A child has been diagnosed with Legg-Calvé-Perthes disease. After teaching the parents about the disease, which of the following statements by the mother indicates the need for further teaching?

Corticosteroids are potent anti-inflammatory and immunosuppressive agents that inhibit leukocyte migration, cytokine production, and T-cell activation. Although therapeutically useful in autoimmune and inflammatory conditions, they significantly impair host defense mechanisms, increasing susceptibility to opportunistic bacterial, viral, and fungal infections.

Rationale:

A. Corticosteroids suppress the immune response by reducing lymphocyte proliferation, inhibiting macrophage activity, and decreasing cytokine signaling. This impaired cell-mediated immunity reduces the body’s ability to fight opportunistic pathogens, making infections more likely even with low-virulence organisms.

B. Decreasing swelling and vasodilation reflects the anti-inflammatory effect of corticosteroids but does not directly explain infection susceptibility. Inflammation reduction occurs, but the key mechanism for opportunistic infections is immune suppression, not vascular changes.

C. Corticosteroids typically cause hyperglycemia, not hypoglycemia, by promoting gluconeogenesis and reducing peripheral glucose uptake. Although hyperglycemia can contribute to infection risk, the primary mechanism remains immunosuppression rather than blood glucose reduction.

D. Osteoporosis is a long-term adverse effect of corticosteroid therapy due to bone resorption, not a cause of increased infection risk. It reflects altered calcium metabolism and osteoblast inhibition, unrelated to immune defense mechanisms against pathogens.

Acute musculoskeletal injury management requires ongoing monitoring of neurovascular integrity, distal circulation, nerve function, and compartment pressure. Compression devices such as bandages may impair perfusion, making early detection of ischemia, sensory loss, and motor dysfunction essential to prevent irreversible tissue damage in pediatric extremities.

Rationale:

A. Determining timing of analgesia administration is relevant for pain control evaluation but is not the priority intervention. Pain management does not directly assess limb viability or detect early neurovascular compromise that may occur from compression bandaging.

B. Applying ice reduces local inflammation and edema formation, but it does not assess limb status. Without first evaluating circulation and nerve function, cryotherapy may mask worsening ischemia or delay detection of compartment-related complications.

C. A neurovascular assessment evaluates capillary refill, pulses, skin temperature, sensation, and motor function. This is the priority because an ace bandage may cause vascular compression, and early detection of compromised perfusion prevents permanent tissue and nerve injury.

D. Elevation reduces venous pooling and edema formation, which is beneficial in sprain management. However, it is a supportive intervention and does not take precedence over assessing neurovascular status, which is essential before ongoing immobilization care decisions.