Children and Adolescents with Spinal Cord Injury
Of the about 11,000 individuals sustaining an SCI due to trauma, about twenty percent are under 20. Most of these are in their late teens and sustained their SCI from a motor vehicle accident. Falls, diving, skiing, cheerleading, football, and other sports make up the rest of the causes of spinal cord injury in children and teens. Young men of color increasingly become spinally injured due to gunshot wounds.
Some children are born to live in a wheelchair because of spina bifida, a congenital illness that leads a child to have an incomplete nervous system at the base of the spinal cord. More rare causes of paralysis in children come from tumors, infections, and other medical diseases.Developing Scoliosis
Children with spinal cord injuries have a higher risk of developing scoliosis as their spine grows. Some may have to have surgery or braces to correct the curvature. They also risk getting hypercalcemia (elevated calcium levels) due to immobilization. Some children will have nausea, vomiting, depression, poor appetite, and malaise. Because of their injury, they are more susceptible to things like pneumonia and pneumothorax. Sleep apnea can be a problem.
Children under the age of ten have immature bladders and have more problems with bowel and bladder incontinence. For this reason, many children will have to be intermittently catheterized; having a chronic indwelling catheter is not recommended.
How a child handles using a wheelchair depends on their age. If the problem is congenital or occurs at a very young age, the child often knows nothing other than being in a chair, so they don’t even understand how they are different from other kids. Older children can have difficulty with self-esteem and need therapy or at least frequent encouragement from their family and friends. Some children regress while in the hospital and will not do anything for themselves.Childhood Rehab
Rehabilitation equipment is primarily designed for adults and must be adapted for children with varying degrees of success. Some places have unique programs with therapy and equipment specially designed for children. There they receive educational, emotional, social, and vocational training.
Some kids handle hospitalization and separation from their parents during rehab, while others struggle. They may feel as though they are losing their loved ones. Parents are forced to face that other people are caring for their children besides them. Parents need to be educated about SCI as well as the child. Children face the same issues as adults with SCI but do so from a less mature place in life. Depression can come quickly in these children. They may have a hard time seeing what their future holds. They often lack the insight to see that their SCI is permanent.Challenges at Home
When back at home, children face even bigger challenges. Their sense of freedom dissolves as they use a wheelchair, and they sometimes find that their friends will no longer play with them. Rehabilitation specialists are often called to schools to teach students and teachers about the child’s strengths and limitations. There are age-appropriate books for parents and children to read about life after paralysis.
Underlying all the difficulty is a child who just wants to be treated like other children. These are often the same children to participate in educating others about their injuries. Before the ADA Act of 1990, kids were more isolated, but now, schools, malls, and other public places are more handicap-friendly. Kids in wheelchairs are seen on children’s television programs, and kids can even buy dolls that are wheelchair-bound.Spina Bifida
Children with spina bifida are paralyzed from the waist down. About 7 out of every 100,000 babies are born with the condition; some need surgery to correct bony abnormalities and cover the exposed nerves. Some children with spina bifida also have hydrocephalus or water on the brain that must be corrected. Some children with lower injuries can walk with braces and crutches, while others are confined to a chair. Bowel and bladder problems remain difficult in almost all children with spina bifida.
Even though spina bifida children know no other way of life, they can become frustrated and resentful around kindergarten when their peers can go to the jungle gym or ride bicycles. It is up to the positive effect of the child and his or her parents to improve the child's self-esteem as he or she faces the challenges of life in a wheelchair. Parental attitude is the most critical factor in the child’s adjustment.Dealing with Peer Pressure
Teens face unique challenges as they try to measure up to their peers. The pressure to conform can be intense, and these teens can quickly feel left out. They may, at the same time, be dependent on others and try to gain some measure of independence. Spinal cord-injured teens often have a rough time as teenagers coping with their changing bodies and the hormonal changes that go on. These kids need help taking notes in class, and they can’t drive like their peers can. They may need an attendant just to get up and prepare for school in the morning. Dating is a tough challenge. They usually can’t drive themselves and have difficulty expressing themselves sexually. Teens need to find outlets in extracurricular activities to feel they genuinely have a good life.Importance of Family Time
Most families know little about paralysis and SCI before having a child with the condition. The chances of reasonable adjustment to the disability depend greatly on their family’s involvement and interest in seeing the child live up to their potential. This is why childhood rehab is often so family-oriented. Parents especially need to go through the guilt and grieving process before they can be helpful to their injured child. Parents often feel a great deal of sorrow for their children and for themselves as well. All their hopes and dreams about the child go out the window, and different goals must be established.
Some parents become overprotective of their injured child, which can hinder their independence. At an early age, injured children need to learn how to do as many things as possible themselves. They need structure and discipline from their families and a healthy balance between dependence and independence. Pushing the child toward independence, regardless of age, should be the goal of every parent of a child with disabilities.Acknowledging Siblings
Siblings must be considered as well. Parents need to let every child in the family know his or her importance within the family setting. The focus can’t just be on the disabled child, or other children will begin to act out and misbehave. Finances become tight, and families may need to locate homes closer to rehab and accessible schools. Siblings are just as affected as parents when one family member develops a spinal cord injury. Roles can change as younger siblings begin to take care of their older siblings who are disabled. This caretaking among siblings should be discouraged as it leads to resentment and anger between siblings.
The road to adulthood and maximal independence is difficult for patients with spinal cord injuries injured as children or teens. It takes cooperation from all family members, the school system, and their peer group to help the disabled teen reintegrate into society.
Editor's Note: updated [cha 7.12.23] Photo by Cotton Bro on Pexels [cs 1227]