Hips, feet, spines and muscles — and the two signs you can recognize across a room.
Every cast, brace and traction on this page needs the same check, and it outranks everything else: neurovascular status distal to the device.
Pain that keeps climbing, is out of proportion to the injury, and is not relieved by opioids — especially on passive stretch of the toes or fingers — is compartment syndrome. That is the emergency, and it comes before pallor or pulselessness, not after.
| What you find | What it means |
|---|---|
| Asymmetric thigh and buttock creases | The classic first clue — look with the baby undressed |
| Limited abduction on the affected side | The hip will not open out |
| One knee sits lower with hips and knees flexed | The femur is riding up |
| Ortolani — a clunk as it goes in | Reducible dislocation |
| Barlow — a clunk as it goes out | Dislocatable hip |
| Later: a limp, or walking on the toes on one side | Missed in infancy |
Pavlik harness under about 6 months: worn almost all day, and the straps are not adjusted by the parents. Teach them to check the skin under every strap, dress the baby in a light layer underneath, and never apply lotion or powder under it.
The foot points down and inward and cannot be brought to a normal position by hand. That last part is what separates it from simple positioning.
Ponseti method: gentle manipulation and a new cast every week, starting in the first weeks of life, often with a small Achilles procedure, then boots on a bar — full time at first, then at night for years.
| Curve | Management |
|---|---|
| Under about 25° | Watch — re-measure as they grow |
| 25–45° | Brace — it stops the curve getting worse; it does not straighten it |
| Over about 45–50° | Spinal fusion |
Bracing is worn most of the day over a thin shirt. The hard part is adolescence, not the brace — ask about it directly.
After fusion: log roll to turn, neurovascular checks, pain control good enough to move, and no bending, twisting or lifting for the period the surgeon sets.
The blood supply to the femoral head is interrupted, most often in boys aged about 4 to 8.
Treatment is containment — keeping the femoral head in the socket while it reheals, with rest, restricted weight-bearing and bracing.
| Juvenile idiopathic arthritis | Adult rheumatoid arthritis |
|---|---|
| Joint swelling lasting 6 weeks or more under 16 | Usually symmetrical small joints |
| Stiffness worst in the morning, better with movement | The same pattern |
| A systemic form with daily spiking fever and a salmon-pink rash | Rheumatoid factor more often positive |
| Silent eye inflammation — needs routine eye checks even with no symptoms | Eye involvement less common |
Morning routine is the nursing win: a warm bath or shower before trying to move, then gentle exercise. Night splints keep joints in position.
Handling is the nursing care. Lift an infant by supporting the buttocks and back — never by the ankles, and never by pulling an arm or leg. Take care with blood pressure cuffs.
Repeated fractures in a small child raise the question of abuse. Both can be true of a family under suspicion — the assessment is done, and it is done without accusation.
What actually shortens life is the heart and the lungs, not the legs. Cardiac and respiratory follow-up matter as much as mobility.
Children break differently: a greenstick fracture bends and cracks one side; a buckle fracture crumples; and a break through the growth plate matters because the bone still has growing to do.
| Check | What you are asking |
|---|---|
| Pain | Is it climbing? Worse when I stretch the toes? That is the emergency |
| Color | Pink, or pale and dusky? |
| Warmth and pulses | Compare with the other side |
| Movement | Can they wiggle fingers or toes? |
| Sensation | Numbness, pins and needles? |
Never put anything down inside a cast to scratch. Never let a plaster cast get wet. Never ignore a new smell or drainage.
Teach: elevate above heart level for the first day or two, ice over the cast, petal any rough edge, and come back for any of the checks above.