Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder

The discussion highlights the unique anatomical features in children, such as the incomplete myelinization of the nervous system, the increased flexibility and resilience of bones, the critical role of the growth plate (epiphysis), and normal positional variations like genu varum and pes planus. Core nursing management principles are detailed, focusing on comprehensive assessment techniques—including evaluating reflexes, muscle tone (hypertonia/hypotonia), and performing specific maneuvers like Barlow and Ortolani for developmental dysplasia of the hip (DDH). Essential medical treatments are analyzed, including the use of immobilization methods such as casting, various types of traction (skin vs. skeletal), and external fixation devices, along with critical nursing implications like frequent neurovascular monitoring to prevent compartment syndrome. The chapter systematically reviews diverse pathologies: congenital defects like neural tube disorders (myelomeningocele), inherited conditions such as Muscular Dystrophy (Duchenne) and Spinal Muscular Atrophy (SMA), and chronic movement disorders like Cerebral Palsy (CP), emphasizing multidisciplinary team collaboration and specialized pharmacologic interventions (e.g., Baclofen, Botulinum toxin) for spasticity management. Finally, common acquired conditions, including fractures, overuse syndromes (e.g., Osgood-Schlatter), scoliosis, and Legg-Calvé—Perthes disease, are covered, providing nurses with the foundational knowledge needed to devise individualized care plans that address physical, nutritional, elimination, and vital psychosocial needs throughout the child’s development.