Screening Infants at Risk for Fractures — Bone Health Promotion Care Guidelines — Clinical Pathway: Inpatient

Screening Infants and Children at Risk for Fractures Clinical Pathway — Inpatient

Bone Health Promotion Care Guidelines – Safe Patient Handling

  • Bone development and safety can be influenced by routine handling. Safe handling minimizes the risk of fractures.
  • Therapeutic positioning for children at risk for fractures will promote opportunities for movement and build bone and muscle strength.
  • Fractures occur when the mechanical force applied to the bone exceeds the mechanical strength of the bone.
  • These handling tips minimize forces to long bones, those most commonly fractured in children with osteopenia.

Tips for Handling Infants and Children with Fragile Bones

Place Fragile Bones sign so it is prominently visible to all clinicians. Units should follow a standard practice for consistent sign placement at the patient’s bedside. The interventions below (on the reverse side of bedside sign) are to be implemented for all patients who receive Fragile Bones diagnosis. Posting the fragile bones sign will alert caregivers to the need for handling precautions as well as remind them of the specifics of those precautions.

Positioning
  • Reposition with each nursing care session
  • Assess for free limbs at risk of inadvertent entrapment during patient movement
  • When awake and playing, provide supports for midline head positioning if needed
  • Repositioning infants
    • Slide open hand and forearm under infant to support head, back, and buttocks
    • Place other hand on infant’s chest and abdomen, sandwiching infant between two hands
  • Repositioning larger children
    • Log roll by turning shoulders and hips at the same time
    • Guide shoulders and hips rather than pulling extremities
Feeding Infants
  • Make sure arms and legs are positioned well and in neutral alignment
    • Ensure arms not behind caregiver’s back
    • Ensure legs not placed at an abnormal angle
  • Burping, place infant upright, gently rub back or use soft taps with padding under the hand
Diapering
  • Slide hand under bottom
  • Gently roll side to replace diaper and clean buttocks
  • Do not lift from ankles
Dressing and Hygiene
  • Slide clothing over arms/legs
  • Dress in loose clothing with wide openings
  • Protect digits from becoming caught in sleeves
  • Do not pull arms/legs through sleeve or pants’ leg; move extremities beyond resistance
  • Do not push, pull or twist limbs
Picking Up/
Holding Infants
  • Option 1: Holding at Shoulder
    • Caregiver bends over supine lying infant so that caregiver’s shoulder touches infant
    • Caregiver slides one open hand under infant’s back and head and the other under infant’s bottom
    • Caregiver lifts the infant onto shoulder while straightening into upright position
  • Option 2: Cradling in Arms
    • Caregiver places one hand with fingers wide apart under infant’s head and body
    • Caregiver places other hand with fingers wide apart under infant’s buttocks and back
    • Caregiver uses forearms to support the infant’s limbs so limbs do not dangle
    • Caregiver leans close to infant and gently lifts infant to caregiver’s chest
    • Do not lift infant from underarms
Transfers
  • Use slow movements, ensure extremities, hands and feet are not caught in clothing
  • Support head, torso, buttocks evenly
  • Do not lift under arms or around ribs
  • Support child at buttocks, not knees, for dependent transfers
  • Refer to Safe Handling Equipment Job Aid for children greater than 16 kg
IV Placement
  • Do not force arms/legs to straighten
  • Do not twist, bend, or rotate arms and legs
  • Reposition child to inspect the entire limb and find the area to place the IV
  • Hold child close to the joint being moved
  • Apply circumferential hold during procedure