Prosthetists are trained to deliver the best possible prosthetic care, regardless of whom the patient might be. But when the patient stands three feet tall and wants to show you his Pokemon cards, it can be challenging for even the most seasoned practitioner.
“Kids are not just miniature adults,” says Ed Moran, CPO, who has specialized in pediatric prosthetics at Lawall Orthotics & Prosthetics since 1981. “Children have anatomical and psychological differences, so prosthetists must treat them differently than adult patients.”
Perhaps one of the most common mistakes an inexperienced prosthetist makes when working with a very young child is breaking down the barriers to good communication. You can't worry a child with technical information,” says Moran. “As they grow into their teen years, they should be more involved in the process.”
Sometimes the success of a fitting session can be determined by the child's perception. “I try to talk with the patient and find out about their avocations. It helps to break down any obstacles to good communication, and to discover what the child may need assistance with accomplishing.” According to Moran, you often have to simply make it fun for the patient in order to gain compliance. He hopes that prosthetists will remember that they are committed to providing a prosthesis that fits properly despite the behavior of the patient.
Prosthetists must often do whatever it takes to make the fitting process more kid-friendly. For instance, when prosthetists use a cast saw to remove the cast on pediatric patients, they put earphones on the patients so that they can listen to music instead of the frightening sound of the saw. It helps to relax the children who may be experiencing anxiety about all the unfamiliar activity and surroundings.
When dealing with pediatric patients, however, the prosthetist has to be concerned with other people besides the patient. In the clinical setting, the practitioner is very involved with helping the family make decisions about treatment in pediatric patient cases. “We do more than just provide a prosthesis,” says Moran. “We often provide the necessary information to help parents understand the child's treatment options and the function and limitation of each component.”
During the fitting process, it is often a parent who speaks for the child. Prosthetists need to realize that they are dealing with the parent and the patient. Moran explains that many times the process can make even the most outgoing child shy. “If I am having trouble getting a little girl to give me feedback about her prosthesis, I will often leave the room for a few minutes. The child will usually tell her mother or father about the fit or comfort of a device before they will open up to me as a stranger.”
From a technical standpoint, there are a lot of differences that a prosthetist must keep in mind when fitting a pediatric patient. In pediatric work, practitioners are dealing with a high number of congenital problems, and limb length isn't always ideal. “As a practitioner, you have to realize the challenges involved with pediatric prosthetics,” says Moran. “Prosthetists who don't typically treat young patients frequently underestimate the force that a pediatric patient can exert on a device. They really push the limits because they're so active.”
Although practitioners don't have as many off-the-shelf products available to them in fitting pediatric patients, technology has come a long way. Better recommendations can be made because there are more choices. “We are seeing a lot of pediatric components on the market now,” says Moran. “Items like silicone gel liners, shuttle locks, energy storing feet, and shock pylons are becoming prevalent in pediatric usage. You know, it wasn't that long ago when every kid was fitted with a SACH foot. Now there are all types of feet available.”
In Moran's experience, parents seem to be the ones who are more concerned about cosmesis. When meeting with the family of a patient, cosmesis is one of the first questions raised when dealing with congenital upper-extremity patients. “I like to urge parents to allow their child the freedom to be without a prosthetic device. Kids normally aren't as concerned with cosmesis as adults are. If you look at the media, physically challenged athletes who have amputations don't wear the cosmetic coverings because they tend to get in the way. Kids look up to these athletes and want to model themselves after these individuals; therefore, they don't see the need for cosmetic covers on their sports prosthetics.”
Another general consideration for prosthetists who work with children is the need for regular follow-up visits. Children and their parents are not capable of evaluating the aspects of a prosthetic fitting, so follow-up visits for evaluation and adjustment are essential. A child's growth can alter the fit of a prosthesis quickly, so prosthetists must plan for growth and make frequent adjustments. And a child does not use a prosthesis the same way that an adult does, Moran notes. “Children don't stand or walk the same way that an adult does. As a prosthetist, I have to be aware of these differences in order to make the necessary compensations that will assure maximum functionality of the fitting for the patient.”
With so many differences to consider, Moran encourages other practitioners to get the education and experience to treat pediatric cases properly. “If a prosthetist isn't very experienced with fitting pediatric patients, I hope that they will get assistance or refer the patient to another practitioner,” he advises.
Ed Moran, CPO, is a member of the American Orthotic & Prosthetic Association, the Association of Children's Prosthetic & Orthotic Clinics (ACPOC), and the American Anaplastology Association.
For more information on pediatric prosthetic clinics in your area go to the ACPOC Web site www.ACPOC.org or call the Amputee Coalition office at 1-888/AMP-KNOW. You may contact Lawall Orthotics & Prosthetics at 1-800/735-4627.
About the Author
Christopher Perry is the manager of Strategic Marketing, a division of Chauncey Johnson & Associates, Inc., located in Memphis, Tennessee.
