Advice by Pediatric Conditions: Injuries & Accidents

Head Injuries And Young Children

Most children under 5 years of age have many head injuries. Injuries that occur as a result of a child running and falling are seldom serious. For the most part, there’s no reason to see the doctor based on the size of the lump or the color of the lump or the sound of the head hitting cement/tile/marble/wood/brick etc. Within 15 minutes following a head injury, you should expect your child to be acting normally. In this situation, it’s rarely helpful to see a doctor.

However, if your child has/had any of the following, see a doctor,

• crying more than 15 minutes after the accident
• more than 1 episode of vomiting
• loss of consciousness
• seizure
• change in personality

For information on head injuries in older children, and especially with sport-related concussions, please visit the sports medicine concussion information page.

Burns

Damage to the skin caused by heat is classified as being

• 1st degree – reddening of the skin
• 2nd degree – blistering of the skin
• 3rd degree – charring of the skin

Third degree burns are a medical emergency. Very few people (including very few doctors) have ever seen a 3rd degree burn, but if you suspect your child has a 3rd degree burn, you should seek emergency medical help.

First and 2nd degree burns are relatively easy to treat and while uncomfortable, are usually not a serious medical problem. For these burns, you’ll note that immediately after the burn, the skin temperature will be elevated. This elevated temperature causes further skin damage that continues hours after the initial insult.

Nothing can be done to undo that damage caused by the initial insult. But the continuing skin damage can be minimized or stopped by cooling the skin. Therefore, as soon as possible, following skin injury, run cool water over the burned area.

For as long as the skin’s temperature is elevated, running cool water over the burned area is beneficial. (You can judge whether the skin’s temperature is elevated by licking you lips and putting them near the burned area. If you feel heat radiating, continue the cooling measures.)

Once you’ve normalized the skin temperature, the next task is to prevent the burned area from becoming infected. If there’s been no blistering (ie, 1st degree burn), there’s no risk of skin infection and no treatment is necessary. If the skin is blistered, leave the blisters alone. Don’t break or open them intentionally. The longer they stay intact, the more resistant (to infection) the skin beneath will be.

When the blisters rupture the skin beneath will be either dry (and resistant to infection) or wet (and prone to infection). If the skin is dry, nothing needs to be done beyond congratulating yourself on good care of burned skin. If the skin is wet (you’ll see the skin “glisten” when angling your line-of-sight around the burn), you should see the doctor. We will prescribe an antibiotic skin cream.

Never apply anything greasy to a burn. Grease tends to insulate heat, accelerating and increasing skin damage.

You should see the doctor if a 2nd degree burn is covering most of a limb or large area of the face or body. And, as discussed above, you should see a doctor if ruptured blisters reveal wet skin.

Cuts

Cut injuries to the skin are very common in adults and children. The main aims of treatment are to stop bleeding and prevent infection. The first is accomplished by applying pressure over the injured area (if you can).

Bleeding that persists beyond 20 minutes should be checked by the doctor. If the bleeding is from an accessible area you should be applying enough pressure to stem the bleeding while the pressure is being applied. If the bleeding is from an inaccessible area (like the mouth), the best you can do is to wait 20 minutes to see if the bleeding stops.

The second aim of treatment, preventing infection, is done by keeping the wound clean with soap and water. Use of antibiotic creams, ointments and salves is unnecessary and generally a waste of time. If you want to do more than wash with soap and water to
help ensure no infection will occur, wash again with soap and water. That is, washing 2 to 4 times per day with soap and water is about the best you can do to prevent wound infection.

When You Need Stitches

There are only 2 reasons to have a wound sutured. The first is to stop bleeding that cannot be (otherwise) stopped and the second is to minimize scar formation..

If the cut is in an area (like the face) for which cosmetic concerns exist, you should see the doctor. If the edges of the wound can be brought closer together (by sutures or some other means) during the healing process, the chances and the amount of scar formation are minimized.

You can always stop bleeding by applying pressure over the wound. However when pressure is released bleeding may restart. If after applying pressure for 20 minutes the bleeding restarts, see the doctor.

Muscle And Bone Injuries

From sprained ankles to twisted knees, from bruised tailbones to a fall on an outstretched arm, injuries to muscle and bone are a normal part of life, especially when we are young. In the pre-school aged child, these injuries are seldom much of a concern and seldom need any treatment except a parent’s reassurance that all is well.

However, if a pre-school aged child shows signs of injury (eg, limping) more than 24 hours after the initial injury, they should probably be checked by the doctor.

Injuries in older children/adults are also usually self-limited.

Sports injuries, however, can halt a vibrant young athlete right in his/her tracks. Careful initial evaluation is crucial in determining appropriate care and safe return to play. As a rule, the younger the athlete, the more cautious one should be. Early and complete evaluation can allow for more complete healing and less complication and risk for future injury.

Regardless of the joint injured- the following principles can help reduce swelling and pain.

• R= Relative Rest (don’t increase pain or put region at risk for further injury)
• I= Ice (maybe helpful for 20 minutes on, 20 minutes off for the first hour, then every 2 hours afterward) Immobilization (splint, sling or brace can help in the initial healing process)
• C= Compression (Ace wrap, foam dressing) Crutches (for initial use if athlete cannot walk safely)
• E= Elevation (put the injured region above the level of the heart to reduce swelling) Exercises (can be recommended by a medical profession to start the healing process)

When To See The Doctor

Children stumble and fall on a regular basis- and most of the time return to usual activity within a few minutes, often with nothing more than a supportive hug and adult reassurance. However, there are several conditions that require medical evaluation. If in doubt, come into the office for further evaluation.

• Seek immediate medical attention
  • Any obvious change in mental status or difficulty breathing deserves immediate medical attention
  • Any open fracture (bone penetrating through skin) or obvious bone deformity also deserves immediate medical attention
• Seek attention within the first 1-2 days after injury
  • Large swelling of a region- especially within 1-2 hours of an injury
  • Inability to walk off the playing surface (leg injuries) or inability to use the arms/hands for everyday activities
  • Any obvious change in the athlete’s ability to run or use the injured region
  • Inability to fully move an injured joint (bend, straighten)
  • Repeated injuries to the same region
  • Past history of serious injury to the same region
  • Immediate need to return to play and uncertainty over the nature of the injury
  • Pain that limits sleep or awakens from sleep