They are not just small adults; some things are very different, though some are just smaller. I often tell our physical medicine and rehabilitation residents in training that there are only two differences between adult and pediatric rehabilitation: 1) growth and 2) development...and maybe a few conditions or diseases of childhood onset they will need to learn about. I then tell them that there are three kinds of people in the world, those who can count and those who can't; and that they only have to read about two things: everything they see on the wards or in clinic, and everything they don't. But today I will try to be more helpful. This article will focus mostly on functional lower extremity orthotic use and how the pediatric practitioner must think a little differently.
What Is Really Different: Growth
Children outgrow orthoses. They really do grow in spurts; if there was a Murphy's Law of pediatric orthotics, it would be that all growth spurts occur immediately after receiving a new orthosis, if one did not occur between the casting and the fitting. And yet, accurate fit is at least as crucial as it is in adults for comfort and function. Frequent adjustments and replacements are to be expected. Many children "sprout up," outgrowing the orthosis in length and height but actually having it become sloppy and loose in fit distally. If you use twister cables, particularly an articulated design, the joint must be kept close to the actual axis of rotation of the knee to avoid the mismatch gradually pulling the child down into a crouched position, with the waist belt falling down around his hips.