Chapter 68: Prosthetics and Orthotics: Pediatric Considerations

INTRODUCTION

The intent of this chapter is to highlight special topics as they pertain to the prescription of prosthetics and orthotics in the pediatric population; for an in depth review of these topics please also see Chapters 48 and 79. A detailed evaluation and history are important in developing a comprehensive management plan in the pediatric rehabilitation population. In addition to etiology and level of involvement, patient goals, level of development, family support, and compliance should be considered. Often children require the assistance of a parent or caregiver for donning and doffing a device as well as proper wear and care of the device. Unlike the adult patient, the child requires more frequent follow-up and adjustments as a result of growth and activity. This chapter discusses pediatric prosthetics and pediatric orthotics. Each section describes common etiologies and design considerations. Treatment decisions to manage both immediate and long-term conditions in the pediatric population should be made with input from the complete medical team, including but not limited to the patient, the patient's family and/or caregivers, the physician, the prosthetist-orthotist, the physical therapist, the occupational therapist, the recreational therapist, the nurses, and the social worker.

PROSTHETIC CONSIDERATIONS FOR PEDIATRIC PATIENTS

Incidence and Etiology

The etiology of the amputation or limb deficiency is an important factor in prosthetic design, alignment, and component selection. The limb loss or deficiency can be congenital, caused by disease such as infection or tumor, or the result of trauma. Approximately 30% of patients have acquired amputations compared with 70% with congenital limb anomalies.¹ Congenital limb anomaly incidence is 5 to 10 per 10,000 live births,² with upper limb deficiencies being three times more common than lower limb deficiencies.³

Common Considerations

There are many factors to consider when deciding on prosthetic treatment for the pediatric candidate. Socket fit is fundamentally important in the overall fit and function of the prosthesis. If the socket is comfortable and well fitting, the patient should benefit from the functionality it is intended to provide. If it is uncomfortable, the child will reject prosthetic wear. The prosthetist's expertise will ensure a properly fitted socket. Some common considerations specific to the pediatric population in the prosthetic treatment design discussed in this chapter include frequency of adjustments and replacements, family involvement, residual limb length, bony overgrowth, alignment, activity-specific prostheses, and component size.

Frequent Adjustments and Replacements

Due to growth and higher physical demands of pediatric patients, more frequent adjustments and replacements should be expected compared with adults. Typically, a pediatric prosthetic socket should last 1 year, but this can vary depending on growth spurts and activity level.⁴ An endoskeletal prosthesis is designed with some postfabrication adjustability to allow for adjustments of the prosthesis and replacement of components (e.g., foot, terminal device, or socket) as ...