Page 16 - Mobility Management, January/February 2020

Pediatric Series
Growing Pains
weight or they’re aspirating and getting pneumonias. So the doctor says, ‘We have to put a feeding tube in.’ As soon as you put a feeding tube in, voila: They’re getting all the nutrients they should have been getting all along, and they start growing in width and sometimes, their height increases, too.
“I tell people to talk with the speech therapist, because the speech therapist normally has an idea, even if the family hasn’t accepted that a feeding tube is needed. The speech therapist can tell you, ‘Hey, they’re really not doing well eating by mouth. I have a feeling in the next year or two, doctors are probably going to say they need a feeding tube.’ They can give you the heads-up, because a lot of times, speech therapists work on feeding.”
Witten added, “With feeding tube kiddos, their diagnosis might be low tone or something like that. So they almost balloon with a feeding tube.”
5. Ask About Medications
“You need to take into account not only a feeding tube, but a Baclofen pump for spasticity can also have a huge impact on seating and positioning,” Witten said.
“I like to ask what medications they’re on, and that goes along with diagnosis,” Kiger added. “Are they on some sort of steroid or are they looking to get onto a program like that? What sorts of infusions are they getting? Sometimes, those lead to appetite increase or decrease.”
6. Is the Diagnosis Progressive?
“Think about degenerative conditions,” Kiger said. “A child or young man with Duchenne [muscular dystrophy] is typically
active and walking around until their diagnosis takes them to a point where they can’t ambulate. All of a sudden, they’re a little bit rounder than when they were younger and were able to move around a lot more, burning more calories.”
When that happens, seat width might need to grow.
7. Has the Child Entered Puberty?
Starting puberty causes kids’ bodies to develop and change in multiple ways. For girls, for example, Kiger said: “If you have a kiddo who’s 8, 9, 10 years old and she’s started her period early, by the time that chair is delivered, she might have gotten so hippy and gained a lot of weight because she was beginning to develop. It is important to know: Have they started their cycle, is it coming soon?”
Especially when the documentation process to qualify for the wheelchair is lengthy, Witten said checking back with the child can be helpful: “If they’re doing an eval in a state where it takes six months to get something approved, they really need to circle back and re-measure before they order that product.”
No Magic Formula
No research or growth chart can perfectly suggest the amount of growth that should be added to a pediatric system.
“It depends on what type of seating, what type of system, whether they’re going to self propel or not,” Witten said. Unfortunately, there’s no magic formula. Pediatrics is very chal- lenging, and very time consuming for the suppliers, too.”
Kiger acknowledged that some ATPs “say adults are way easier, because they’re not changing in size and ability as much.” m
When Should We Expect Growth “Spurts”?
Any parent who has tried to keep a refrigerator well stocked with teenagers in the house can testify that kids go through “growth spurts” — periods during which they grow quickly in a short time.
While parents joke about the impossibility of keeping up with kids who outgrow their clothing soon after it’s bought, growth spurts for children who use wheelchairs also pose challenges for the seating and mobility team.
When They Grow
According to The Nemours Foundation, a non-profit dedicated to children’s health, kids grow the most during the first year of life, when babies typically grow 10" in length and triple their birth weights. After that, growth slows.
“By age 2, growth in height usually continues at a fairly steady rate of about 2.5" (6 centi- meters) per year until adolescence,” the foundation said.
After a child’s first year, the next major growth spurt happens with puberty, which the foundation said lasts two to five years and typically happens between the ages of 8 and 13 for girls, and 10 and 15 for boys. By the end of puberty, kids will have reached or will be very close to their adult height.
Of course, children grow at different rates, so any growth spurt guidelines are just guidelines. But even standard guidelines can serve as a starting point when determining how much growth to build into a pediatric wheelchair. m
14 JANUARY/FEBRUARY2020|MOBILITYMANAGEMENT MobilityMgmt.com
BROTHERS: DEPOSITPHOTOS/MELKING