Fractures about the elbow are very common in children, but the anatomy of the child’s elbow may make the diagnosis less obvious than in a mature skeleton. An understanding of the ossification and fusion of the secondary growth centers about the elbow is essential to avoid overlooking these injuries and to optimize treatment. If plain radiographs are equivocal, an arthrogram of the elbow may clarify the anatomy and diagnosis. Early neurologic and vascular complications are not uncommon and must be recognized before fracture reduction. Many late complications, such as malunion, osteonecrosis, and physeal bridging, are largely preventable by correct early diagnosis and treatment. Anatomic reduction of articular surfaces, restoration of physeal anatomy, and near-anatomic alignment of fracture fragments in the frontal plane are the corner-stones of successful treatment of pediatric elbow fractures.

What is an elbow fracture? An elbow fracture (FRAK-chur) is a break in one or more of the bones in your child’s elbow. It may also be called a broken elbow. The elbow is the joint where the upper arm bone (humerus) meets the two forearm bones (radius and ulna). The elbow joint helps greatly with arm movements.

What causes an elbow fracture? A fall on an outstretched hand, in an attempt to stop a fall, often causes an elbow fracture. This may also happen by falling directly on a bent elbow. Your child’s elbow may be broken while playing sports. A bad twist of the elbow and overuse of the elbow may also lead to fractures. Broken elbows may occur because of a direct blow or if the elbow is hit straight on.

What are the signs and symptoms of an elbow fracture? Your child may have pain, swelling, and bruising in the injured elbow. Your child’s arm may bleed if the skin is broken. The bones may poke through the skin, not look normal, or look bent or out of place. He may have a hard time moving his elbow, arm, or hand, or may refuse to use his elbow or arm. Your child may hold the elbow with his other hand to lessen the pain. Your child’s arm, elbow, or hands may feel weak, numb, or tingly.

How is an elbow fracture diagnosed? Imaging tests may be needed to see if your child has a broken bone. These may also be done to check for other injuries, such as a bone, muscle, or blood vessel problem. Your child may have one or more of the following:

• Bone scan: During this test, pictures are taken of your child’s bones. Your child is given a small, safe amount of radioactive dye in an IV. Caregivers can look at the pictures for broken bones, infection, or cancer in the bones.
• Computerized tomography scan: This test is also called a CT or CAT scan. This is a type of x-ray that uses a computer to take pictures of your child’s arm and elbow. Your child may be given a dye before the pictures are taken to help caregivers see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your child’s caregiver if your child is allergic to shellfish or has other allergies or medical conditions.
• Magnetic resonance imaging scan: This test is also called an MRI. The test uses magnetic waves to take pictures of your child’s arm and elbow.
• X-ray: This is a picture of the bones and tissues in your child’s elbow. X-rays of the elbow and arm may be done to check for broken bones or other problems. Several pictures of your child’s bones may be taken. X-rays of both your child’s injured and uninjured elbows may be needed.

How is an elbow fracture treated? Treatment will depend on how bad your child’s fracture is and whether other parts of his elbow are affected. Your child may need one or more of the following:

• Devices: Keeping the broken elbow from moving is very important. A splint or cast with a sling may be put on your child’s elbow and arm. This may be used to decrease pain and prevent further damage to the broken bones.
• Medicine: Medicines may be given to help with your child’s pain. Your child may need antibiotic medicine or a tetanus shot if he has a break in his skin.
• Supportive therapy: Ice packs may be put on your child’s elbow to decrease swelling, pain, and redness. Physical therapy may be needed once swelling and pain are gone. A physical therapist may assist your child with special exercises. This may help his elbow recover faster and become stronger.
• Surgery: Your child may need surgery with an elbow fracture, especially if his bones are out of place. It may also be needed if your child’s fracture does not heal with other treatments. Surgery helps return bones to their normal position by putting them together with pins, wires or screws. Surgery may also be done if your child has other injuries, such as nerve or blood vessel damage.

If your child is afraid of the hairdresser’s, then try to cut their hair at home. They will feel safe and comfortable and you will save time and money

. However if you don’t have any hair cut experience, you might want to seek out a step by step guide on children’s hair cutting.

Hair Care Troubles and Hair Tips for Kids

Trouble washing your child’s hair?
Try to use a mild shampoo in his or her favorite color or scent. Sometimes children are more willing to wash their hair with a fun shampoo, especially if it doesn’t sting their eyes.

If you’re having trouble combing their hair, try to create trust and reassurance by allowing them to comb and brush their own hair on their own terms.

Do not brush your child’s hair 100 strokes before bedtime in the traditional manner. Although combing the hair will promote shine and condition, brushing to this extend will over stimulate the sebaceous glands and make the hair greasy and heavy. Doing a quick brush to get the tangles out should be sufficient. Remember to use a comb on wet hair rather than a brush or you risk creating static electricity, which leads to breakage.

Physical Signs of Child Abuse
1. Unexplained burns, cuts, bruises, or welts in the shape of an object
2. Bite marks
3. Anti-social behavior
4. Problems in school
5. Fear of adults

Emotional Signs of Child Abuse
1. Apathy
2. Depression
3. Hostility or stress
4. Lack of concentration
5. Eating disorders

Sexual Signs of Child Abuse
1. Inappropriate interest or knowledge of sexual acts
2. Nightmares and bed wetting
3. Drastic changes in appetite
4. Overcompliance or excessive aggression
5. Fear of a particular person or family member

Signs of Neglect
1. Unsuitable clothing for weather
2. Dirty or unbathed
3. Extreme hunger
4. Apparent lack of supervision

In cases of divorce, the court of jurisdiction for the divorce proceedings also determines child custody arrangements. Under the common statutory provision, if the spouses have children together while married, the parents have joint guardianship over that child and the parental rights are equal. Each parent has an equal right to the custody of the child when they separate.

The parent with custody controls decisions pertaining to the child’s education, religious upbringing, and health care. Courts have the option of choosing one of several types of custody. Temporary custody grants custody of the child to an individual during the divorce or separation proceeding. Exclusive custody endows one parent with all custody rights to the exclusion of the other parent. The non-custodial parent may receive supervision rights or in certain cases, supervised visitation rights. Joint custody grants the parents equal rights in making decisions regarding the child’s upbringing. Courts award joint custody for cases in which both parents can properly perform their duties as parents. If one parent sues for exclusive custody, the suing parent must rebut a presumption that joint custody is in the child’s best interests. A court can award the custody of a child to a third-party if the third-party has sought custody. The third-party is often a grandparent or other close relative. If a marriage results in multiple children, a court has the authority to separate the children and split the custody between parents in accord with the best interest of each particular child. Ordinarily, however, the best interests of a child will be to live with that child’s siblings, in part for reasons of emotional support.

When determining the home in which to place the child, the court strives to reach a decision in “the best interests of the child.” A decision in “the best interests of the child” requires considering the wishes of the child’s parents, the wishes of the child, and the child’s relationship with each of the parents, siblings, other persons who may substantially impact the child’s best interests, the child’s comfort in his home, school, and community, and the mental and physical health of the involved individuals.

Visitation Rights

When a court awards exclusive child custody to one parent, the non-custodial parent maintains the right to see and visit the child, absent extraordinary circumstances. If the court’s custody decree fails to mention visitation rights, the law implies the parent’s right to visitation. Thus, an express prohibition on visitation must exist within the decree in order to deny parental visitation rights because visitation rights stem from the fact of parenthood. Even though this strong presumption in favor of visitation rights exists, courts may impose restrictions on visitation by noncustodial parents.

If a party convinces the court that visitation rights would be injurious to the child’s best interests, then the court possesses the authority to deny visitation rights. This best interest of the child analysis, however, does not give dispositive weight to the child’s stated desires because parents inherently possess the right to attempt to repair the parent-child relationship. Cases in which courts deny visitation rights often include noncustodial parents who had physically or emotionally abused the child in the past and noncustodial parents severely suffering from a mental illness that would emotionally devastate the child. Noncustodial parents who are incarcerated or who have a prison record are not categorically denied visitation rights.

If a parent refuses to obey the court’s visitation or custody decree, the court can order the parent in indirect contempt of court.

Like other aspects of family law, the states control most law in the field of child custody.

OKLAHOMA CAPITOL — Unlicensed childcare facilities operating in Oklahoma will no longer be tolerated when a change in the state law goes into effect Nov. 1.

When Gov. Brad Henry signed House Bill 2643 into law June 2, it expanded the use of an emergency order to close any unlicensed child care facility operating in Oklahoma that is not in compliance with mandated child care licensing requirements.

Prior to HB-2643, an emergency order could only be used to close a licensed child care facility for being out of compliance with state requirements. The law now gives Oklahoma Child Care Services (OCCS) the authority to act on unlicensed child care.

“While we do not believe the majority of people provide unlicensed child care to violate the law, it is illegal, and the new law gives us the authority to act when such operations are brought to our attention,” said OKDHS Child Care Services State Licensing Coordinator Janice Matthews.

Some states have seen a surge in unlicensed child care as the economy tightens on working families across the country. Oklahoma’s legislative action last session is an attempt to get ahead of any possible surge occurring in Oklahoma.

“The Child Care Facilities Licensing Act of 1963, states that anyone who provides care to children must be licensed in Oklahoma,” Matthews said. “The amendment of this Act strengthens the original intentions.

“We know unlicensed childcare is attractive to some parents because it can be less expensive. At the same time, unregulated care can be more dangerous for children in care because providers may not be meeting the minimum health and safety requirements that are in place. Parents need to understand unlicensed facilities are illegal in Oklahoma.”

This is also a notice for parents who will be inconvenienced by having to leave their jobs to remove the children from the unlicensed facility. Additional time could also be lost from work while parents try to locate a licensed program at the last minute.

Oklahoma Department of Human Services OCCS does not want the new law to be a hardship for parents but are mandated by law to enforce the closure of unlicensed care. Facilities currently providing child care without a license can contact the local OKDHS Human Services Center in their area before Nov. 1 to begin the process to become licensed.

There are a few states (mostly in the South) that have laws providing that if everything else is equal, the mother may be preferred; but in those states, many fathers have been successful in obtaining custody, even if the mother is a fit parent.

In some states, courts say that mothers and fathers are to be considered equally, but the courts then go on to hold that it is permissible to consider the age or sex of the child when deciding custody. That usually translates to a preference for mothers if the child is young or female. But, again, it is possible for fathers in those states to gain custody, even when the mother is fit.

Although judges are supposed to be neutral in custody disputes between mothers and fathers, some judges may be biased based on sex of the parent. As a group, judges are less biased in deciding custody cases today than in times past, although some observers believe bias still exists. An advantage of having an attorney experienced in family law cases is that the attorney may know which judges may be biased and which are not. The attorney also may know what types of evidence will appeal to the judge and which types will not.

In many jurisdictions, it is possible to obtain a change of judge by asking for it. Such a change often is called a change of venue. In some states, a litigant is entitled to one change of venue without having to present a reason. The request, however, must be made before the judge has ruled on substantive issues in the case. If you are faced with a judge you suspect of bias, a change of venue can be useful (although you would want to consider the other judges to whom the case might be transferred and be reasonably sure than the change will not make the situation worse).

If a case is transferred to a judge who you or your attorneys don’t like, it will be difficult to obtain a second change of venue. Courts do not wish to allow parties to keep bouncing cases between judges. Courts are usually unwilling to order a second change of venue unless there is a clear, specific showing of prejudice by the judge to whom the case has been transferred. If you are before a judge who you believe to be biased (and a change of venue cannot be obtained), sometimes you must just put on the strongest case possible and hope for the best.

Possible prejudice in favor of mothers

Judges, based on their background or personal experience, may have a deep-seated belief that mothers can take care of children better than fathers and that fathers have little experience in parenting. Such judges may carry those views onto the bench, in which case a father may have a very difficult time gaining primary custody.

A Louisiana case illustrates the point. The trial judge gave custody to the mother saying, “It is just a physiological fact that girl children should be with their mother if there are no serious differences [between the fitness of the parents].” Since the trial judge’s bias was clear on the record, the appellate court reversed the decision and ordered that there be further proceedings–without applying improper presumptions based on sex of the parents. In cases in which the trial judge is less explicit about his or her prejudice, it may be more difficult to obtain a reversal if the trial judge was prejudiced.

Possible prejudice in favor of fathers

As noted in the section on evolution of custody standards, prejudice based on sex of the parent is not a one-way street. Sometimes prejudice runs in favor of fathers.

Some judges tend to automatically favor fathers, particularly if the children are boys. In an Iowa case, for example, a trial judge gave custody of two boys, ages nine and eleven, to the father, saying that the father “will be able to engage in various activities with boys, such as athletic events, fishing, hunting, mechanical training and other activities boys are interested in.”

The trouble was that the testimony before the before court did not support the judge’s presumption. The record in the case did not show that the boys were interested in hunting or mechanical training or that the father’s skills in those areas were superior to the mother’s. In fact, the mother went fishing with the boys more often than the father.

The Iowa Supreme Court reversed and gave custody to the mother, who had been primarily responsible for raising the children. The court said, “The real issue is not the sex of the parent but which parent will do better in raising the children. It logically follows that neither parent has an edge based on the sex of the children either.”

Another possible prejudice in favor of fathers may be regarded as a prejudice against working mothers. In some cases, it appears that judges have looked askance at working mothers, perhaps holding mothers to a higher standard than fathers and viewing a working mother as not serving the best interest of her child. Such judges also may view a father who shows slightly-above-average involvement in parenting as “exceptional” and reward him with custody.

It is difficult to assess how widespread this view may be among judges. Some commentators assert that bias against working mothers, especially professional women, may be a significant factor. Others suggest that a review of appellate court cases does not disclose widespread prejudice against working mothers, although it exists to some degree. If anything, most judges seem to admire a mother (or father) who can simultaneously manage work and raising children.

A parent’s work schedule normally is not a decisive factor in custody, unless there is a major difference in the amount of time each parent can spend with the child. If after a divorce, one parent will be able to spend much more time with the child than the other parent, that is a factor in favor of the parent with the more flexible schedule.

The U.S. Census Bureau reported that in 2003, there were 12.4 million households headed by single parents living with their own children under age 18. Of those households, 10.1 million (81 percent) were headed by mothers and 2.3 million (19 percent) were headed by fathers.