A pediatric patient undergoing orthopedic correction may be at risk for pressure ulceration. Identification of a child at risk allows for closer monitoring and preventive interventions. The author is from the Shriners Hospitals for Children in Houston, Texas.


Pediatric patients at risk include:

(1) myelodysplasia (developmental abnormality of the spinal cord such as spina bifida occulta)

(2) cerebral palsy

(3) clubfeet

(4) scoliosis

(5) other


Risk factors for pressure ulceration:

(1) paralysis

(2) immobility

(3) insensate areas (unable to recognize an early injury)

(4) high activity (increased likelihood of trauma or friction)


Skin trauma:

(1) friction

(2) foreign debris rubbing skin

(3) chemical or thermal burns

(4) trying to scratch skin covered by a cast or appliance

(5) walking barefoot or with areas of exposed skin


Problem with orthopedic device:

(1) poorly fit

(2) improperly worn

(3) failure to change as the child grows


Moisture causing skin maceration:

(1) perspiration

(2) swimming or bathing with cast

(3) incontinence


Preventive measures:

(1) instruct the caregivers and patient to regularly inspect skin and problem areas for signs of skin damage or breakdown

(2) wear protective clothing and shoes to reduce environmental injuries

(3) keep areas dry and free of foreign debris

(4) maintain proper nutrition

(5) wear the orthopedic device properly and make adjustments as the child grows


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