Cuts, Strains, Sprains and Fractures

Cuts, strains, sprains and fractures are a common, and sometimes scary, occurrence in childhood. Everyone should keep a first-aid kit handy, but your most important tool is knowing how to take care of these injuries.

Using the following guidelines will help you confidently treat your child when the injury takes more than the healing power of a hug and kiss. 

Minor cuts, also called lacerations, usually stop bleeding after a few minutes. Wash the area thoroughly with soap and water. If necessary, apply a sterile bandage as soon as possible.

More serious cuts cause heavy bleeding, which must be controlled immediately. Apply firm, direct pressure over the entire area of the wound for at least 10 minutes with a thick pad of sterile gauze or a clean cloth. Elevate the area that is bleeding (raise above heart level) while you continue to apply pressure — unless there is a chance that the bone is broken. If you release pressure or the child squirms away, start timing again at zero for a full 10 minutes. You may need to continue applying pressure until you see the physician. Don’t use iodine or antiseptics before the physician examines the area.

A severe cut may have damaged blood vessels, nerves or tendons underneath the skin. Call your child’s physician right away if the cut:

A sprain is a pulling or tearing of a ligament, the thick tissue that connects bones and joints. Symptoms include pain, swelling, joint instability and sometimes bruising. A strain is the pulling or tearing of a muscle that has been overstretched or overused.

Sometimes it’s hard to tell a severe sprain from a broken or fractured bone. Since both are serious injuries, always seek medical help, and treat it as if it were a fracture (as below).

The treatment of strains and sprains is fairly simple, but takes time. Returning to normal activity too soon can lengthen healing time. Sustaining a second injury to the same area within six weeks can extend the healing time.

The first six to 48 hours after a sprain are the most critical. Just remember PRICE:

  1. Protection: Applying a splint or brace can protect the child from further injury.
  2. Rest: This decreases the chance of re-injury and allows healing.
  3. Ice: Applying ice to the area for 20 to 30 minutes often (every two hours, if possible) helps reduce swelling and pain. Ice should never be applied directly to the skin or through plastic. A bag of ice should always be wrapped in a cloth or towel to avoid frostbite injury to the skin.
  4. Compression: Your doctor may recommend that you use an elastic bandage or prescribe a special splint for the area. If you use an elastic bandage, it is important to remove it four times a day and rewrap it so it doesn’t become too tight should the swelling increase. Do not allow your child to wear the bandage to bed at night. If the area becomes cold, numb or blue, the bandage is too tight and should be taken off immediately. If your doctor prescribes a splint or brace, follow the directions that come with it.
  5. Elevate the area immediately. Elevation decreases swelling and promotes healing. The injured part should be elevated above the level of the heart. 

Your doctor may recommend medication, such as acetaminophen (Tylenol®) or ibuprofen (Motrin®), to help reduce pain and inflammation. It’s important to take medications only as directed. If pain lasts more than three or four days, the injury should be evaluated by a doctor. Never give aspirin unless specifically instructed to do so by your doctor.

Pain, tenderness, swelling, deformity and the inability to use the injured area are symptoms of fractured or broken bones. All fractures or suspected fractures require immediate medical attention.

If you suspect a fracture:

  1. Immobilize the area to minimize ¬movement including the joints above and below a suspected fracture. Use rolled newspaper, magazines or a pillow.
  2. Apply ice packs immediately to keep ¬swelling down.
  3. If there is any possibility of head, neck or spinal injury, keep the victim from moving. Call 911 or the local EMS immediately. 
  4. Do not give the victim anything to eat or drink. This could interfere with surgery (which may require anesthesia) that may be necessary to treat the fracture.
  5. Never try to push back or realign any protruding bone in an open fracture. Gently apply clean cloths to reduce bleeding. Keep the fractured part immobilized and head for the hospital emergency room. 

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