As a parent, seeing your child struggle with knee pain or instability can be concerning. Whether due to a sports injury, growth-related issues, or a medical condition, pediatric knee braces can provide crucial support during healing and daily activities. However, the efficacy of a knee brace depends significantly on proper fitting and adjustment.
At Orthopedic Appliance Company, we've been providing custom orthopedic bracing for children throughout Western North Carolina since 1960. Our experience has shown that many parents struggle with the proper fitting of their child's knee brace, which can lead to reduced effectiveness and compliance. This comprehensive guide will walk you through everything you need to know about properly fitting and adjusting your child's knee brace for maximum benefit and comfort.
1. Understanding Pediatric Knee Braces
Before diving into fitting techniques, it's important to understand the different types of knee braces available for children and how they function.
1.1. Different Types of Knee Braces for Children
Prophylactic Braces: Designed to prevent injuries during sports and active play. These are commonly used for children who participate in high-impact activities or have a history of minor knee injuries.
Functional Braces: Provide stability for knees with ligament injuries (such as ACL, MCL, or PCL injuries). These braces help limit harmful movements while allowing necessary motion for healing and function.
Rehabilitative Braces: Used after surgery or serious injury to immobilize the knee while allowing controlled movement during the healing process.
Unloader/Offloader Braces: Less common in children but used for conditions like juvenile arthritis to reduce pressure on specific parts of the knee joint.
Patellofemoral Braces: Focus on proper tracking of the kneecap (patella) and are used for conditions like patellar tracking disorder or after patellar dislocation.
1.2. Materials and Design Features
Pediatric knee braces typically feature:
- Lightweight materials that won't impede a child's movement
- Adjustable straps to accommodate growth
- Breathable fabrics to prevent skin irritation
- Hinges that provide stability while allowing appropriate range of motion
- Non-slip features to prevent migration during activity
Unlike adult braces, pediatric versions are specifically designed to accommodate growing bodies while providing the necessary support. They often have more adjustment options and are sized appropriately for smaller limbs.
2. When Your Child Needs a Knee Brace
Understanding when a knee brace is necessary helps ensure you're addressing your child's needs appropriately.
2.1. Common Indications for Knee Bracing in Children
- After knee surgery or injury during the rehabilitation phase
- Ligament sprains or tears (ACL, MCL, PCL, LCL)
- Patellar (kneecap) instability or dislocation
- Osgood-Schlatter disease (growth-related knee pain)
- Prevention of injuries during sports
- Certain neuromuscular conditions affecting knee stability
2.2. The Importance of Professional Assessment
While this guide provides valuable information on fitting and adjusting knee braces, it's essential to start with a proper evaluation by a healthcare professional. This typically includes:
- Physical examination of the knee
- Review of your child's medical history and activity level
- Potential imaging studies like X-rays or MRIs
- Evaluation of gait and movement patterns
- Recommendation of the specific type of brace needed
Never attempt to diagnose your child's knee condition or select a brace type without medical guidance. The wrong brace could potentially delay healing or worsen the condition.
3. Step-by-Step Guide to Measuring for a Knee Brace
Accurate measurements are the foundation of a properly fitting knee brace. While professional fitting is ideal, these guidelines can help you check fit or prepare for a fitting appointment.
3.1. What You'll Need
- Flexible measuring tape (cloth or plastic)
- Paper and pen to record measurements
- A helper (if possible)
- A comfortable place for your child to sit with their leg extended
3.2. Key Measurements
- Mid-Thigh Circumference: Measure around the mid-thigh, about 5-6 inches above the center of the kneecap.
- Knee Circumference: Measure around the center of the knee at the kneecap while the knee is slightly bent (about 30 degrees).
- Mid-Calf Circumference: Measure around the calf at its widest point, usually 4-5 inches below the center of the kneecap.
- Length Requirements: For longer braces, measure from mid-thigh to mid-calf. For specific brace types, follow the manufacturer's guidelines.
- Knee Width: For some braces, measure the width of the knee joint from side to side.
3.3. Common Measuring Mistakes to Avoid
- Taking measurements over clothing (measure directly on skin or over very thin clothing)
- Measuring with the tape too tight or too loose
- Measuring with the knee in full extension when a slight bend is needed
- Not measuring both legs for comparison (even if only one knee needs bracing)
- Failing to note growth spurts that might affect fit
4. Proper Fitting Techniques
Once you have the appropriate brace and measurements, follow these steps for a proper fit:
4.1. Initial Fitting Guidelines
- Start Fresh: Have your child sit comfortably with the leg extended and the knee slightly bent (about 30 degrees).
- Position the Brace: Place the brace behind the leg, centering the kneecap opening (if present) directly over the kneecap.
- Secure Lower Straps First: Fasten the strap below the knee first, then the strap above the knee. This stabilizes the brace before final adjustments.
- Check Alignment: Ensure that any hinges align with the center of the knee joint from the side view. The brace should be centered on the leg from all angles.
- Adjust Tension: Straps should be snug but not tight enough to impair circulation or cause discomfort. You should be able to fit one finger under each strap comfortably.
4.2. Key Indicators of Proper Fit
A properly fitting knee brace should:
- Stay in place during movement without significant slipping
- Allow appropriate range of motion based on the brace type and treatment plan
- Feel secure but not painfully tight
- Not cause skin irritation or excessive pressure points
- Allow normal blood circulation (no numbness, tingling, or color changes)
- Be comfortable enough for the prescribed wearing duration
4.3. Red Flags for Poor Fit
Watch for these signs that indicate the brace doesn't fit properly:
- Brace slips down during activity
- Skin becomes red, irritated, or develops pressure sores
- Child complains of pinching or digging sensations
- Excessive sweating or heat build-up under the brace
- Child resistive to wearing the brace due to discomfort
- Hinges not aligning with the knee joint
- Numbness, tingling, or coldness in the foot or toes
5. Adjustment Instructions
Even a perfectly fitted brace will need adjustments over time, especially for growing children.
5.1. When to Make Adjustments
- After initial break-in period (usually 1-2 weeks)
- Following significant growth spurts
- With changes in activity level or type
- If swelling increases or decreases
- When transitioning between seasons (different clothing layers)
- If your child consistently complains about specific areas of discomfort
5.2. How to Make Common Adjustments
Strap Tension: Loosen straps if you notice red marks lasting more than 20 minutes after removal or if your child complains of pinching. Tighten straps if the brace slips during activity.
Hinge Position: If the hinges don't align with the knee joint, reposition the entire brace. The center of the hinge should align with the center of the knee joint when viewed from the side.
Padding Adjustments: Add additional padding under pressure points if your child experiences discomfort. Many braces come with extra padding that can be strategically placed.
Range of Motion Settings: Some braces have adjustable range of motion settings. Only modify these under direct supervision from your healthcare provider.
5.3. Tools for Adjustments
Most pediatric knee braces can be adjusted with:
- Hook and loop fasteners (Velcro)
- Simple strap adjustments
- Allen wrenches (for some hinged braces)
- Padding additions or removals
Always refer to the specific instructions for your child's brace model, as adjustment mechanisms vary.
6. Special Considerations for Active Children
Children lead active lives, and their braces need to accommodate various activities.
6.1. Sport-Specific Adjustments
High-Impact Sports: May require tighter fitting during the activity and looser fitting during recovery periods.
Water Activities: Some braces are water-resistant but may need special care after exposure to chlorine or salt water.
Winter Sports: May require adjustments to fit over additional clothing layers or under specialized gear.
6.2. School Considerations
- Provide written instructions for teachers or school nurses
- Consider having a backup brace at school
- Teach your child how to make minor adjustments independently (if age-appropriate)
- Address any physical education modifications with teachers
6.3. Growth Accommodations
Children grow quickly, so regular assessment of brace fit is essential:
- Check fit monthly during growth spurts
- Monitor for signs that the brace is becoming too small
- Consult with your orthotist about adjustable braces that can "grow" with your child
- Consider the season and changing clothing needs when assessing fit
7. Care and Maintenance
Proper care extends the life of the brace and ensures optimal function.
7.1. Cleaning Instructions
Fabric Components:
- Hand wash with mild soap and lukewarm water
- Air dry completely before reapplying
- Never use bleach or harsh chemicals
- Avoid high heat (dryers, heaters, direct sunlight)
Hinges and Metal Components:
- Wipe clean with a damp cloth
- Check for and remove debris regularly
- Apply lubricant as recommended by the manufacturer
7.2. Regular Inspection
Examine these components weekly:
- Straps for fraying or loss of elasticity
- Hinges for smooth operation
- Padding for compression or tears
- Frame for cracks or deformation
- Fasteners for security and function
7.3. Replacement Guidelines
Most pediatric knee braces need replacement:
- Every 6-12 months during periods of rapid growth
- When the brace no longer stays in position despite adjustments
- If components fail or break
- When the brace shows significant wear that affects function
- After major changes in treatment plans or rehabilitation phases
8. Troubleshooting Common Issues
Even with proper fitting, issues can arise. Here's how to address the most common problems:
8.1. Skin Irritation
Prevention:
- Ensure skin is clean and dry before application
- Use a thin cotton sleeve under the brace if recommended
- Apply the brace with smooth, wrinkle-free positioning
Solutions:
- Check for pressure points and adjust straps accordingly
- Apply silicone-based skin protectants to vulnerable areas
- Consider hypoallergenic padding if sensitivity occurs
8.2. Slippage
Prevention:
- Ensure proper sizing and initial fitting
- Apply according to instructions with appropriate tension
- Consider grip features or sleeves designed to reduce migration
Solutions:
- Reassess strap tension
- Check positioning relative to anatomical landmarks
- Consult your orthotist about anti-migration features
8.3. Comfort During Extended Wear
Prevention:
- Gradually increase wearing time as recommended
- Ensure appropriate sizing and adjustments
- Use moisture-wicking materials under the brace when possible
Solutions:
- Schedule "break times" if medically appropriate
- Address specific discomfort areas with targeted adjustments
- Consider multiple brace options for different activities
9. When to Seek Professional Help
While many adjustments can be made at home, certain situations warrant professional intervention:
9.1. Signs That Professional Adjustment Is Needed
- Persistent slippage despite multiple adjustment attempts
- Ongoing skin irritation or pressure sores
- Pain during brace wear that doesn't resolve with adjustment
- Significant change in your child's condition, weight, or growth
- Mechanical failure of any brace component
- Uncertainty about proper fit or function
9.2. What to Expect During a Professional Fitting Appointment
During a visit to a pediatric orthotist, you can expect:
- Comprehensive assessment of the current brace fit
- Evaluation of your child's comfort and function
- Measurement updates
- Professional adjustments to all components
- Education on home adjustment techniques
- Discussion of wear schedule and care instructions
9.3. Follow-up Care Recommendations
Most children benefit from:
- Scheduled follow-up appointments every 3-6 months
- Immediate evaluation if issues arise between appointments
- Coordination between the orthotist and treating physician
- Regular reassessment as growth or activity levels change
Frequently Asked Questions
1. How long will my child need to wear a knee brace?
The duration varies widely depending on the condition being treated. Some injuries require bracing for several weeks, while ongoing conditions might need longer-term support. Always follow your healthcare provider's specific recommendations.
2. Can my child sleep with the knee brace on?
This depends on the type of brace and your doctor's instructions. Some rehabilitative braces are designed for overnight wear, while others are meant only for daytime activities. Ask your doctor for specific guidance.
3. How can I tell if the knee brace is too tight?
Signs of excessive tightness include numbness or tingling below the brace, skin that appears pale or bluish, excessive discomfort, or indentations in the skin that last more than 20 minutes after removing the brace.
4. My child complains that the brace is hot. What can I do?
Choose moisture-wicking fabrics under the brace, ensure proper fit (overly tight braces can increase heat), and ask your orthotist about more breathable options. Some manufacturers offer summer versions of their braces with more ventilation.
5. How often should I replace my child's knee brace?
During periods of rapid growth, a brace might need replacement every 6-12 months. For older children with slower growth, braces might last 12-18 months before needing replacement.
6. Can my child participate in sports while wearing a knee brace?
Many children can continue sports activities while wearing a knee brace, though this depends on the specific injury, brace type, and sport. Work with your child's healthcare provider and coach to determine appropriate activity levels and necessary precautions.
7. What should I do if the brace causes skin irritation?
First, ensure the brace is properly fitted and not too tight. Try using a thin, breathable sleeve under the brace. If irritation persists, consult your orthotist about alternative materials or designs.
8. Is it normal for my child to resist wearing their knee brace?
Some resistance is common, especially initially. Focus on comfort, explain the benefits in age-appropriate terms, establish a consistent routine, and use positive reinforcement. If resistance persists despite a properly fitted brace, discuss concerns with your healthcare provider.
Conclusion
Properly fitting and adjusting your child's knee brace is crucial for effective treatment and comfort. While the process may seem overwhelming initially, with practice and attention to detail, most parents become adept at making necessary adjustments.
Remember that your child's comfort and compliance are essential to successful treatment. Take time to listen to their feedback about how the brace feels and watch for non-verbal cues indicating discomfort or problems with fit.
At Orthopedic Appliance Company, we're committed to providing the highest quality pediatric orthotic care throughout Western North Carolina. Our team of certified orthotists specializes in customized solutions for children of all ages at our locations in Asheville, Fletcher, and Hickory.
For professional fitting, adjustment, or consultation about your child's knee brace, contact us to schedule an appointment. We're here to support your child's journey to improved mobility and function with properly fitted orthotic devices.
Remember that this guide provides general information, and your child's specific needs may vary. Always consult with your healthcare provider or orthotist for personalized guidance regarding your child's knee brace.