In this section
Note: This guideline is currently under review.
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.
See major trauma-primary survey guideline (link) and cervical spine injury guideline (link) for initial assessment
See cervical spine injury guideline (link)
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 is 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
Spinal Cord Injury (Acute Management) evidence table
Please remember to read the disclaimer
development of this nursing guideline was coordinated by Janine Evans, Rosella - PICU,
and approved by the Nursing Clinical Effectiveness Committee. Updated April 2015.