John Loiselle, MD, FAAP, highlights pediatric musculoskeletal injuries in the office and acute care setting

At the 2024 American Academy of Pediatrics National Conference and Exhibition, John Loiselle, MD, FAAP, chief of emergency medicine at Nemours Children's Hospital in Delaware, presented an insightful discussion on the ten most common musculoskeletal complaints in pediatric patients. His focus was on how children's developmental anatomy predisposes them to certain conditions that differ significantly from those in adults, and what pediatricians need to know to effectively diagnose and treat these injuries.

Loiselle explained that children are more susceptible to certain musculoskeletal injuries due to the presence of growth plates that are absent in adults. “Children have growth plates that adults do not have, and therefore these begin to hypertrophy during the growth spurt,” he noted. This developmental process puts children at risk of specific injuries, such as: B. a slippage of the epiphysis of the femur, in which the pressure from growth and weight affects the growth plate in the hip joint.

He also emphasized that musculoskeletal problems often occur in primary care and are not immediately referred to orthopedic surgeons. “Most of us think that we're all going to see the orthopedic surgeon, but we don't imagine the orthopedic surgeon,” Loiselle pointed out, emphasizing the importance of pediatricians in determining which cases require further specialist care.

During his talk, Loiselle discussed the range of injuries children can sustain depending on age and stage of growth, covering common areas such as the ankle, elbow and wrist. “I will talk about the different types of diseases or injuries that can occur in this ankle,” he said, emphasizing the need to consider age-specific anatomy when assessing a child's musculoskeletal conditions.

Loiselle gave pediatricians practical advice on how to handle physical exams in children, urging them to begin with careful observation. “I spend a lot of time focusing on the observation portion of the assessment and seeing what the child can do spontaneously with that limb,” he advised, pointing out that jumping into a hands-on exam too quickly can reduce a child’s pain can make things unnecessarily worse.

With this presentation, Loiselle sought to provide pediatricians with the knowledge to effectively assess and treat pediatric musculoskeletal conditions, minimize chronic problems, and ensure timely referrals when necessary.