Is It Broken?

A lot of my columns are about how to keep your child out of the Pediatric Emergency Department.  Possible fractures, though, are one time where coming in is the best move. More on this from our two guest columnists, Dr. Nicole Miller and Dr. Sonja Wilson, Family Practice residents at the University Hospital and Clinics here in Lafayette: James woke up Christmas morning and ran downstairs to see what Santa brought.  A note on the Christmas tree said "look outside!"  He opened the back door to find a new trampoline!  James quickly dressed and ran out to enjoy his new toy.  After a few bounces though, he found himself on the ground crying in pain.  His shin was swollen, and it hurt too much to get up and walk.  James and his parents went to the Emergency Department and found that he had fractured his leg.  On Christmas Day! The holidays are here and with this will come new toys and activities.  Kids will be out of school and spending time on bikes, ATVs, trampolines, and scooters.  In the ER at Lafayette General we will be seeing more visits for injured hands, wrists, arms, feet, ankles, and legs.  What is a family to do?  Start by preventing these injuries! Part of preventing fractures is having good bone health.  This starts with a healthy diet. The American Academy of Pediatrics (AAP) recommends that kids get 400 International Units (IU) of Vitamin D every day.  One cup of milk is 100 IU.  Vitamin D can be found in a variety of foods and drinks, including soy products and orange juice.  Your skin can make Vitamin D as well, as long as it is exposed to sunlight.  Kids should have at least 15 minutes in the sun every day. How to prevent an injury?  The AAP recommends against having children operate ATVs or other gasoline-powered vehicles, and recommends against having a trampoline.  These are known to have a high risk of causing fractures or even more life-threatening injuries. The key to safe toys is to keep in mind the age, size, and maturity of your child. When buying new toys like bikes and skateboards, don't skimp on the safety accessories! Also buy helmets for bikes, and helmets and knee/elbow/wrist guards for skateboards. Learning to ride a bike also means learning traffic rules for bike safety. Find a safe place for your child to play.  Avoid busy roads, hills, and streets with multiple parked cars.  Always supervise your kids while playing.  Even with all of this protection, kids get hurt.  Kids play and explore and fall down.  Usually this results in simple bruises and sprains, but sometimes a broken bone results. When should you worry?  Signs of fracture include bruising and swelling over a bone, a snapping sound on impact, difficulty walking or using the injured limb, and obvious crookedness in the limb.  It is harder to tell if young children have a fracture; they can't tell you about the pain they are experiencing.  If a toddler stops using a hurt limb- bring them in. So what should you do if you think your child has a fracture?  First, limit movements of the hurt limb- apply a splint of rolled up magazines taped around the hurt bone.  DO NOT GIVE YOUR CHILD ANYTHING TO EAT OR DRINK UNTIL YOU SEE A DOCTOR!  If the bone is broken your child may need sedation or anesthesia to fix the bone, and an empty stomach is essential before sedation.  Then bring them in to a place with an x-ray machine. While some practices and urgent care clinics have x-ray, that is not all you need for fracture care.  The facility also needs to be able to put on a splint or cast and have access to an orthopedic surgeon.  For some fractures the bone may need straightening, and then the facility needs to be able to safely sedate the child and/or have an operating suite equipped for children.  Call ahead to the place you plan to go to be sure it has all the services your kid might need. Have a safe holiday season Acadiana!