Pediatric – week 9 discussion 2nd reply

Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.   

CBY discussion: 

What are 3 differential diagnoses of leg pains in school-age children? Include the pathophysiology of the 3 differentials.

Growing pains: a common cause of leg pain in childhood, are characterized by poorly localized pain at night, which frequently wakes the child from sleep; no objective signs of inflammation; and no daytime symptoms (Hay, et al., 2020). Growing pains (benign idiopathic paroxysmal nocturnal limb pains): underlying cause and pathogenesis are not known, but contributing factors may include1excessive physical activity (DynaMed, 2018).

Fibromyalgia : Fibromyalgia is a chronic pain syndrome characterized by diffuse musculoskeletal pain, fatigue, sleep disturbance, and chronic headaches. Weather changes, lack of sleep, and stress exacerbate symptoms (Hay, et al., 2020). The exact mechanisms of fibromyalgia development are unknown, but impaired central pain processing involving altered neuroreceptor and neuropeptide physiology appears to be primary disease driver (DynaMed, 2018).

Restless leg syndrome: Restless legs syndrome (RLS) is a neurologic disorder characterized by the irresistible urge to move the legs, usually worsening at rest, relieved with movement, and occurring in the evening or at night.The pathogenesis generally unknown, but hypotheses include: hypodopaminergic hypothesis based on relief of symptoms with dopaminergic treatment exacerbation or unmasking of symptoms with dopamine antagonists circadian pattern of RLS symptoms mimics circadian pattern of dopa-responsive dystonia. RLS patients usually exhibit iron deficiency (< 50 ng/mL) in many (DynaMed, 2018). 

What laboratory or radiographic studies are appropriate for children with leg pains? Explain

In the case of growing pains, there are no diagnostic tests as it is considered a benign condition. However, if symptoms such as fever, swelling, and pain that doesn’t get better with massage, heat, and pain medicine persists., diagnostic studies such as x-ray would be warranted. Testing to consider to rule out underlying causes if presentation is atypical includes:

• complete blood count with differential and erythrocyte sedimentation rate
• electrolytes, metabolic profile (including calcium, phosphorus, alkaline phosphatase)
• rheumatoid factor
• muscle enzymes
• x-rays (typically with focal or asymmetric pain) (Dynamed, 2018).

How do musculoskeletal injuries in children differ from those in adults? In terms of injury type and location.

Cartilaginous bones: The bones of children are more cartilaginous and flexible than those of adults, and for this reason, green stick fractures are common in children i.e: fracture of supracondylar rather than dislocation of elbow (The Royal Children’s Hospital Melbourne, n.d).

How does the nurse practitioner decide the extent of the diagnostic work-up in a child with extremity pain?

The NP noticed that:

• Pain that doesn’t get better with massage, heat, and pain medicine
• Pain during the day
• Swelling, redness, or joint pain
• Pain due to an injury
• A fever or other signs of illness, like poor appetite or weight loss exists (Gavin, 2021).

What fractures are common in pediatric patients, and what are the ages associated with them?

Most common fractures are of the elbow and femur. Depending on the age of the child, the growth plate may be open, which places the child at risk of injury to the growth plate and subsequent abnormal healing limitation to the future bone growth (Burns, et al.,2019).

Choosing one of the diagnoses you’ve come with; how would you treat the condition?

Growing pains:

• Leg massages, rubbing, and heat therapy for acute pain.
• The use of acetaminophen or nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen for intense or recurrent pain. Advise to avoid regular and long-term use.
• Stretching exercises or physical therapy
• Cognitive behavioral therapy for children with low pain threshold or emotional disturbance and family stress
• Follow-up if symptoms worsen over time or if child develops any atypical symptoms (DynaMed, 2018). 

References

Burns, C., Dunn, A., Brady, M., Starr, N., Blosser, C. (2019). Burns’ pediatric primary care (7th ed.). Saunders. ISBN:9780323581967.

DynaMed (2018).Fibromyalgia. Retrieved from https://www.dynamed.com/condition/fibromyalgia#GUID-7473CBD0-9BDA-4298-9FB0-2355F4497641

DynaMed (2018).Growing Pains. Retrieved from https://www.dynamed.com/condition/growing-pains#GUID-A55BBA45-ED81-42D3-B129-FE3540E07651

DynaMed (2018). Restless Legs Syndrome (RLS) . Retrieved from https://www.dynamed.com/condition/restless-legs-syndrome-rls#GUID-2F28AF86-7F69-4B33-A796-D52CC22D244C

Gavin, M. (2021). Growing Pains. Retrieved from https://kidshealth.org/en/parents/growing-pains.html

Hay, W., Levin, M., Deterding, R. Abzug, M. & Sondheimer, J. (2020). CURRENT diagnosis and treatment: Pediatrics (25th ed.). McGraw-Hill. ISBN: 978-1260457827.

The Royal Children’s Hospital Melbourne  (n.d). Retrieved from https://www.rch.org.au/trauma-service/manual/how-are-children-different/