Kids will be kids. We want to encourage them to experience new things and explore their environment. Exploration is usually encouraged until an accident happens. For example, your child decides they do not want to go to bed so they jump out of their crib at 18 months old or they decided they can make the jump to the next rung on the monkey bars.
Signs that a limb is broken: Usually, their limb will be limp. Most likely they are not able to bear weight on the limb. Any type of movement could cause more pain, or in the case of a broken arm, they might not be able to hold their sippy cup or their toy. Also, they might not be able to bear weight to walk if it is a lower extremity injury.
The best options for treatment:
First and foremost, if there is an emergency, please call 911 or go to your local ER. Examples of emergent situations are loss of consciousness, open fracture, bleeding that cannot be controlled, if there was a head injury involved or something seems off about the child. Please seek immediate medical attention for any above scenarios.
For children who are in stable condition you have the following options:
1) If you have a PPO plan and do not need a physician referral to go to a specialist. Call your local orthopedics to see if they will see you. You can also call your pediatrician to see who is on their list of referring orthopedics. Most orthopedic offices have x-ray services in their office. This is beneficial because you don’t have to make another trip somewhere else.
2) Many cities have a dedicated orthopedic urgent care in the area that will evaluate and cast at the same location. Regular urgent cares are also an option, but you will still have to follow up with an orthopedic for further evaluation.
3) Go to your primary care office, get evaluated, get an x-ray at a local radiologist and follow up with orthopedic same day.
4) Lastly, if all else fails there is always the ER. Most likely you will have to follow up with an orthopedic in the next couple days after initial evaluation.
What to expect:
After the initial evaluation and you are told your child needs a cast, they will usually place some type of split on the injury for 3-5 days. If you are at an urgent care or ER you will follow up with the orthopedic office. If you went to the orthopedics to begin with, you will probably just follow up at that office. If no surgery is required, the splint is placed so that the initial swelling that comes from the injury will decrease before placing on the cast. It is important to have support of the limb with a splint. They will give a sling if it is an upper extremity. Placing the arm or leg up will help decrease swelling. The reason for the splinting first is that it decreases the risk for impingement, ie cutting off the circulation to the limb, those first initial days of the injury.
Once the swelling has stabilized, an appointment will be made for cast placement. Which they will also take some x-rays at that time. Usually there is a 2 week follow up, where they will check on the progress of the healing bone. Then at 4-6 weeks there is another follow up where at that point a decision is made to take off the cast, splint or need for longer time in the cast.
The day after the cast is taken off can be painful for the child. Sometimes their limb can become atrophied with disuse. The day my child got her cast off my daughter was in so much pain she couldn’t fall asleep at night. What was helpful for her was when I used an ace wrap around her arm to provide some support. After the first night, that she did not need any more additional support. If you are feeling like there is something wrong in terms of pain or atrophy after the cast is removed follow up with your orthopedic doctor. If atrophy is an issue look into physical therapy.
Pain Management:
Tylenol and Advil are your child’s friend during this time. Its ok to give them some Advil or Tylenol if they have pain during the process. Pain management is very important. If they are experiencing pain anytime during the process it does not hurt to provide pain management support for them. There were times when the bone was healing, and it was a couple weeks into the cast and my daughter would complain of pain (most likely from the new growth). It is important to work through and address the pain that your child is feeling. There might be some circumstances that premedicating them might be helpful. Specifically, it is helpful during the transition from splint to cast initially and when they go from cast to no cast.
Managing the cast near water:
Many breaks happen in the summertime. Kids are more active, more probability for accidents to occur. Sponge bath to start with while they have the splint. The most helpful in-house item that helped protect cast from being affected by water was CLING wrap. Starting at the most distal point (hand or foot), I would cover my child’s hand with the cling wrap. I would work my way up the limb until I got to the top. You can use packing tape at the top and bottom for a nice seal fit. I still wouldn’t allow my child to leave the limb in the water for a long period of time, but it keeps the stress of the cast disintegrating at the pool to a minimum. Sadly, swimming lessons will have to be cancelled until the child is cleared by the orthopedic specialist.
Our bodies are amazing and in a few short weeks your child will be back at it climbing, swimming and running! Good luck mama!
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