Parental Perspectives on Children's Functional Experiences After Limb Fracture

Abstract

Background: Fractures are a common childhood injury. Although the pain associated with fractures is well described, the related functional impact is less understood. When a child's function is impaired, his or her ability to participate in day-to-day life is restricted. Eighty percent of children with fractures experience compromise in daily function. An in-depth understanding of function can guide emergency department (ED) providers' discharge instructions.Objectives: Our aim was to report caregivers' perspectives of the functional impact of limb fractures on their children's day-to-day life activities. Methods:We performed a qualitative study using interviews of caregivers of children (aged 5 to 11 years) who received care for acute, nonoperative long bone fractures in a pediatric ED. Audio-recorded, semistructured telephone interviews were completed 7 to 14 days after the ED visit. Interviews were primarily open ended, including questions targeting areas of function from existing pediatric fracture literature. Qualitative analysis was completed using content analysis.Results: Twenty-five interviews were included in the final analysis. Most of the children were diagnosed with upper extremity fractures, and most participants were mothers. All parents reported a change in their child's function. The most commonly affected areas were sleep, activities of daily living, and play. Play was either self-limited by the child or restricted by the parent. Pain was worse in the first days after discharge. Many children struggled emotionally with functional limitations. All children required help from their parents to perform daily tasks; this required adaptive strategies such as planning, changes to household routine, and missed work. Key concerns from parents included regression in the child's independence and fracture healing and complications.Conclusions: Function is universally impaired in young children with fractures, significantly affecting family life after discharge. Discharge conversations with families should include pain management, changes to activities of daily living, family routines and play, and expectations for fracture healing.

Adolescent and Caregiver Perspectives on Living With a Limb Fracture

“…Our team previously described the experiences of young children (5-11 years old) with acute long-bone fractures that showed function was universally impaired and most accommodating adaptations were made by the caregivers. 7 This study expands our understanding of functional changes following acute injury by capturing both youth's and their caregivers' perspectives. Unlike our previous study, caregivers were generally less burdened by youth's injuries, and most youth participated in physical activities through modifications rather than avoiding activity altogether.…”

“…The interview guide was derived from a previous study by the same research group, modified to reflect the developmental differences in adolescence as compared with earlier childhood benefiting from the methodological and content experts of our team. 7 Each interview began with open-ended questions, with optional prompting and follow-up questions to target specific topics of interest (eg, sleep, school, sibling dynamics). Additional interview questions were added as novel themes were identified by the concurrent qualitative analysis.…”

“…Youth displayed strong intrinsic motivation to preserve all capacities of function, which could in part explain the decreased caregiver burden (as compared with the younger age group). 7 When independence could not be preserved and further exclusion from physical activities was experienced, many youth became disappointed and occasionally socially isolated. This was notably different from the younger age group where children experienced predominantly sadness from missing out on enjoyable activities and anxiety from fear of reinjury.…”

“…This was notably different from the younger age group where children experienced predominantly sadness from missing out on enjoyable activities and anxiety from fear of reinjury. 7 For this reason, we suggest both youth and caregivers are educated about the importance of adapting difficult activities in a way that promotes youth independence and preserves function. Caregivers should also be patient with their youth and understand that although tasks may seem cumbersome, they generally prefer to complete them autonomously.…”

What influences physician opioid prescribing for children with acute pain?

“…1,[32][33][34] Participants voiced the importance of a well-thought outpatient pain management plan, but also described a relative discomfort in prescribing opioids for at-home use, when compared to the inhospital setting. Given the impacts of inadequately managed pain as an outpatient can negatively impact a child's functioning through altered sleep, appetite, play/ sport/school participation, and mood, 35 further focus on training and knowledge-sharing with clinicians to support their prescribing for at-home use is required.…”