We report on the experience with our first seventy patients who had
reflex sympathetic dystrophy and were less than eighteen years old (average
age, 12.5 years). In our series, the patients were predominantly girls
(male to female ratio, 11:59) and the lower extremity was involved most
often (sixty-one of the seventy patients). The average time from the
initial injury to the diagnosis was one year, which indicates that the
syndrome remains under-recognized in patients in this age-group.
Conservative treatment with physical therapy, transcutaneous electrical
nerve stimulation, psychological therapies including cognitive-behavioral
management and relaxation training, and tricyclic anti-depressants was
effective in improving the average scores for pain and function for forty
patients. Sympathetic blocks were helpful for twenty-eight of thirty-seven
patients. Thirty-eight of the seventy patients in the series continued to
have some degree of residual pain and dysfunction. Reflex sympathetic
dystrophy in children differs in presentation and clinical course from the
syndrome in adults. It is best treated in a multidisciplinary fashion.