Maintaining healthy bones is important at any age, but for children, whose bones are still developing, it’s particularly pertinent. Avoiding injury is a big part of it, and instilling good lifelong habits is another. Dr. Brian Davison from Orthopedic ONE covers crucial issues in the development of growing bones.
What can parents do to help their children grow strong bones?
Nutrition is of vital importance. Parents need to make sure their children are getting the proper amounts of vitamin D and calcium in their diets in order to build string bones. Children need to get 1,000 milligrams of calcium a day and 600 IU of vitamin D. Just recently, it was discovered that 10 percent of all children in the U.S. are vitamin D deficient, and 60 percent have suboptimal levels of vitamin D.
What bones are most commonly broken by children?
The most common fractures, based on percentage of all pediatric fractures, are the distal radius or wrist (26 percent), clavicle (11 percent), fingers (10 percent) and ankle (7 percent).
What signs should I look for that a bone might be broken? When should I take my child to the doctor on suspicion of a broken bone?
Swelling and pain over the bone are the most common signs of fracture. Bruising often occurs slightly later. The child may feel nausea when the area is moved. And in more severe fractures, children may say they can feel the “bones moving.”
I would recommend seeing a physician if your child experiences any of the signs mentioned above after an injury that seems likely to cause a fracture.
What are some risk factors parents might not think of?
This may not be a surprise, but boys sustain 61 percent of all fractures. The age at which fractures are most common is 13-14 years in boys and 11-12 years in girls.
What are the most common types of breaks, and what do recovery times look like?
The most common fracture is the “buckle” fracture, which occurs commonly at the wrist. It will generally heal in four to six weeks with proper care.
Children have growth plates in their bones, and these plates are frequently involved in a fracture. While most heal in four to six weeks without growth disturbance, some growth plate fractures can cause the bone to lose the ability to grow or cause it to grow asymmetrically, which may cause deformity over time.
What effect can a broken bone in childhood have later in life?
The majority of fractures will heal well with correct alignment and will cause no long-term damage. If a fracture is handled improperly or neglected, it could heal with significant deformity, which could cause problems later in life. There are some fractures that have more potential to create deformity or issues into adulthood, such as fractures that affect either growth plates or joint surfaces. Fractures with significant damage to joint surfaces can lead to arthritis.
What are good habits to instill in children to cultivate strong bones in adulthood? What foods promote good bone health?
Good nutrition and weight bearing exercise are key. As adults, it’s also important to avoid smoking and alcohol intake, as both lead to lower bone mass. High caffeine intake is also harmful to bone strength.
Milk, yogurt, cheeses and green leafy vegetables all support healthy bones.
How can eating disorders affect bone health?
Peak bone mass occurs in most people around age 30, but girls should have accumulated 90 percent of peak bone mass by age 18, and boys by age 20. During puberty, our bones are growing rapidly and becoming stronger. During this time, it is very important to get adequate vitamin D and calcium in our diet. Any eating disorders during this time can have a major effect on a person’s bone health for the rest of his or her life. The higher our peak bone mass is at 30, the less chance of osteoporosis later in life.
One known cause of childhood bone fractures is parents going down playground slides with children in their laps. What are some other activities parents might be surprised to learn are dangerous?
In elementary school, the most common activity in which a fracture occurs is play. We can't tell our kids to stop playing! Falls while running or from a height and collisions with other kids are the usual culprits. The best way to prevent injury is to make sure children, especially small children, are not climbing on objects that may lead to a fall.
Fractures in teenagers are usually the result of sport. In this case, you can prevent injury by making sure your child is playing at the appropriate level and with children of the same ability.
What are some of the more recent advancements in broken bone recovery, particularly among children?
Many fractures, especially those with significant healing problems, can now be treated surgically. We also tend to cast or immobilize fractures less often than we used to and for less time, which helps to decrease stiffness in joints and loss of bone mass.
Are there medications that can have an effect on bone health? What are some examples?
Corticosteroids, often prescribed to treat asthma, can have a negative effect on bones if taken for a long period of time. They decrease calcium absorbed from food and increase calcium loss from the kidneys. Other medications that can lead to bone loss or damage include many commonly prescribed psychiatric drugs. With any medication, it's important to be aware of the side effects and discuss any concerns with your physician.
Do children who don’t get enough physical activity have any increase in injury risk?
Weight-bearing exercise is a key factor in developing peak bone mass or strong bones. Exercise that makes you work against gravity – such as walking, running, tennis, dance and hiking – is best. At least 30 minutes of this a day is ideal. Bone is a living tissue that responds to stress by getting stronger.
We also know that overweight children have more fractures than those of optimal weight. Maintaining a healthy weight through good nutrition and encouraging at least 30 minutes of weight-bearing exercise daily can decrease your child’s risk of fracture.
Is overexercise a potential risk as well? How much is too much?
Excessive weight-bearing exercise can lead to stress fractures. For this reason, it is good to engage children, especially young children, in a variety of activities instead of focusing on just one. Of course, there is no way to say exactly how much is too much for any particular child.
Dr. Brian Davison
Brian L. Davison, M.D., is a board-certified orthopedic surgeon, fellowship-trained in orthopedic trauma. His special interests include care of challenging fractures and total joint replacement and reconstruction.
He received his medical degree from the University of Iowa College of Medicine. His internship and residency were completed at University of Wisconsin Hospitals, and he completed a fellowship in Orthopaedic Trauma and Reconstruction at Vanderbilt University Hospital.
Davison is a fellow of the American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, Ohio Orthopaedic Society, Columbus Orthopaedic Society and Vanderbilt Orthopaedic Society, and is board certified by the American Board of Orthopaedic Surgeons.
Davison has published a variety of articles on orthopedic injuries and treatments and participated in a number of national, regional and local presentations on such topics.
14%
of pediatric leg fractures are caused by children going down slides on the lap of a parent or caregiver. The rubber soles of children’s shoes catching on the sides or bottom of the slide plus the weight of an adult makes for a dangerous combination. Let Junior slide alone or at least remove his shoes before riding down with him.
Source: Journal of Pediatric Orthopedics, 2009
