In this section
Spinal cord injury (SCI) in children is a rare injury that can result in permanent loss of motor and sensory function, and dysfunction of the bowel and bladder. Impairment of these functions result in significant social and psychological consequences for the child and their family. SCI is often associated with a traumatic brain injury. In children and adolescents SCI is most commonly a result of road traffic accidents, falls or diving into water.
Children with SCI experience multiple health care problems including autonomic instability, complications of immobility and bowel or bladder dysfunction. Management in the acute phase is aimed at preventing further spinal cord injury, maintaining physiological stability, and commencing routine care of the skin and establishing good bladder and bowel care.
This guideline is aimed at the acute management of children with injury to the spinal cord.
major trauma-primary survey guideline (link) and
cervical spine injury guideline (link) for initial assessment.
See cervical spine injury guideline (link)
function may be affected by SCI. The muscles and sphincters of the bladder are
normally controlled by neurological input and spinal reflexes. Loss of this
normal neurological control of the bladder is commonly referred to as a
neurogenic bladder. The aim of bladder care is to prevent infections, minimise
and contain incontinence and find an appropriate way to empty the bladder. This
will need to be related to the child’s developmental level, lifestyle, and
family needs. For the adolescent patient sexual function also needs to be
Bowel function will be affected by loss of neurological control of its function (neurogenic bowel). In addition, medications such as antibiotics and opioids, immobility, alterations are food, fibre and fluid intake may affect function. Patients are at risk of constipation, impaction, and diarrhoea. It is important to achieve
regular bowel emptying. Constipation is not only troublesome but can also trigger major complications such as autonomic hyper-reflexia (dysreflexia).
Patients with SCI are at risk for postural hypotension when moving from supine to sitting upright. This is due to loss of sympathetic autonomic nervous system innervation and include an inability to regulate BP normally with vasoconstriction. Do not attempt to start sitting patient up until medical approval given.
To avoid problems with postural hypotension:
Abnormal muscle tone and lack of movement can result in joint contractures. Referrals should be made to Physiotherapy, Occupational Therapy and Orthotics within 1-2 days of admission:
Make appropriate referrals:
The following are the most common complications seen for these children. The prevention and management is described above under the relevant headings:
Click here to vide the evidence table for this guideline.
Please remember to
read the disclaimer.
The revision of this nursing guideline was coordinated by Helen Jowett, Trauma Service Manager, and approved by the Nursing Clinical Effectiveness Committee. Updated February 2023.