Top Tips Management

• The management of musculoskeletal conditions is multidisciplinary and multiprofessional. The approach is holistic and clear communication is crucial. 
• Pain assessment and management in children can be challenging. Small children may not verbalise that they are in pain; check for other signs of discomfort (e.g., withdrawal of a limb, not using a limb or being upset or irritable).
• Education and support for the child and family is important. There may be a period of uncertainty before the diagnosis is confirmed and there is often much anxiety.  
• For children with chronic conditions, ‘poor or fussy eating’ is often common and may be associated with weight loss and poor growth. It is important to record and monitor growth and development.
• It is important to discuss school attendance and engagement in peer group activities as this can indicate the impact of symptoms and disease for the child and family.
• If completing assessment with a young person, allow the opportunity to talk to them alone without their parents – they may wish to talk to you.
• Children and young people with chronic conditions also have generic health issues – these may impact management and need to be addressed as part of transitional care.
• Children are different to adults and it is important to be aware of the differences – children’s arthritis is a different condition to adult arthritis.
• The doses of medicines are determined by body weight or surface area.
• Medicines used to treat inflammatory conditions are often immunosuppressive. Children may be very immunosuppressed as a result of their disease and treatment. They are prone to infection and may deteriorate rapidly. Live vaccines are contraindicated. 
• If a cannula or venepuncture is required assess the suitable site avoiding swollen or sore or restricted joints and handle limbs carefully.