As your child grows up, he's bound to get plenty of scrapes, bumps, and bruises along the way. But sometimes broken bones are part of childhood, too.
Amy Ball of Glenview, IL, learned this firsthand when her son Braedon, who was 2 at the time, fell while jumping on a trampoline. An X-ray in the ER showed a fracture just below his knee. He had to wear a cast on his leg for over a month. Amy soon discovered that she had a big role to play to keep him comfy and prevent another injury.
"The hardest part was trying to explain to a 2-year old who just barely learned how to walk that he couldn't walk or stand," she says. "During the first few days we spent a lot of time propping his leg up with pillows, watching TV, reading books, and keeping him entertained as best we could."
Her approach was just right, according to John Gaffney, DO, chief of pediatric orthopedic surgery and vice chairman at Winthrop University Hospital in Mineola, NY.
"The most uncomfortable time is during the first week when the fracture is fresh and the injury is new," he says. "Swelling is at its worst the first 24 hours after a fracture occurs."
The First Days After an Injury
As much as possible, try to raise the area with the broken bone above your child's heart. "Fluid in the arm or leg will flow back to the heart, which helps reduce swelling and will make the child more comfortable," Gaffney says.
While this is most crucial during the first day, try to prop up the injury any time your child is sitting or lying down to reduce pain. "If you notice any swelling in the fingers or toes near the injury, elevating the limb can help," he says.
During the first 24 to 48 hours after a fracture, ice the injury around the clock. "Place an ice pack right on top of the splint or cast where the injury is located," Gaffney says.
Replace the ice or ice pack as often as you need to over the next 24 hours. Be sure to use a re-sealable plastic bag or kitchen towel to make sure the cast doesn't get wet.
For pain, most children can safely take over-the-counter acetaminophen or ibuprofen, says Elizabeth Matzkin, MD, an orthopedic surgeon and chief of women's sports medicine at Brigham and Women's Hospital in Boston.
Taking Care of a Cast
It's likely your child will complain that it feels itchy under his cast. That happens because oils that sit on his skin aren't washed away like normal.
"Don't let kids stick anything down there," Matzkin says. "We've cut casts off and have found pennies, pencils, and other objects. If you stick something down there, you risk scratching the skin and can cause an infection."
Instead, tap gently on the outside of the cast to see if the itch goes away. Another option is to use a hair dryer set on cool and blow air down it.
If those methods don't work, you could give your child a dose of diphenhydramine (Benadryl) to help make him less itchy, Matzkin says. But it can make him drowsy, so it's best to take it at bedtime.
Ask your doctor if your child needs to avoid getting his cast wet. Many need to be kept dry, but some are made of newer materials that can handle the moisture.
If you do need to keep it dry, you can buy special cast covers that seal at the end. "There's no brand or type that's 100% effective, so never submerge the cast in water," Gaffney says. "The cast cover offers some protection if the cast gets splashed, but still be sure to hold the cast out of the water. Sponge baths are ideal while the cast is still on."
Getting Into a Routine
Once swelling and pain go down after the first few days or week, kids will start to feel better. This means they'll want to get back to all of their usual activities.
"The best thing parents can do is help their child understand, in an age-appropriate way, that the cast is there to help their bone heal," Matzkin says. "The sooner it heals, the sooner they'll be able to do fun things again. It's important to avoid activities that involve the affected area or risk reinjuring it."
Older kids will have an easier time understanding this than younger ones. "At the time of his injury, Braedon was really into Cookie Monster, so we got him a blue cast," Ball says. "We told him that it was a special Cookie Monster cast and while he was wearing it he could only crawl and sit. I made a game out of it to help him go back to crawling again."
Most kids and parents look forward to the day the cast comes off. But your child may be surprised to find that his arm or leg feels funny or even painful at first.
"There's stiffness within the joints, ligaments, and tendons because they haven't been able to move them for a while," Gaffney says. "Adults might be able to tolerate this a little more, but a child might not understand why their arm or leg hurts." Fortunately, as he continues to stretch and move, the stiffness will improve and he'll soon feel better.