Nursemaid’s Elbow, Febrile Seizures, Sever’s Disease – PediaCast 312

Show Notes

Join Dr Mike in the PediaCast Studio for more answers to listener questions! This week’s topics include nursemaid’s elbow, febrile seizures and Sever’s Disease.

Nursemaid’s Elbow
Febrile Seizures
Sever’s Disease

Contact Dr Mike – Show Questions, Comments, Topic Ideas
Nationwide Children’s – Request an Appointment or Referral
Nationwide Children’s – Non-Urgent Medical Questions


Announcer 1: This is PediaCast. 


Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello everyone, and welcome once again to PediaCast. It's a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It is Episode 312 for March 25th, 2015. We're calling this one "Nursemaid's Elbow, Febrile Seizures, and Sever's Disease". I want to welcome everyone to the program. 

I have another Listener Edition of the show coming your way today. And we have some great listener questions really that had been coming in the past few weeks. So please keep those rolling in because when you ask, you can be sure there's plenty of other parents out there asking the exact same question. And it's easy to get your question on the show; I'll remind you how to do that in just a few minutes. 

First though, couple of other reminders, don't forget about our 700 Children's Blog. It's where we call upon the collective pediatric expertise of our entire institution, and present a fantastic collection of articles for moms and dads, written in a way you can understand and find useful. Some recent topics: three things women with congenital heart disease should know about pregnancy; also car seat safety; prevention of peanut allergies, and how to get a black belt in giving medicine. 

That's one every parent should read. I can't tell you how many times that getting your child to take medicine is really a very real barrier to your child getting well. They won't take the medicine. So be sure to check out how to get a black belt in giving medicine. Again, you can find these articles and more at 


I also want to remind you about something that's really exciting for me. It's pretty much been consuming my time for the last few weeks. And that is PediaCast CME. It's our brand new podcast aimed at pediatric providers including pediatricians, pediatric subspecialists, family practice doctors, nurse practitioners, physician assistants, and students of any kind (medical students, nursing students, ANP and PA students). We're going to crank up the science with general pediatric topics, along with faculty development items to help pediatric teachers and researchers improve upon their craft as well. 

We're going to launch on April 1st, 2015. All the details including episodes, Show Notes, and how you can earn free Category 1 CME credit for participating, all that information is available at So be sure to check that out if you are a provider, or please share the news if you know a pediatric healthcare provider. 

Show's also will be available on iTunes and on those podcasting apps for iPhone and Android. That's PediaCast CME launching April 1st, just one week away at 

All right, what are we talking about this week on this particular program. Well, thanks to you my faithful listeners, I have some great topics lined up for you. 

Nursemaid's elbow, you may or may not have heard of this. It's pretty common. Toddler's arm gets pulled and they stop using it. A simple maneuver gets everything working again, but how do you tell the difference between this and another injury such as a full blown dislocation or a fracture? Are X-rays needed? And why in the world is it called a nursemaid's elbow? I'll have the answers coming up. 

And then, febrile seizures, we've covered this on PediaCast in the past, but it's been a  few years and time for a refresher. Why do some children have seizures with fever? Are fevers dangerous? Do they somehow harm the brain? If not, why do they sometimes result in seizures?  And why at other times, do seizures not occur with fever? What's going on? When do you worry? We'll cover the topic in our usual  nuts and bolts fashion coming up. 


Then, Sever's disease. OK, lots of you have probably heard of a nursemaid's elbow and the febrile seizures, Sever's disease on the other hand, well, maybe not so much, but it's actually fairly common, especially for active kids in the pre-teen years. Maybe your child has or has had this symptoms, but they weren't bad enough to seek medical treatment. It's one of those things that probably more common than we think. I'll have the definition, cause, symptoms treatment, prevention, all that good stuff coming your way in just a few minutes. 

Don't forget, if you like to get your question in the program, or you want to direct me to a news article or a journal article, have just a topic suggestion, it's easy to get in touch. Just head over to and click on the Contact link. You can also call the PediaCast voice line at 347-404-KIDS. That's 347-404-K-I-D-S or 5437. Leave your message that way, and if you like we can get your question and your voice on the program. 

Also, I want to remind you the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So, if you have a concern about your child's health, make sure you call your doctor and arrange a face-to-face interview and a hands-on physical examination. 

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at

All right, let's take a quick break, and we'll get right into answering your questions. That's coming up right after this. 



Dr. Mike Patrick: All right, first up is Paul from Las Vegas. He says, "I looked at the archives, but I didn't see that you've done a show on nursemaid's elbow. It will be a great topic to cover, please."

Well, I agree with you, Paul. Nursemaid's elbow is an excellent topic to cover. Thanks for the suggestion. It's a very common issue on toddlers, and many parents out there know exactly what I'm talking about. Your child's arm gets pulled. They stop using it. You seek medical help, the doctor does a simple maneuver involving your child's forearm or elbow, and within a few minutes, your child is using his or her arm normally again.

It's called a nursemaid's elbow because back in the day, when the baby sitter was called a nursemaid, she might grab your child by the arm and say, "Hey, you're coming with me." And, of course, your child might not want to go, and their legs collapse in protest, and their arm gets pulled. These days, parent's elbow would probably be a better term to use, since it's usually a mom or dad pulling their child's arm. It may not be a protesting child. Maybe a parent who lifts their child up by the arms or swings their child by the arms, or may happen when two or more kids are roughhousing and an arm gets pulled. 

Regardless of the exact mechanism, the underlying cause, again, is a pull on the forearm at the elbow. A kid can even give themselves a nursemaid elbow by rolling over with an outstretched arm beneath them, which effectively causes the arm to be pulled. 

So, what exactly is happening here? Well to understand, we need to take a closer look at the anatomy of the elbow. You have three bones coming together – the humerus of the upper arm, and then the radius, and the ulna of the forearm. The radius is on the thumb side, and the ulna is on the pinky finger side. So these three bones all come together at the elbow. 


There's also a ligament called the annular ligament, which originates on the ulna just below the elbow, wraps around the head of radius and re-attaches on the other side of the ulna. This ligament keeps those two bones in close proximity, but allows controlled movement  as the forearm moves from pronation to supination, or from the hand facing down to the hand facing up. So, we're not talking about the elbow moving like a hinge, but rather the forearm rotating about the axis of its length, as you go from hand facing  down to hand facing up. 

So, everybody with me so far? So what happens with the nursemaid elbow is that when the arm is pulled at the elbow, the head of the radius, just beneath the elbow on the thumb side, partially slips out of the grip of the annular ligament. And the medical term for this is a subluxation of the radial head. It's not really a dislocation because the bones are still in their proper relationship with one another. It's just that the head of the radius is partially slipped out of the ligament that holds it next to the ulna. 

When is this most likely to occur? Well, I previously said it happens when the forearm gets pulled, which is true. But, the other part of the story is this, it's more likely to occur when there is some looseness or laxity of the annular ligament — so it allows the bone to pop out —  and when a child has enough  weight but is still small enough to be entirely picked up by their arms, so that enough body weight is being suspended entirely from the elbow. 

The age when these conditions are most likely to be in place is the toddler years. You can see it in the infants and young school-aged kids, but  the vast majority cases are seen during the toddler years. Also, some kids are more prone to having this happen compared to others. Probably because they have more looseness or laxity of the ligament, or just the anatomy of the head of the radius is such that it slips out easily. So there's probably a genetic component to this. Once it happens, these kids are more prone to happening again. Again, probably due the makeup of their ligament and bone structure. Also, they're just more likely to be in the same high-risk situations where the arm gets pulled. 


OK, so when the head of the radius is subluxed or slips partially out of the annular ligament, what symptoms do we see? Well, kids with this condition aren't able to  rotate their forearm from pronation to supination, or from hand facing down to hand facing up. The forearm catches because the head of the radius is partially slipped out of the annular ligament, and attempts to rotate the forearm are uncomfortable. So kids keep their arm still — usually pronated, because that's the position that is usually there when their arms gets pulled, the hand facing down with the elbows slightly flexed and the arm resting at their side. 

So when you see a toddler holding their arm like this, with the hand down, elbows slightly flexed, the arm resting at their side and not using it, and there's a history of the arm being pulled, that's usually enough to diagnose a nursemaid elbow clinically. Then, we can do a quick maneuver which returns the head of the radius to its proper position under the annular ligament. 

There are couple of options for the maneuvers you can do, including hyper-pronation at the elbow and supination, followed by flexion. Which maneuver is used is  decided upon by the judgment of the provider caring for your child — which one they're more comfortable with, which one they have better luck getting it to work. 

Another thing to mention, if there's a history of trauma or injury rather than just a pull, or if the history is unknown, but there is concern for a possible fracture maybe due to soft tissues swelling or bruising or point tenderness, then X-rays maybe obtained to screen for a fracture before a maneuver is attempted. 

However, most of the time, when nursemaid's elbow is diagnosed clinically, X-rays are not  needed. Another time we may get X-rays is when the simple maneuvers don't  fix the problem. Sometimes, the maneuvers don't fix the problem and the X-rays are negative, in which case, we usually apply a splint in case an occult fracture is present — so really small fractures you just can't see on the X-ray and refer the child to see an orthopedic surgeon. 


But again, most of the time, the problem is quickly corrected and your child's symptoms completely resolve within just a few minutes. Very satisfying from the doctors' point of view because you fix the issue right then and there. We love that. 

Kids who are prone to this usually outgrow it by the time they go to kindergarten. Why? Well, there are several reasons. The annular ligament in these kids may lose its looseness or laxity. It may become tighter around the radius, making it more difficult for the radius  to slip out. Also the anatomy of the bone changes and makes it more  likely that the head of the radius will stay underneath that ligament. And it's also more difficult to suspend your child's entire weight by their elbows once they get to a certain age. Although, lots of school-aged kids do tend to hang off monkey bars, and we don't see this happening often in those kids. So a maturing anatomy really does play a big role in this problem going away. 

Some parents learn to diagnose and fix nursemaid's elbow on their own at home, especially if it's recurrent and it's happened a time or two. However, if it's your first go-round, don't try this at home. You don't want to manipulate a fractured arms, so be sure to see a doctor. But there are some families who are kids are prone to this during the toddler years, especially when the kids are really active and are roughhousing with other kids and it just seems to happen. It shouldn't be happening every day, but maybe happening more frequently, then you want to take them to an urgent care or your doctor's office. 

Lots of families are capable of diagnosing this based on history and examine, fixing it with one of the two maneuvers we discussed, but you want a doctor showing and teaching how to do this before you try it on your own. 

So that's nursemaid's elbow in a nutshell, very common problem. Thanks, Paul, in Las Vegas for  suggesting it. We always appreciate it.


All right, let's move on. Chong, in Seattle, says, "Could you please talk about febrile seizures on PediaCast? We read enough materials online, but we are still worried each time our son, who is now 21 months old, has a seizure with a fever. He's had four so far since he was 10 months old and each one has lasted less than three minutes. We would love to know why there aren't any groups or foundations that support children who have febrile seizures. Thanks. — Chong."

Well, thanks for the question, Chong. It's been a few years since we covered febrile seizures, so this will be a great time to review them. And once we do, I think the answer to your question should become quite apparent. 

So first, a little bit of background. Febrile seizures are the most common seizure disorder in kids. Febrile seizures are divided in the three types —
simple, complex and symptomatic. 

So let's define what each of those are. A simple febrile seizure occurs in the presence of a  fever in children who are six months of age to about five years of age. That's the most common time when you're going to see this. A seizure is s generalized tonic-clonic seizure. In other words, it involves the entire body with a stiffening and shaking, and a simple febrile seizure lasts less than 15 minutes. The child has no history of significant neurological problems, so the baseline neurological exam is normal, and the neurological exam after the seizure episode continues to be normal. And the fever is not caused by meningitis or encephalitis, which is infection of the brain or the fluid in membranes that cover the brain and spinal cord. 

So that's simple febrile seizures. The important take-home here, again, it's associated with a fever. It's brief, and lasts less than 15 minutes, and involves the entire body.


So what is a complex febrile seizure? Well, sort of the opposite of the simple febrile seizure. In this case, the seizure may be focal rather than  generalized, or it may be a prolonged seizure, lasting more than 15 minutes. Or, the seizures may occur multiple times in fairly close succession. So, you have a febrile seizure, and then an hour later, you have another one. And maybe that evening, and the next day, you have one. So it's a cluster of febrile seizures. Now, we would call that complex febrile seizure. 

What about symptomatic febrile seizures? Well, in this case, the child has a pre-existing neurological abnormality or the neurological exam after  the seizure is abnormal, or the child has meningitis or encephalitis at the time of the fever and seizure. 

So what causes febrile seizures? Well, current thinking suggests that most febrile seizures occur as a result of a rapid rise in temperature after a period of temperature stability in a person with a genetic predisposition to having this happen. OK, so what does that mean? Basically, you know, you're cruising along at a normal body temperature, your kids get a fever and the temperature rises rapidly. So it's not how high the fever goes. Really, it's more of a function of how rapidly the fever develops after a period of having a normal body temperature. 

Not only that, if you took a hundred kids and gave them the same temperature curve, so you gave them that same period of normal temperature and then a rapid rise when they get their fever, you know, mostly during the toddler years — just like nursemaid's elbow — most kids are not going have seizure with that. So what's the difference between the kids who do have the seizure with that and the majority of kids with the same temperature curve who don't have a seizure with it? Well, the difference is the genetics. So, you have to have a brain that's sort of predisposed  to responding to a rapid change in body temperature, by having a brief seizure. 


Now, there are exceptions. Regression to a normal temperature after a fever spike may provoke febrile seizures in some other kids. Well, the kind of febrile seizure that your child has, or the mechanism of it, tends to follow a family pattern with a sudden rapid temperature rise  being the most common trigger. 

The take-home here, though  it's not the  height of the temperature that's causing brain damage that causes a fever. That's not what's happening. It's more like a reboot  of the brain when the temperature changes quickly and from many of these  kids, the seizure is the first sign  of illness. So, you know, they are fine. They have a brief seizure, and all of a sudden you'll realize, Hey, they're hot and now they're acting sick. So the most common thing that we see is this happening right at the very beginning  of the illness, although not always. 

What about frequency  in the patterns? Well, in the United States, 2% to 5% of children ages six months through five years will experience a febrile seizure. Of these kids, 70% to 75% of them  will have simple febrile seizures, 20% – 25% will have complex febrile seizure, and only 5% will have  the symptomatic form of a febrile seizure.

Children who have had a febrile seizure  are more likely  to have another one. One-third of children who have one, who have another one at some point  before age five, if the fist seizure is prior to 12 months of age, the chance of recurrences is 50%. If the first seizure is after 12 months of age,  the chance of recurrence reduces to 30%. And this reflects the fact that there is a genetic component  to these seizures.

Kids with a history of febrile seizure also have a slight risk of epilepsy. Epilepsies are chronic seizure disorder, so you have seizures that don't necessarily just happen with fever, they can happen at any time. The rate of epilepsy for kids with the history of febrile seizure is around 2.5% so it's not a big  risk,  but, it is still twice the risk of a general population.  


What do you do the first time that a febrile seizure happens? Again, often, the seizure will be the first sign that there's a problem. And you know, from your  point of view, your child suddenly collapses and they're stiff or shaking. So, the first thing you want to do is always asses, but don't assume it's a seizure. 

You want to assess their ABCs, their airway, breathing and circulation. And I would really highly recommend that all parents take a CPR class. Your local Red Cross is a great resource for that, but there may be others in your community. Also, take a refresher course every year as well, because you're probably not using those skills very often. Unless you're in a line of work where you would come across kids who collapse frequently. 

So it's a good idea for all of us, really, to have a refresher course on CPR. And, of course, you're not going to do CPR for a febrile seizure, but I'm just saying it's kind of a scary thing when this happens the very first time, and you want to make sure that you look at the ABCs first to make sure that your kids are not choking on something or having some other problem than a febrile seizure. 

You want to make sure that your child is in a safe place during the seizure — on your lap or on the floor and away from objects. If there's a breathing problem — they're not breathing, or blue in the face — you want to call 911. Or if they're just unconscious or it's a seizure that's lasting awhile, you want to call 911. If it's a simple febrile seizure that last less than 15 minutes, and your child's breathing fine and they're not blue, then rather than calling 911, it'd be a good idea to just call your doctor. 

You're always on call for your doctor's office, and let them know what happened and what your child's temperature is. Describe the entire episode, and then your doctor can help you determine the best place for your child to be checked out. 

Now, if it's a family that has had with some recurrent febrile seizures, this is not your first rodeo, just want to check in with your doctor and let them know, yeah, they have another brief febrile seizure. But they don't necessarily have to be examined every single time they have one. After first one though, it's probably a good idea to have your child looked at, and your regular doctor, if you call him, can let you know where the place for that to happen is.


If your kid looks good and the seizure just lasted three minutes, your doctor may say, "Hey, let's check him out in the morning in my office." Or they may say, "Why don't you go and go to the emergency department? Have someone take a look at him. Or go to your local urgent care center if they have pediatric expertise at that center." So you definitely want to touch base with a healthcare provider when your child has a seizure. 

Again, if it's a seizure that's lasting a long time, or you have any concern, call 911. If it's brief one and your child's looking good, call your doctor. 

So, what kind of workup is needed for simple febrile seizures? Well, really a little work up is needed if it's a simple febrile seizure, especially if the fever has  a known source. So you know what's wrong with the kid. You look at him, and maybe there's an ear infection, maybe a viral infection. But you know where the fever is coming from, and it was a brief uncomplicated simple seizure, then really, no workup may be needed at all depending on the judgment of the physician who's seeing you. 

Blood counts can sometimes be helpful in determining if there's a serious bacterial infection versus a viral process that's going on. Electrolytes might be useful if the child has a history of vomiting or diarrhea, so you think they could be at risk for an electrolyte disturbance.

EEG's where we put the electrodes up to the brain and look at the brain waves, those are not indicated for simple febrile seizures. 

Now, if your child are less than 12 to 18 months of age, your doctor might suggest a spinal tap to rule out meningitis. Depending on your child's age and the clinical situation, this is going to more likely be needed for young infants or infants who are very irritable or they have a stiff neck. It's kind of gray area, and you have to trust your doctor's clinical judgment on whether a spinal tap is needed. Spinal taps — or lumbar puncture, another name for them —  are generally not needed for kids over 18 months, unless they have other symptoms that make you think about meningitis, like a stiff neck, bad headache, extreme irritability, those kinds of things. 


What about complex febrile seizures and symptomatic febrile seizures? Well, again, if this is the first one, or there's been a pattern and the pattern is changing, then your doctor might suggest an imaging study such as MRI of the brain or a CT Scan of the brain. Might be a little more likely that someone would want to do a spinal tap to look for meningitis depending on your child's age and other symptoms that are present. 

Those kids with complex febrile seizures or abnormal neurological exams after a seizure, they may need an EEG, or we look at the brain waves and checking electrolyte panels especially if the seizure is not stopping, and a referral to a pediatric neurologist will all be common things to do with a complex febrile seizure or symptomatic febrile seizure.

What about treatment? Well, simple febrile seizures really don't need treatment. They just fix themselves. Prolonged complex febrile seizures may need anticonvulsants to stop the seizure if it's lasting more than 15 minutes. These kids may actually have epilepsy that was first provoked by a fever. The fever didn't cause the epilepsy. They just had epilepsy underlying, and their first seizure was triggered by a fever. 

Children with frequently recurring febrile seizures may need the anticonvulsant therapy. This is rare and should be managed by a pediatric neurologist. So, if every time your child gets a little fever, they have a seizure with it, especially during the winter season, putting them on an anticonvulsant medicine may make some sense. But, again, you want to do that in collaboration with a pediatric neurologist. 

What about prevention? Well, there's really no good prevention unless they recur frequently and neurology is using anticonvulsant or anti-seizure medications. But remember, these medications do have some side effects, and their use should not be just a knee-jerk response, but there are some situations when kids would need that, and that may help prevent frequently recurrent  febrile seizures. 


Remember, the seizure usually happens  with the first, temperature spike only, and once the seizure is over, and your child is awake enough, you could give them Tylenol or ibuprofen  to help them feel better, if the fever is still present. They usually is after the seizure is over, but it is unusual for the seizure to repeat after that initial spike. Sometimes it happens, you know, if it's happening in clusters, then we would now call that a complex febrile seizure. But, the most common pattern is just to have an isolated one, and even though the fever is progressing, it does not happen again. 

If you think your child might be getting ill, and they're prone to febrile seizures, should you start Tylenol or ibuprofen to prevent that temperature spike? You know, the research is not really clear on that. This may or may not prevent a seizure. Some kids will still have a febrile seizure even with fever reducers on board. Also, you don't want to give Tylenol and ibuprofen with every little sniffle, because then you might be using those medicines all winter long. And long-term frequent use of Tylenol and ibuprofen can have its own set of problems. 

The good news is that, in the end, the overwhelming majority of febrile seizures are not  harmful even when they recur and kids usually outgrow the tendency after age five. Remember, the seizure is not the result of damage to the brain caused by a fever. That's not what happens. It's simply a way that  some brains react to a rapid change in temperature.

So, to answer Chong's question, why aren't there any groups or foundations that support children who have febrile seizures? Well, the reason is because most febrile seizures are simple ones. They usually aren't dangerous or harmful and they usually go away on their own by the time your child goes to kindergarten. 

For complex febrile seizures, and especially for recurrent complex febrile seizures, when your child's more likely to be followed by a pediatric neurologist and maybe treated with an anti-convulsant therapy or an anti-seizure medication, at that point really your child has epilepsy. It may not be epilepsy that last a lifetime, but it's epilepsy and there are plenty of groups and foundations who support that. 

Chong, for your particular case, four seizures between the ages of 10 and 21 months,  each associated with a fever and each lasting less than three  minutes, by definition, these are simple febrile seizures, which again are generally not harmful and are very likely to be completely outgrown by the time your child goes to kindergarten, which is why support groups and foundations are not needed.

So, hope that helps, Chong, and as always, thanks for the question.


Next up is Carrie. She says, "My ten-and-a-half-year-old daughter has been diagnosed with Sever's disease in both heels. The podiatrist ordered orthotics, which she has been wearing now for a few months. I've noticed she is also slightly bow-legged. Could this be causing her Sever's Disease and can her bowed legs be corrected? 

Thank you so much. I recommend PediaCast to the parents of all my students birth through age five." 

All right. Well thanks for the questions, Carrie. Let's start with the ins and outs of Sever's Disease, and then we'll address the bowed legs.

So, what is Sever's Disease? It's actually a type of bone injury involving the growth plate located in the lower back portion of the heel where the Achilles tendon attaches to the bone. And this growth plate becomes inflamed and causes pain.

Why? Well, there's actually several factors that come into play here. First, the heel bone in many kids grows faster than the ligaments, tendons and muscles of the lower leg. And this results in the Achilles tendon becoming tight and stretched, and it has a tendency to pull the growth plate away from the rest of the bone in the heel which sets up inflammation and pain at this location. I added that repetitive stress on the Achilles tendons, especially when kids are very active with high impact sports such as track, basketball, gymnastics, also standing for long periods of time, poor fitting shoes, shoes which lack adequate support and frequent repetitive movements and exercises — all of these things can contribute to stress and inflammation in the heel region at that growth plate.


So when does this happen? Well, the most common time is during the early portion of the adolescent growth spurt, because this is the time of maximum mismatch between heel bone growth and muscle ligament, tendon growth in the lower leg. And because this is also a time when lots of kids are active with high stress repetitive movements. 

So, what ages exactly are we talking about? Well, usually the 8 to 13-year-range, 8 to 13 years of age for girls, and 10 to 15 years of age for boys. So, Carrie, your daughter at ten and a half years is definitely at a prime age for Sever's disease.

What symptoms do we usually see with inflammation and pain of the heel? Well, heel pain, of course, especially after high impact activities, but also difficulty walking. Pain and stiffness in the morning is common, and sometimes swelling and redness of the skin overlying the heel.

How is this condition diagnosed? Many times it can be diagnosed clinically looking at your child's age, their activities, the history, their physical exam, location of discomfort. X-rays might be helpful, not usually in diagnosing this particular condition but for ruling out other problems such as  a fracture, or bone infection or other form of bone disease.

Treatment's pretty straight forward. A properly-fitting and well-supported shoes may help. Orthotics can help accomplish this. Although, keep in mind, the goal here is comfort. If orthotics seem to make things worse, which sometimes they do, if they're ill-fitting, then they're not doing their job. 

Also pay attention to price. Orthotics can get expensive. And properly fitted, well-supported shoes don't have to come from a medical supply store. Your local shoe store may also have plenty to offer. 

The main course of treatment — and this is certainly more important than orthotics — is lots of rest to allow the growth plate to heal. For particularly painful episodes, ice packs every 20 minutes for a couple of hours for a few days, elevating the extremity above the heart,  and non-steroidal anti- inflammatory drugs such as ibuprofen may be helpful as well. Your child may need to take a long break from sports and activity. Physical therapy may also be helpful to help stretch and strengthen lower leg muscles and  tendons.


The best place to get help with this condition to find out exactly what you should do for your particular child is your regular doctor. You can also see a pediatric orthopedic surgeon for this or even a pediatric sports medicine physician.

So, Carrie, if things aren't progressing well, that's where I would go for additional help.

OK, what about the bowed legs? Well, these are not associated with Sever's disease. They don't cause Sever's disease, and they don't result from Sever's disease. In most cases, bowed legs aren't a problem at all. As your child grows upward, those bones have a tendency to straighten out and correct themselves.  

Now, there are some exceptions to this. If your child has frequent fractures or the bowed legs seemed to be causing a functional problem — which is almost never the case — then something else may be going on. As always, if this is a concern, seeing your regular doctor or an orthopedic surgeon or a pediatric sports medicine expert would definitely prove helpful in determining what exactly is going on, and what, if anything, that you need to do for it.

So that's Sever's disease in a nutshell, Carrie. Thanks for the question. Thanks for listening, and thanks so much for sharing the show with others. I really do appreciate that.

Don't forget, if you have a question for me, it's really easy to get in touch. We can get your question answered on the program just like what we did these three. Just head over to and click on to Contact link. I do read each and every one of those that come through. We'll try to get your comment or question or topic suggestion on the show. 

You can also call 347-404-KIDS. That's 347-404-5437 and leave a message that way. 

All right, let's take a quick break and I will be back to wrap up the show right after this.



Dr. Mike Patrick: All right, there's just enough time  to say thank you to all of you out there for listening. Really do appreciate your support of this program through the years, really. We're almost  going on ten years. I think we're about nine years in now. 

And for the first time, we are adding another podcast to the lineup, Pediacast CME. Really, the idea here is that we have a program… Because over the course of these years, we've really collected lots of healthcare providers in the audience. So, the show is really aimed at moms and dads, but we get a lot of questions and feedback and iTunes reviews that I see from pediatric providers. So, we wanted to really provide something that would really be useful for them as well. Already, in a lot of our interview shows, where we do a nuts and bolts of a particular pediatric topic, we go into enough detail  that it should easily qualify for Category 1 CME credit. 

The issue has been, in order to do that, you really have to have a program that is  approved by a CME accrediting agency and have some standards and things set up. And so in order to do that moving forward, we've created PediaCast CME, which you can find at Our plan is to  go live with that next week, on April 1st.

It's really an easy thing. The shows are very similar to this particular program. Basically, if you listen to our interview shows, it's just like that. Except that you can go to, sign up for an account which is free. It just literally takes two or three minutes to sign up for an account. Once you signed up for an account, you log in. Once you log in, the CME activity will appear on the Show Notes. Pretty easy. 

So for anybody, the podcast in the Show Notes are available for moms and dads, and providers, anyone who wants to come along and listen to the podcast, read the Show Notes. Just like this program, it's there.


But if you want a free Category 1 CME, and that is presented through Nationwide Children's Hospital in our Education Office, then, you want to sign up, log in and once you log in, the CME activity will automatically appear for you in the Show Notes of each episode at 

A quick, like four-question post-test, just to verify if you did listen to the program. Right there from that page, can submit the post-test and we immediately e-mail a certificate of participation to you. We also keep the record in our Education Office for six, so that the CME activity that you did, if you ever need verification for it or you've lost the email or you didn't print it out, you can find that easily. 

So, again, that's PediaCast CME over at So all my providers in the audience make sure that you check that out.

And the moms and dads, a lot of you like those interview programs where we go into depth, so you can check those out as well.

Don't forget, if you are in the Central Ohio area, Nationwide Children's offers urgent care service at seven convenient locations, including our downtown Main campus,  Dublin, Hilliard, Marysville, Westerville, East Broad, and Canal Winchester. You can find exact locations, hours of operation, and approximate wait times on our website, You can also find urgent care information in our mobile app called MyChildren's, and available for iPhone and Android. 


Of course, you should always check with your regular doctor before going to any urgent care, just to make sure it's the right thing to do, given your child's problem and situation. And if your child has a serious or life-threatening problem, head to your nearest emergency department or call 911.

That's all the time we have today. PediaCast is a production of Nationwide Children's Hospital. Podcast are available in iTunes, under the Kids and Family Section of their directory, and reviews there are always welcome and helpful. 

We're also on iHeart Radio, simply search for PediaCast. You'll also find PediaBytes, B-Y-T-E-S, on iHeart Radio. Those are shorter clips from the show and a bit  easier to take in if you only have a few minutes. 

We're in most podcasting apps for iPhone and Android including the Apple podcast app, Downcast, iCatcher, Pod Bay, Stitcher and TuneIn. 

Of course, there's the landing site,, where you will find an archive of more than 300 episodes, our Show Notes, written transcripts of each program, our Terms of Use, and an easy Contact Page to ask your questions and suggest your topics. 

You can also call our voice line and leave a message that way. The number, again, 347-404-KIDS, 347-404-5437. 

And then, there's social media, PediaCast is on Facebook. Be sure to follow us there for breaking pediatric news and commentary, plus it's a cool community of moms and dads supporting one another. We're also on Google Plus, Twitter and Pinterest, less of a community feel on those spaces, but if you're there, follow and share to keep up-to-date with the latest show topics. 

Of course, there's good old fashion face-to-face media. We always appreciate talking us up with your family, friends, neighbors and co-workers, anyone with kids or anyone who takes care of children. Finally, please tell your child's doctor about the program. Next time you're in for a check-up, say, "Hey, doc, there's a great evidence-based pediatric podcast for parents called PediaCast. You should share it with your families," and to help you do that, they have posters available under the Resources tab at

All right, that is a wrap for this one. Until next time, this is Dr. Mike, saying stay safe, stay healthy, and stay involved with your kids. So long everybody. 



Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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