It seemed like a pretty ordinary wipeout on the ski hill—six-year-old Ayden Ziegler fell hard on the last run of the day, trying to avoid an adult who cut in front of him. “I gave him a hug, and then we skied the rest of the way down the hill, walked to the parking lot and drove home. End of story, I thought,” says his mom, Kristina. After icing his knee and eating dinner, Ayden went to bed. At 5 a.m. he woke up crying with pain, so his parents drove him to the emergency department, where, to their surprise, an X-ray showed a slight break near his left knee. Ayden was in a full-leg cast for three weeks and then went to physiotherapy for another three.
Ayden’s unlucky break is not unusual. Rodrick Lim, head of the paediatric emergency department at the Children’s Hospital at London Health Sciences Centre in London, Ont., says fractures (a break or crack in a bone) make up about five percent of the injuries his department sees. Here’s what you need to know about kids and broken bones.
Parents are used to the regular bumps and bruises that can be fixed with a cold pack and a hug. Signs of a broken bone, however, include swelling, pain, crookedness and an inability or unwillingness to move the body part or put weight on it. In severe cases, the break is obvious because the broken end of the bone is poking through the skin (this would normally be the result of a serious incident, like a fall from a high place). If this is the case, don’t bring your kid to the hospital on your own, which could make this injury, called an open or compound fracture, worse. Call an ambulance, keep her still and gently support the injured area with a pillow or folded blanket while you wait (and try not to faint).
Not too much pain and no sign of a bone piercing the skin? Call your doctor’s office for advice or drive to the emergency room. Make the trip more comfortable by propping up the injured area with something soft, like a folded towel. You can also loosely roll up a magazine and secure it with tape around the injured area, and use a bag of frozen veggies or an ice pack wrapped in a cloth to reduce swelling. If your kid is in a lot of discomfort, you can give her a regular dose of pain medication, like Tylenol or Advil, says Lim.
Sometimes, what you think is a sprain or bump is actually a break. That’s because kids’ bones are softer and more flexible than adults’ and will sometimes bend and crack rather than break into two separate pieces (this is called a green-stick fracture). There might not be much pain or swelling, and your kid may be able to use the injured area normally at first. If pain persists for more than a couple of hours, it’s best to get the injury checked out just in case.
Fixing the break
Once you’re at the hospital, your kid will get an X-ray to help doctors figure out what’s going on. If she needs a cast, it will be made of either plaster or fibreglass, depending on your doctor’s preference. Fibreglass is lighter and way more durable, so it’s usually used on a stable fracture, where the bone is broken but is not out of place to a great extent. Some hospitals charge an extra fee for a fibreglass cast.
In some instances, your kid might not even need a cast. Beth Gillespie’s five-year-old daughter, Lily, flipped off the top of the couch and landed hard on her shoulder. At first she wasn’t in too much pain and could move her arm well. But after a couple of days, Lily didn’t want to raise it above her head, so they headed to the emergency room, where an X-ray showed a small fracture in her upper arm. “Because the break wasn’t all the way through the bone, and it was near her shoulder, she just had to keep her arm in a sling for about a week and a half,” says Gillespie. Fortunately, Lily adjusted well to the sling, getting a friend to carry her school backpack and sitting with her teacher on a field trip to avoid being jostled.
Kids are susceptible to a type of break called a growth-plate fracture, which refers to damage to the layer of soft growing tissue near the ends of bones. As it heals, the damaged growth plate may grow more slowly or at an angle, so for a bad fracture, your doctor may ask you to make regular appointments over the following year or two to make sure the bone is healingproperly. If it isn’t, your kid may need surgery. Also, “if your child broke his arm two years ago and it starts to look a bit funny, get it checked out,” says Devin Peterson, an orthopedic surgeon at McMaster Children’s Hospital in Hamilton, Ont. There may be an issue with the growth plate.
Breaking a bone is a hassle, but most kids take it in stride. And, hey, getting the cast signed by your friends is a definite highlight. As for Ayden, a few days after he got his cast, he became the family’s mini-sticks hockey goalie, using his cast to block each shot, a huge grin on his face.
When my almost-three-year-old daughter, Jane, needed a bright pink full-leg cast for two weeks followed by a splint for two weeks, she handled the situation surprisingly well, thanks in part to a $7 plastic lap desk from a big-box craft store, a “cast” I knit for her teddy bear’s leg (you could also use a toilet-paper roll or a cut-off tube sock) as well as repeated viewings of the Curious George episode in which George has his leg in a cast. Here are some other tips to help your kid deal with a cast.
- Read up: Your Body Battles a Broken Bone by Vicki Cobb (Lerner Publishing Group) shows cool images of a bone’s healing process, magnified tens of thousands of times by an electron microscope. For younger kids, My Trip to the Hospital by Mercer Mayer (HarperFestival) is about how the beloved Little Critter copes with a broken leg.
- Help beat the itch: A hair dryer set on “cool” aimed under the cast dries sweaty skin. An antihistamine like Benadryl can also help a bit with the itching that can result from wearing a cast, says Ron El-Hawary, chief of orthopedics at IWK Health Centre in Halifax. Never use a pencil or other object to scratch, because it can damage the skin and lead to infection. (Over the years, Devin Peterson, an orthopedic surgeon at McMaster Children’s Hospital in Hamilton, Ont., El-Hawary and their colleagues have found everything from rulers and paper clips to Lego and coins stuck in casts.)
- Calm cast-removal fears: “We make sure kids see that the saw used to remove a cast can’t cut skin,” says El-Hawary. “We also offer ear protectors if they don’t like the noise.”
A version of this article appeared in our October 2015 issue with the headline, “Bone up”, p. 37.