Chapter 42: Special Diagnostic Issues in Children

In this Chapter

• Special features of history taking in children

• Special features of the physical examination in children

• Unique features of bone growth and injury

Introduction

"Children are not small adults."

This is a well-known, but often overlooked maxim. When pointed out, it is so obvious that writing about it may seem unnecessary, but it bears emphasis and should be kept in mind throughout the various discussions in this chapter.

Pediatric practice like all physical therapy practice is constantly evolving. With the adoption of Vision 2020 by the American Physical Therapy Association, physical therapists are expected to practice as doctors of physical therapy.¹ Pediatric physical therapists serve children and their families in many environments where they may be the initial health care provider evaluating a child's or infant's ability to move. Because pediatric physical therapy practice is the only physical therapy practice that is federally mandated (IDEA),² the expectation that pediatric physical therapists will recognize signs and symptoms and accurately diagnose patients as part of providing those services is crucial.

Special Features of History Taking in Children

The Age of a Child is the Defining Feature in Differential Diagnosis

Many diseases only occur at specific ages or are extremely rare at other ages. For example, Legg-Calvé-Perthes disease more commonly occurs in the hip of boys ages 4 to 6, while a slipped capital femoral epiphysis would be more commonly expected in a boy ages 12 to 15. If a boy presents with increasing weakness at age 7 or 8, Duchenne muscular dystrophy is a more likely diagnosis than spinal muscular atrophy III.

Exact age is important to establish. In some cultures, for example, in Saudi Arabia where birthdays are not celebrated, a child's exact age is not well documented. The ages of children adopted from another country are often only estimates. This has been the case in children from orphanages in Romania, Russia, and some parts of China. A healthy skepticism is needed if such a child does not fit within the expected range of norms. Bone age radiographs and standardized developmental testing may help to determine an approximate age. Additionally, infants who are born prematurely (more than 3 weeks early) are evaluated based on "adjusted age" until they are 2 years old. This means that a child born 2 months early, who has now lived 4 months since delivery, would be regarded as a 2-month-old in terms of developmental performance, not as a 4-month-old.³

The History is Generally Obtained Secondhand Through the Parent

Especially when children are young, parents provide all the information. It is easy to overlook the fact that the information provided by a parent may be misinterpreted by the health care provider.

PARENTS ...