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Children's Medical Services - Special services for children with special needs
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Infant Toddler Development Training
Module 6, Lesson 4

Limb Problems

baby sleepingLimb malformations and amputated limbs are other types of orthopedic conditions seen in infants and toddlers. A limb malformation is defined as a deformity of a limb and includes webbed fingers or toes. The malformation may be as small as a misshaped thumb or missing digits (fingers or toes) or a loss or partial loss of an arm or leg. Infants and toddlers who are born with malformed limbs often have other associated conditions, particularly if they have certain rare syndromes. A team approach to treatment is needed. The child will see an orthopedist and also specialists who make orthotic or prosthetic devices. An orthotic device is a device that increases the child's independent functioning. A prosthetic device (prosthesis) is an artificial limb. Please note that the child with an uncomplicated malformation may not qualify for Early Steps.


Some infants and toddlers may need surgical removal of all or part of a limb. This is called amputation and the child is referred to as an amputee. The child will need support of their medical team that may include a child life specialist. The child life specialist is a person who has special training and who works in the hospital to help children cope during hospitalizations and stressful events. Children need support to adapt to a body image that is changed. The family also will need support to make decisions regarding the amputation and to cope with feelings about the altered appearance of their child.

Medline Plus Amputees is a resource that can be accessed for information about limb loss. The website has peer contact for parents of children who are congenital amputees and also contains information on summer camps for children as they get older.

Consider how the ITDS can help families who are coping with the altered appearance of their child due to limb loss? Can you give at least one idea?

Traumatic Brain Injury

2 little girls swingingA traumatic brain injury is a trauma that is sufficient to result in a change in level of consciousness and /or anatomical abnormality. Both the neurological and the orthopedic systems may be affected dependent on the severity of the trauma. Approximately one in twenty-five children each year will have a head injury, including scalp lacerations. One in 500 children will have a significant traumatic brain injury that results in altered consciousness. Children, birth to 5 years of age, represent a high-risk group because of their continuing motor and cognitive development.

A brain trauma may be mild, moderate, or severe.

  • Mild trauma - an example of a mild head injury is a concussion. There is usually a brief loss of consciousness, confusion, or amnesia. Concrete neurological findings are generally not present and the effects of the injury are temporary. There may be a behavior change, irritability, and change in cognitive functioning, and an increase in learning problems after a concussion, but these are relatively brief in duration.
  • Moderate to severe trauma - this may result in coma. A coma usually is a sign of diffuse axonal (nerve) injury, but the coma may also be the result of a focal injury. Coma is evaluated on scales that rate eye, motor, and verbal responses.

Head injury is often local in effect, but this depends on the nature of the forces that create the injury. Inertial forces tend to cause more diffuse damage and more internal injury. Forces such as those that may occur in high-speed automobile accidents may also cause spinal cord injury, deep organ involvement, and orthopedic problems.


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