title: Effects of paediatric limb loss on healthcare utilisation, schooling and parental labour supply.
abstract: OBJECTIVE
  To explore the impact of childhood limb loss on families in terms of healthcare utilisation, schooling and parental labour supply.
  
  
  METHODS
  Data were obtained from a cross-sectional, retrospective pilot survey of 123 parents or caregivers of children with limb loss selected randomly after stratification by aetiology (i.e. trauma, malignancy and congenital limb deficiency) from among eligible families identified by the Amputee Coalition of America. Healthcare utilisation, school (child) and labour market (parents) participation were examined.
  
  
  RESULTS
  Children with limb loss use health services frequently and miss school for limb loss-related concerns. Over half of all parents adjusted their work participation in response to their child's limb loss. The use of prostheses may increase direct and indirect costs of limb loss. Children with acquired limb loss (amputation following trauma or cancer) were more likely than those with a congenital limb deficiency to use a prosthesis.
  
  
  CONCLUSIONS
  Our data suggest that the impact of limb loss on families of affected children may include substantial costs, particularly when school and work effects are taken into account. Further research is needed to identify the full household- and societal-level costs of childhood limb loss and suggest interventions to reduce the burden experienced by families.
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, Shrewsbury, MA, USA. sharada.weir@umassmed.edu
authors.forename: Sharada
authors.initials: S
authors.lastname: Weir
authors.forename: Patti
authors.initials: P
authors.lastname: Ephraim
authors.forename: Ellen
authors.initials: E
authors.lastname: Mackenzie
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000671:Amputation, Surgical / Q000191:economics* / Q000534:rehabilitation; D000673:Amputation, Traumatic / Q000191:economics* / Q000534:rehabilitation; D001186:Artificial Limbs / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004493:Education; D004651:Employment; D005260:Female; D005382:Financing, Personal; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D017880:Limb Deformities, Congenital / Q000191:economics* / Q000534:rehabilitation; D008297:Male; D016524:Parental Leave; D010865:Pilot Projects; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States