What is the recommended activity progression for a 7-year-old with a right distal both bone (forearm) arm fracture showing evidence of healing 8 weeks post-injury?

Activity Progression for 7-Year-Old with Healing Distal Both-Bone Forearm Fracture at 8 Weeks

At 8 weeks post-injury with evidence of healing, initiate a home-based progressive exercise program starting with active finger and wrist range of motion exercises, followed by gradual return to age-appropriate activities as tolerated without pain. 1

Immediate Activity Recommendations

• Begin active finger motion exercises immediately if not already started, as finger motion does not adversely affect adequately stabilized or healing fractures and prevents stiffness 1
• Start gentle active wrist range of motion exercises, progressing palmar flexion and dorsiflexion gradually 2
• Initiate elbow flexion and extension exercises, as studies show progressive improvement from restricted motion (110° flexion at 4 weeks) to near-normal motion (142° flexion at 24 weeks) 2

Progressive Activity Algorithm

Week 8-10 (Light Activity Phase):

• Perform gentle active range of motion exercises for fingers, wrist, and elbow 3-4 times daily 1, 2
• Allow light activities of daily living using the affected arm (eating, writing, light object manipulation) 1
• Avoid any impact activities, sports, or lifting objects heavier than 1-2 pounds 3

Week 10-12 (Moderate Activity Phase):

• Progress to resistance exercises using light objects (small balls, therapy putty) if pain-free 2
• Gradually increase weight-bearing activities through the arm (pushing up from chair, light wall push-ups) 1
• Begin sport-specific movements without contact or impact (throwing motions without ball, swimming strokes in air) 4

Week 12+ (Return to Full Activity):

• Progress to full activities only when the child demonstrates pain-free range of motion at rest and with exertion 1
• Return to contact sports and high-impact activities requires full, pain-free range of motion equal to the uninjured side 1, 2
• Studies show most children achieve functional recovery by 24 weeks with mean wrist dorsiflexion of 86° and normalized elbow extension 2

Home Exercise Program Structure

• A home exercise program is equally effective as supervised physical therapy for uncomplicated pediatric forearm fractures and represents the recommended approach 1
• Parents should supervise exercises 3-4 times daily, with each session lasting 10-15 minutes 1
• If symptoms worsen or pain increases at any stage, reduce activity level for 24-48 hours before attempting progression 5

Critical Monitoring Parameters

• Schedule follow-up evaluation if the child experiences unremitting pain, as this may indicate complications such as malunion or delayed union 1
• Monitor for any loss of rotational motion (supination/pronation), as rotational malalignment does not remodel and requires intervention 1
• Assess for persistent stiffness, particularly in finger motion, as prolonged immobilization without movement significantly increases risk of permanent stiffness 1

Expected Recovery Timeline

• At 8 weeks, most pediatric both-bone forearm fractures show radiographic healing and can tolerate progressive loading 2, 3
• Full functional recovery typically occurs by 16-24 weeks post-injury in children aged 7 years 2
• Children under 10 years demonstrate excellent remodeling potential, with minimal residual angulation and full range of motion expected even with some initial deformity 6

Activity Restrictions to Maintain

• Avoid contact sports, climbing, and high-impact activities until 12+ weeks or until cleared by orthopedic follow-up 3
• No heavy lifting (>5 pounds) until demonstrating full pain-free range of motion 1
• Restrict activities that involve falling risk (skateboarding, trampolines, monkey bars) until complete healing confirmed radiographically 3

Common Pitfalls to Avoid

• Do not allow premature return to contact sports even if the child feels "fine," as reinjury risk remains elevated until complete remodeling occurs 3
• Avoid prolonged immobilization beyond what is necessary, as this significantly increases stiffness risk 1
• Do not ignore complaints of persistent pain, as 6-7% of cases develop complications requiring intervention 2