Chapter 53: Musculoskeletal & Joint Disorders in Children

Musculoskeletal & Joint Disorders in Children explores the management of musculoskeletal and articular conditions within pediatric nursing, emphasizing the profound physiological and psychological impacts of immobility on a growing child. It details how restricted movement can lead to systemic complications, including muscle atrophy, bone demineralization, and cardiovascular or respiratory decline, while highlighting the nurse’s role in mitigating sensory deprivation and developmental regression. The text moves into traumatic injuries, outlining the PRICE protocol—protection, rest, ice, compression, and elevation—for soft-tissue damage like sprains and dislocations, and provides a deep dive into fracture management. Key assessment tools like the "6 P's" (pain, pulselessness, pallor, paresthesia, paralysis, and pressure) are established as vital for detecting ischemia and compartment syndrome. The chapter also covers the complexities of orthopedic devices, from the application and maintenance of various casts to the mechanical principles of skin and skeletal traction, such as Bryant or halo devices. Congenital deformities, including developmental dysplasia of the hip (DDH) and clubfoot, are discussed alongside their respective treatments like the Pavlik harness and Ponseti serial casting. For adolescent populations, specific attention is given to structural issues such as scoliosis and kyphosis, as well as acquired conditions like Legg-Calve-Perthes disease and slipped capital femoral epiphysis (SCFE). Furthermore, the chapter addresses infectious and neoplastic challenges, ranging from osteomyelitis and septic arthritis to bone cancers like osteosarcoma and Ewing sarcoma, emphasizing the necessity of multi-modal therapy. Finally, it outlines the chronic management of autoimmune disorders, specifically juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE), focusing on pharmacological interventions, physical therapy, and the long-term psychosocial adaptation of the family unit.