Screening Infants at Risk for Fractures — Therapeutic Interventions — Clinical Pathway: Inpatient

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

Therapeutic Interventions

Considerations for Infants

  • Daily physical activity for bone development and mineralization during the fetal and neonatal periods can prevent fractures.
  • In the last trimester of pregnancy, the unborn infant demonstrates frequent bouts of physical activity against the resistance of the amniotic fluid and the uterine tissues. This resistive exercise stimulates the development of muscle mass and bone mineralization.
  • The preterm infant hospitalized in the N/IICU is at risk of experiencing significantly fewer movement opportunities due to the combination of the loss of uterine supports with the effects of gravity on the infant’s ability to move.

Considerations for All Children

  • Sedation, paralysis and medical interventions such as endotracheal tubes and intravenous lines can further dampen critically ill children’s movement abilities.
  • The need to preserve the integrity of such medical interventions can lead to the overuse of positioning supports, which can limit active movement.

Therapeutic Interventions and Rationale

Intervention Rationale/Additional Information
Maximize Mobility Assist child achieve highest level of mobility each day to promote range of motion
Promote Active Range of Motion Non-Restricting Positioning Supports
  • Immobility, decreased weight bearing and muscle tension forces on the bones increases incidence of osteopenia and fractures
  • Utilize positioners to support limb and promote increased active movement
  • Consider including opportunity for active movements in any therapeutic positioning decisions
Use of Least Restrictive Boards to Support IV Lines
  • IV boards
    • Add weight to a baby’s arms and can limit active movement
    • The extra weight at the distal end of an extremity increases risk of mid-shaft fracture of long bone
Collaboration with
Unit-Based Safe Patient Handling Coach
PT/OT Consult Consider when traditional positioning devices or techniques are not effective