Osteopenia frequently develops in bones secondary to disuse and nutritional issues. 8 Fractures occur more easily in osteopenic bones. Children with limited movement and osteopenia may sustain fractures without excessive force being used. Lifting or moving an older child may cause fractures when osteopenia is present. Stretching and range-of-motion exercises used to prevent the development of contractures also can result in fractures if the person doing them is unaware of osteopenia and uses an aggressive stance for therapy. Fractures may present with discomfort and swelling of an extremity and should be considered in the irritable, severely impaired child. Fractures may be treated with casting if the child has and uses voluntary movement, but soft wraps may be used in the child with significantly limited voluntary movement. Displaced fractures are uncommon, and, when present, forceful activity is generally involved. Routine handling and therapy generally are not associated with this type of injury. Consultation with an orthopedic surgeon and hospitalization may be required.

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