As students return to playgrounds and sports fields, falls and sports-related injuries often follow. For parents, the hard part can be deciding whether a child needs rest and ice or medical attention.
The types and locations of common injuries often change with a child’s age and activities, according to Dr. Aaron See, a pediatric orthopedic surgeon with Methodist Children’s Hospital.
He said common injuries he sees in elementary-age children are in the wrists or elbows after playground falls, while knee and ankle injuries become more common among older athletes.
“Often what we find is that children are out of school and then they go back to school, and they want to be on the playground,” Dr. See said. “They haven’t done it for a while, and they’re not as good as they thought they were, and there tend to be some falls.”
Is it a sprain or a broken bone?
Unfortunately, it’s not always possible to distinguish a sprain from a broken bone -- also called a fracture -- just by looking at it, but the way symptoms change during the first hour or two can offer clues.
“If you allow the child to have a brief period of rest and they show some improvement without a lot of swelling, that tends to lean more toward a sprain or strain,” Dr. See said. “If the pain continues, the swelling increases or there are some obvious changes in the way the injured area looks, the injury should be evaluated in the emergency room with an X-ray.”
He said age matters, too. A toddler might communicate pain by suddenly becoming inactive, while an older athlete who limps off the court and cannot return to play also deserves attention.
“Watch how they act. Watch what they do,” Dr. See said. “I think the biggest thing is watching their activity level and how they’re able to return. That will give you a really good clue.”
When should an injury be evaluated right away?
An arm or leg that looks bent, crooked or out of place should be evaluated in an emergency room. Increasing pain, swelling or bruising that does not improve with rest, ice, elevation and an age-appropriate over-the-counter pain reliever -- used as directed -- should also be medically evaluated.
“If the child has hurt their wrist, leg or ankle, look at the toes or the fingers,” Dr. See said. “If they’re having trouble moving the fingers, or something a little farther away from the injury doesn’t feel quite right, those are signs that should be looked at right away.”
If emergency evaluation appears necessary, Dr. See advised keeping the child comfortable and protecting the injury from further movement. He also advised asking before giving the child food or drinks, because surgery or sedation may be needed.
Not every broken bone comes with an obvious warning sign. A nondisplaced fracture -- one in which the bone remains aligned -- can resemble a sprain. A parent might reasonably let a child rest overnight, then seek care when the pain has not improved.
Dr. See wants parents to know they should not blame themselves if the injury is discovered to be more serious than they initially thought.
“It is really tricky sometimes to tell the difference between a simple sprain and a nondisplaced fracture that doesn’t need surgery,” he said. “I often tell the families, ‘You’re doing the right thing. It’s OK. No harm has come to it.’ There are usually some obvious signs if something must be cared for right away.”
Why children’s growing bones are different
Children’s bones are still growing and may bend or partially break in ways adult bones do not. They also tend to heal more quickly.
“There are many injuries that would get treated with surgery in an adult that, in growing children, we just treat with either a cast or other nonsurgical care,” Dr. See said. “Children can heal a lot of things that adults can’t.”
Growth plates allow bones to lengthen and form properly. In uncommon cases, an injured growth plate can slow down or cause a bone to grow in a different direction, which can cause one limb to grow differently or a bone to grow at an angle.
Because younger children still have years of growing, the orthopedic team may continue monitoring a growth plate after the fracture heals. Follow-ups can include periodic visits and X-rays, plus guidance about changes to watch for at home.
“A little bit of intervention up front can prevent a lot of problems down the road,” Dr. See said.
What might treatment look like?
At a Methodist Healthcare hospital or freestanding emergency room, X-rays may be taken to check for a possible broken bone. A pediatric orthopedic specialist can review the images and help determine whether the child needs care in the hospital or a follow-up appointment in the office.
Dr. See said many fractures do not require surgery. Treatment can instead include a brace or cast, based on the child’s age, activities and ability to follow restrictions.
“One of my favorite jokes is, ‘Do we need to protect the child from themselves?’” Dr. See said. “I can ask a child not to walk on their leg for four weeks, but good luck with a 3-year-old. When that 3-year-old feels better, they’re going to walk on it.”
A cast may give a young child added protection, while an older child might reliably use a removable brace. The decision ultimately includes a conversation with parents about the child’s habits and home environment.
“Tell me about your child and what you think we may need to do, because every child’s situation is different,” he said. “Do they have siblings who like to play? Is your child very active? Is there a big dog at home? Those details help us think through the right treatment plan.”
Helping young athletes stay healthy
Not all orthopedic pain follows a sudden injury. During growth spurts, bones may lengthen faster than muscles can adapt. When children who are active or involved in sports move to a more demanding level of competition, it can lead to knee, back and muscle pain.
“The muscles work. The bones work. But the bones have lengthened and the muscles haven’t kept up,” Dr. See said. “With a little bit of a stretching regimen, a lot of this stuff gets better.”
He said warming up before being active, stretching after -- while the muscles are still warm -- and wearing proper protective equipment can all help to reduce minor injuries.
If pain continues despite stretching and rest, an evaluation can help determine whether physical therapy may be beneficial.
“I’ve had patients attend a short course to let the therapist educate them and help them understand what they should be doing,” Dr. See said. “Even just three or four weeks can really help.”
Good nutrition can also help support growing bones. Dr. See advises families to speak with their child’s doctor or pediatrician to understand if supplementation might be appropriate.
Methodist Healthcare provides orthopedic care for children from birth through age 18, including treatment for broken bones, sports injuries, scoliosis, bone tumors, limb deformities, hip dysplasia, foot conditions and more.
Learn more about pediatric orthopedic care at Methodist Children’s Hospital.