Welcome to Stay in the Game, a monthly blog where the team from The Queen's Health Systems share the latest tips on the treatment and prevention of sports injuries. We want to help you play hard and be well - a winning combination that will keep you in the game all season long.

Children are NOT little adults

Although they often look like miniature versions of ourselves, children are NOT little adults. In addition to being smaller than adults, children's bodies also function differently and they need physicians specifically trained in taking care of them. These specialists are important to ensure that they fully recover from illnesses and injuries and that they do so without inappropriate interventions such as unnecessary surgery.

Here I will discuss how children and adults differ from one another, what a pediatric specialist is, give an example of how a pediatric specialist may treat something differently and help you to figure out if your child needs a pediatric specialist.

Children vs. adults - What are the differences?

Even at the most basic level, children have normal vital signs that are different from those of an adult. In general, their heart rates and breathing rates are faster than ours, and what would be a normal rate in an adult could signal a very serious condition in a child.

Medicines to treat illnesses and other conditions are sometimes different in a child versus an adult. And even when the same medication is used, the dosage is often less for a child and is usually based upon their weight rather than a preset amount.

Children are also actively growing and developing which means their bodies are, literally, constantly changing. A treatment approach at one phase in their life may no longer be appropriate as the child ages. A 5-day-old newborn is different from a 5-month-old infant, who is different from a 5-year-old child, who is different from a 15-year-old adolescent. Even amongst children of the same age, significant differences in development occur and it is possible for two 12-year-olds with the same medical problem or injury to require very different treatments.

For sports, there are a couple of other differences that many folks are unaware of. First, young children do not sweat as much because their sweat glands are still underdeveloped. This means they may not be able to cool off as efficiently and may be at increased risk for heat related injuries. Second, when a child falls or is injured they are much more likely to sustain a broken bone (fracture) rather than a ligament or tendon injury because their bones are relatively weaker than an adult's bones. In addition, children's bones fracture differently and they can break without showing up on x-ray (this is called an occult fracture) or they can break by crumpling or bending slightly rather than actually cracking (this is called either a buckle fracture or a greenstick fracture).

What is a Pediatric Specialist?

All physicians go through the same basic training - college, medical school and residency - which takes about 11-13 years to complete. After residency some physicians choose to do a Fellowship, additional training that concentrates on a specific focus of interest within their area of medicine or surgery. Once this Fellowship training is done, they are considered to be a Specialist. There are many types of Pediatric Specialists and in general if there is an Adult Specialist then there is probably a comparable Pediatric Specialist to match.

Example of Pediatric Specialty Care

I am a pediatric orthopedic surgeon, which means I specialize in taking care of bone and joint injuries and disorders in children. In adults, displaced fractures (broken bones that have shifted out of position) very commonly require surgery to heal properly. In children, however, the same injuries can be treated successfully not only without surgery but also without even having to straighten out the bones.

These x-rays are of a 9-year-old child who sustained a severe fracture of the lower portion of their forearm just above the wrist joint.

X-rays at the time of injury:

Previously, this type of injury was always treated with an attempt to straighten the bones and surgery was often required to achieve realignment. We now know, however, through research done in my clinic right here in Hawaii that in children 10 years of age and younger this injury does NOT need surgery and in fact does not need to be straightened out at all. The injury can be allowed to heal "as is" in a cast and over time the bones will straighten out on their own.

X-rays taken in the cast without straightening the bones:

X-rays taken immediately after the cast was discontinued:

X-rays taken 2 years later – the bones have straightened out on their own:

This process is called "bony remodeling" and only occurs in children. It is important to understand that this does not occur in all children and it is the knowledge and experience of the specialist that allows this approach to be selected for the proper patient.

Does my child need a specialist?

Not all children require the services of a Pediatric Specialist. Many mild to moderate illnesses and injuries can and should be treated by your child's primary care physician (PCP) -- i.e. their pediatrician, family medicine physician or medicine-pediatrics physician. Only when the condition is severe enough that it exceeds the expertise of the PCP should consultation with a specialist be considered. Your child's PCP knows the most about them and is therefore in the best position to decide when a specialist may be necessary and having a conversation with them is the best way towards figuring this out.

The After Hours Center at The Queen's Medical Center – West Oʻahu provides Central and West Oʻahu families with easy access to care for minor injuries and illnesses. The center is open daily and treats adults' and children's health conditions after their doctor's regular business hours. It's a convenient alternative to going to the Emergency Department for minor illnesses and injuries. Simply walk in, or call 808-691-3115 for more information.




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