A Primary Care Provider’s Guide to Pediatric Spinal Cord Injuries

Spinal cord injury (SCI) in youth presents with unique manifestations and complications as compared to adult-onset SCI. The primary care clinician must consider the physical, physiological, cognitive, and psychological changes transpiring during childhood and adolescence. For example, when evaluating a child with potential autonomic dysreflexia (AD) or orthostatic hypotension, the primary care clinician needs to be cognizant of the blood pressure norms in youth that vary with age. Specifically related to SCI, anticipatory guidance should incorporate issues such as shifts from walking to full-time wheeled mobility, decreased adherence with self-care during adolescence, risk for musculoskeletal issues such as fragility fractures and scoliosis, and greater risk for bullying.

• 1
  Youth with SCI should receive all recommended immunizations per the Centers for Disease Control and Prevention. All youth with SCI have compromised pulmonary function and are at high risk of pulmonary infections, particularly those with cervical or thoracic level lesions.
• 2
  Spine deformities are an extremely common problem in pediatric SCI, especially if the injury is sustained prior to skeletal maturity; 98% will develop scoliosis and 67% will require surgery.
• 3
  Many youth with SCI demonstrate spasticity. Increased tone may be used functionally by some youth; however, when problematic, attention should be directed to potential inciting factors, such as noxious stimuli below the zone of injury (eg, ingrown toenail or hip dislocation).