Treatment

For all but the simplest injuries, the doctor may recommend that the injury be treated by an orthopedic surgeon or a pediatric orthopedic surgeon. Treatment should be started as soon as possible after an injury, and it generally involves a mix of the following:

• Immobilization The affected limb is often put in a cast or splint, and the child must limit any activity that puts pressure on the injured area.

• Manipulation or surgery If the fracture is displaced, the doctor will have to put the bones or joints back in their correct positions either by hand or during surgery. After the procedure, the bone will be set in a cast to enclose the injured growth plate and the joints on both sides. The cast is left in place for between a few weeks to two or more months. The need for manipulation or surgery depends on the location and extent of the injury, its effect on nearby nerves and blood vessels, and the child's age.

• Strengthening and range-of-motion exercises These treatments may also be recommended after the fracture is healed.

• Long-term followup Evaluation includes X rays of matching limbs at three- to six-month intervals for at least two years. Some fractures require periodic evaluations until the child's bones have finished growing.

Most growth plate fractures heal without any lasting problems. However, if the injury was severe and the blood supply was cut off, growth can be stunted. If the growth plate is shifted, shattered, or crushed, a bony bridge is more likely to form and the risk of stunted growth is higher. An open injury in which the skin is broken carries the risk of infection, which could destroy the growth plate.

gum disease Infection at the roots of the teeth that causes bleeding, receding gums that—if unchecked—can lead to tooth loss.

New research at the University of Michigan School of Dentistry showed that it is possible to treat severe root-level bacterial infections with antibiotics, not surgery. Until recently, most dentists treated gum disease by scraping or planing away the root-level plaque and tartar caused by bacteria. In severe cases, oral surgeons made cuts at the gum line to improve access to the affected roots.

The new treatment includes drug capsules to be taken for two to four weeks (depending on the severity of the problem), followed by as many as three rounds of topical antibiotics by temporarily gluing on experimental drug-impregnated cellu lose film into the root surface. Using this regimen, researchers avoided surgery or extraction for 88 percent of patients, including 67 percent of those with teeth identified by other dentists as too infected to save.

habit A strong behavior pattern that is repeated again and again. Five of the most common habits of children that often annoy parents include nail-biting, thumb sucking, hair twirling, nose picking, and breath holding. Although a child's habits may be irritating to parents, in most cases a habit is just a phase in the normal developmental process and no need for alarm. Habits also tend to occur in clusters, so it is not unusual to see a child chewing on her nails while entwining her other hand in her hair.

Some studies estimate that 40 percent of children between the ages of five and 18 chew on one or more nails; occasionally a child also may bite his toenails. Both boys and girls appear equally prone to the habit in earlier years, but as they get older, boys are more likely to be nail-biters.

Hair-twirlers are likely to be girls who spend time twisting, stroking, or pulling their hair, usually beginning in early childhood and lasting until adolescence. In some girls, the behavior may first appear during the teen years.

Nose picking appears to be a habit that usually begins in childhood but may actually linger into adulthood. In fact, a 1995 study of adults found that 91 percent picked their noses on a regular basis.

Thumb sucking is another popular habit that probably begins when an infant's thumb brushes the mouth as the result of random movements. Some children also suck their fingers or their entire fists. Most thumb suckers are younger children, but while about 45 percent of two year olds suck their thumbs, only about 5 percent of 11 year olds do.

Breath holding is yet another popular habit. Actually watching a child try to stop breathing can be a frightening experience, but it is more worrisome to parents than dangerous for the child.

Breath holding may begin in infants as young as six months old and tends to occur in tense and overly active children. In a few cases, the child may hold his breath so long that he passes out; rarely, breath holding may trigger a seizure. Most often, children try holding their breath about once a week, although in some children it can happen several times a day.

Causes

Experts admit that they are not always sure what causes a habit, but they know it is a learned behavior that usually provides a positive experience for the child. Habits may develop as entertainment for a bored child, or as a coping mechanism to soothe an anxious one. Biting nails or twirling hair might be one way a child relieves tension, just as a parent might try to relax by having a cocktail or exercising.

Studies also suggest that nail-biting may have a strong genetic component. other habits may be holdovers from infancy, such as thumb sucking as a common self-comfort behavior that has pleasurable associations with feedings and cessation of hunger. The behavior may linger into childhood because of its positive associations. Hair twirling, too, may be an attempt by a child to regain the feelings associated with close contact with the mother's body or clothes.

Still other children will engage in habits to attract attention or as an attempt to manipulate their parents. If your child feels that you are ignoring him, he may engage in the annoying habitual behavior because he knows that it will provoke a reaction from you. A child who does not want to go to bed early may holds his breath to frighten his parents into allowing him to stay up longer. This is a learned behavior that may signal a child who is trying to gain control of his environment. Breath holding is said to be more likely to occur if parents are overprotective or insistent upon rigid schedules.

Treatment

Most habits eventually disappear. Often if a parent ignores a habit, the behavior will eventually stop when the child no longer needs it or outgrows it. Many habits, in fact, do disappear when a child reaches school age.

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