I have been in the O&P profession for more than 25 years and have focused most of that time in pediatrics, including working in pediatric O&P specialty facilities, pediatric O&P education, and consulting for pediatric orthopedic programs.
Serving pediatric O&P patients presents unique challenges, such as the size, cost, and adjustability of the devices. New technology rarely comes in child-friendly sizes. However, the pediatric O&P client base and reimbursement percentage for most facilities is small, so having practitioners and research and development (R&D) departments that specialize in pediatrics is cost-prohibitive and difficult to justify. Managing the device during a child's musculoskeletal development presents additional difficulties. Often a child's growth is not uniform, so the device might have to be adjusted in one aspect but remain the same in another—for instance, a prosthetic socket might be outgrown but the pylon height is still acceptable. Since children are constantly growing, adjustability is important to minimize the expense of frequent replacements for outgrown devices.
Despite these challenges, O&P pediatric specialization is necessary to provide this population the same level of care and consideration as the adult O&P patient population. Pediatric specialization extends beyond O&P knowledge to include an in-depth understanding of numerous syndromes, neurological issues, musculoskeletal problems, and degenerative diseases that are not often seen in adults, as well as other complicating diagnoses such as autism. Further, many disorders involve abnormal muscular development and bone growth issues that also are uncommon in adults. This requires O&P practitioners to give special consideration to functional development, gait training, and therapeutic goals of the pediatric O&P population—all of which will change multiple times during the child's growth and physical development.
Given these issues, what are possible solutions?
Developing partner programs with pediatric specialty facilities may be one answer. Private facilities and manufacturers may need to research the nonprofit sector to find ways to fund research and new technology through grants or private foundation contributions. Pediatric orthopedic care facilities often allow resident or fellowship programs that will increase exposure to common pediatric O&P cases; these programs could possibly be expanded to include O&P practitioners.
Other ways to increase and/or share the specialized pediatric knowledge within your practice may include volunteering with schools, summer camps, and other child-focused programs, or encouraging your employees to do so. Summer camps that specialize in diagnosis-specific populations—such as spina bifida or cerebral palsy—can not only expose O&P practitioners to other pediatric-related issues but can also promote knowledge sharing with other medical professionals. O&P practitioners might gain access to a wider array of O&P solutions, some perhaps more prevalent in one geographic location than another. These volunteer opportunities may also open the door to educate others about the O&P profession and O&P-related pediatric issues, be it camp counselors who are currently in the medical profession, students contemplating such a career, or therapists who are working in schools.
As with all areas of O&P, we must think outside of the box and be creative with our solutions to challenges in pediatric O&P care, including R&D funding and reimbursement issues. I remain hopeful that our mission to help improve children's lives by providing quality and innovative O&P devices in a family-centered, collaborative care environment, will guide us to continue to educate, inspire, and problem solve within the O&P profession, and specific to pediatric O&P care.
Justina S. Shipley, CO, BOCPO, MEd, FAAOP, is the director of orthotics and prosthetics at Shriners Hospitals for Children, Shreveport, Louisiana. She is the immediate past president of the Louisiana Association of Orthotist and Prosthetist (LAOP) and serves on the Orthotic and Prosthetic Activities Foundation (OPAF) executive board.