth looking different.

Overall, the pediatric population represents a small percentage of O&P patients, while requiring specialized devices that cater to their physiology. Judith Philipps Otto examines the availability of pediatric devices in "Is Pediatric Progress in O&P Keeping Pace With Kids?" Reinforcing the idea that children have their own special needs, Don Cummings, CP/L, FAAOP, cautions that downsizing adult components for use in children often undermines strength and durability. Other experts we interviewed echo concerns that one of the greatest challenges with pediatric O&P devices is that they must be small and lightweight enough to fit properly, while tough enough to sustain the paces children put them through-far more punishing forces than those put on adult devices. Coupled with these challenges, since the market is small, there is a proportionately small return on investment for development costs. Yet gains have been made and the experts offer suggestions to spur further creative efforts.

I hope this issue, dedicated to treating children as children, offers insight for encounters you may experience with your own pediatric patients. Happy reading.