Accidents

Accidents are of concern to parents of any child. The situation is especially complicated by the fact that injuries may not be recognized promptly because of diminished pain and temperature sensations. Thus, burns, pressure sores, and even broken bones may go unnoticed. As the child with decreased pain sensation does not instinctively learn to avoid harmful situations, he or she must be taught how to avoid potential injury, and to recognize the signs of injury.

Burns

To avoid burns, hot liquids such as coffee, tea and soup should be tested for your child. At the same time he or she can be taught to look for signs of heat, such as steam. Similarly, tap and bath water should be regulated until the individual can learn to use a method, other than touch, to determine water temperature. Bath thermometers are easy to use and can help the patient learn to avoid dangerously warm water, as well as very cold water.
Hair dryers, toasters, coffee pots, and exposed radiators and pipes are a few household items commonly associated with burns. In some cases the hazard can be removed or made safe (i.e. covering the radiator). In other cases your child must be made aware of the potential danger of the item and supervised in its use.

Steam vaporizers should not be used. They provide no special benefit over cold-water vaporizers and are particularly dangerous. Mild burns do not require special care. However, if there is blistering, a physician should be contacted.

Heating pads should not be used. Even the use of warm compresses should be carefully monitored. 

 

 

Joint Problems

Joint injuries are extremely common in patients with pain insensitivity. Problems with balance often result in trauma to the feet (especially the big toe). Insensitivity to pain, repeatedly sitting in awkward postures, frequent falls, and leaning heavily on joints such as the elbow all place significant stress on weight bearing joints making them susceptible to injury. Over time, repeated injuries weaken and eventually destroy the joint. This type of joint injury is known as aseptic or avascular necrosis, or Charcot joint.

In patients with reduced perception of pain, joint injury often goes unnoticed until there are overt clinical signs, such as swelling or instability. As the joint damage worsens with continued injury and small pieces of cartilage (connective tissue) become loose, patients may complain of discomfort. Joint discomfort should be investigated immediately by an orthopedist. Conservative treatments, such as rest and bracing, may be sufficient, if the diagnosis is made early enough. When damage to the joint is severe, surgical treatment may be necessary.

Fractures

The perception of pain from the joints or from the bone is severely reduced in patients with pain insensitivity. Swelling and/or slight discomfort with movement may be the only sign of a broken bone. Discoloration may or may not be present, depending on how the injury was sustained. If a fracture is suspected an x-ray image should be taken. If a bone is broken healing takes place in a normal fashion. If casting is necessary, care must be taken to avoid the development of pressure sores. Complete immobilization should be avoided, unless absolutely necessary, as children with neurological problems develop muscle weakness more quickly with disuse. Respiratory problems are also more likely during periods of sustained bed rest, as the clearing of secretions to more difficult. Chest physiotherapy is advised during periods of bed rest and physical therapy is recommended afterwards.

 Pressure Sores

Pressure sores occur from prolonged pressure on one area. It is more likely to occur in an individual who does not appreciate pain or discomfort. Sites at risk include bony prominences such as the hips or the coccyx. Pressure sores can also develop on ears. A pressure sore is more likely to occur during a prolonged period of inactivity and bedrest when an individual might lie in one position for an extended period of time. It might also occur with ill-fitting shoes, orthotics or braces.

The first sign of a pressure sore is a reddened area of skin. The area may even look slightly raised and feel firm before the skin starts to break down and form a sore. Therefore periodic changes of position (turning) is important even though one might be reluctant to disturb sleep and the skin should be checked regularly for reddened areas. The area should be rubbed gently with a cream to increase circulation and the pressure removed.   Use of sheepskin liners, egg-crate foam pads, and even waterbeds has been helpful.

Once the area of skin has opened or ulcerated, then it has to be treated like a burn by a medical professional.

Sun Exposure

Warm environments and sun exposure can pose special problems for individuals with decreased sweating. Thus patients are at greater risk for heat stroke, as well as heat exhaustion. Some warning signs of heat intolerance are as follows:

• Headache
• Weakness
• Nausea
• Feeling faint, dizzy or lightheaded

To avoid problems there are a few simple measures:

• Use sun tan lotion rather than an oil (Oil prevents cooling)
• Use wet t-shirts to wet towels to avoid overheating
• Increase fluid intake
• Avoid strenuous activity or long walks
• If the environmental temperature is greater than 80° F (26.7° C), then an activity in air conditioning is advised.