Using your research skills to find appropriate evidence, list the factors that may be contributing to the growing problem of vitamin D deficiency in the UK.

Answer:

• Children are less likely to be found playing outdoors. This has been attributed to safety and need for supervision and preference for computer games and television.
• Older children and teenagers wear makeup with sunscreen.
• Parents cover children up when outside in the sun to reduce risk of sunburn
• High factor sun screen is recommended (factor 50) to protect children from sunburn, but this obliterates any vitamin D synthesis.
• Cultural dress code.
• Cultural diet e.g. babies who are breast fed exclusively by a mother.
• Obesity – vitamin D is fat soluble, reducing ability for obese children to store it.

The Royal College of Paediatrics and Child Health have produced a position statement that outlines the problem and supports current measures to educate health professionals and families (RCPCH, 2012).

For an overview of the orthopaedic health issues related to vitamin D deficiency and the role of the nurse in prevention and management of hypovitaminosis D, access and read Judd (2013).

Reference

Judd, J. (2013) ‘Rickets in the 21st century: A review of the consequences of low vitamin D and its management’, International Journal of Orthopaedic and Trauma Nursing, 17(4): 199–208.

Royal College of Paediatrics and Child Health (2012) Position Statement Vitamin D. Available at: www.rcpch.ac.uk/system/files/protected/page/vitdpositionstatement

Look at the advice for parents and carers given by the International Hip Dysplasia Institute (www.hipdysplasia.org) and reflect on the support and reassurance you can give parents in this difficult time.

Answer:

• It is not their fault. The most common risk factor is breech presentation and family history of hip dysplasia. In 75 per cent of cases of hip dysplasia there are no known risk factors.
• Evidence shows that the Pavlik harness is 95 per cent successful in treating DDH.
• Reassure parents that their child will walk.
• Direct parents to reliable written information, such as the International Hip Dysplasia Institute (www.hipdysplasia.org) and Steps (www.steps-charity.org.uk).
• With permission, put parents in touch with other families whose child has had treatment for hip dysplasia.

• What suggestions can you make to enable parents to help their child who has LCPD?

Think, for example, about switching activities, offloading the hip during painful episodes (crutches, bed rest) etc.

Answer:

• The nurse needs to appreciate that Perthes disease is more common in young boys and parents worry that they will not be able to stop their child from running and jumping (activities that will make the affected hip painful).
• Recommend low or non-impact activities such as swimming and cycling.
• Advise that when the child has hip pain, they rest (this may be watching a DVD to encourage ‘sofa’ rest). They will benefit temporarily by using crutches or a child’s Zimmer frame to offload the hip.
• Inform parents about ‘help’ groups, such as Perthes Association UK.

Think about how different people express or interpret pain.

•           What does pain mean to you?

•           How can we as nurses assess pain? What tools are available?

Answer: See Richardson, G. (2012) ‘Pain expression in different cultures: A qualitative study of the analysis for the cues of pain in different cultures’,  degree thesis for Bachelor of Health Care (Nursing) Degree Programme in Nursing. Available at: www.theseus.fi/bitstream/handle/10024/43628/GraceRichardson.pdf?sequence=1

• What are the options for managing the child’s AMP so they can participate in their physical therapy to regain normal function?

Answer: See

Joslin, R. (n.d.) Pain Amplification Syndrome: Encouraging Children and Young People with Pain Amplification in Physiotherapy.  Available at: http://kssdeanery.ac.uk/sites/kssdeanery/files/Presentation%20-%2023.10.2014.pdf

West Sussex Paediatric Chronic Pain Service. A specialist service for children and young people with chronic musculoskeletal pain.