Sizing Up Boo-Boos Big and Small


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When kids get hurt, parents and caregivers are first responders. They clean and bandage cuts and scrapes, apply ice to bumps and bruises, and remove painful splinters while drying tears and offering hugs of reassurance. For the most part, parents are confident in their role as first-aid providers for minor injuries. It's the more complicated or emergent situations that can create a sense of uncertainty or panic. We asked area experts for advice on evaluating and treating common childhood injuries.

Skin injuries

From the missteps of toddlers to the bike wrecks of teens, bandaging cuts is part of parenting. But not all cuts are created equal. How can parents tell if stitches are needed?

Dr. Nicole Parkerson, a pediatrician at Raleigh Pediatrics, advises parents to call their provider first if they are unsure. "We can do most stuff in the office," Parkerson says, "but wounds that won't stop bleeding after four to five minutes of applying pressure or wounds that are gaping should be seen at the E.R. to err on the side of caution."

Raleigh parent Kristen Shelton opted to head straight to the emergency room after her 3-year-old son fell. "I thought he was just upset until he took his hand off of his forehead and blood went everywhere." It only took 15 minutes to sew up the wound, but "he cried during the procedure because he was scared, so it felt more like 15 hours to me," she recounts. "But afterward they gave him a lollipop and he was fine. I didn't recover from the experience nearly as quickly as he did."

Burns are another common childhood injury, especially for toddlers and preschoolers. Kids are frequently scalded by coffee, irons and curling irons, according to Dr. Lisa Ferrari at Durham Pediatrics.

"Wash the burn with soap and water, but don't dress the wound without it being looked at first," Ferrari says. "If the burn is blistering, see a doctor within 24 hours." She also suggests giving the child acetaminophen or ibuprofin as soon as possible since burns can be painful.

Bites also call for soap and water. If your child is bitten by a dog, find out the animal's rabies status or call animal control. Cat bites are actually more dangerous than dog or human bites.
"Children who are bitten by a cat will definitely need to be seen by their doctor and given antibiotics," according to Ferrari.

Breaks and sprains

Sprains and broken bones are common injuries for all age groups. Because bones and ligaments are internal, deciding whether an injury requires rest and ice or an X-ray and a cast can be difficult for parents. Obvious deformity or cuts near the site of the injury may indicate a break, according to Dr. Keith P. Mankin of Raleigh Orthopaedic Clinic.

"Make sure the limb is the same color as the rest of the skin to see if the blood supply is intact," Mankin says. "If any of these things are abnormal, the child should be seen immediately."

Some breaks are fairly easy to detect. Chatham County parents Paula and Erik Butler knew right away their 8-year-old daughter's arm was broken after she fell from a tree house. "Her arm looked like a tepee," Paula says. "She looked pale, almost in shock."

Anne and Geoff Krouse of Raleigh also could easily tell that their 2-year-old daughter had suffered a break when her foot slipped while walking down a set of stairs with her dad.
"She fell into his arms screaming a scream we had never heard from her," Anne says. "Even after we calmed her down, she didn't want to put any weight on the affected ankle."

But not all breaks share the same telltale signs. Jenny and Darrin Bryan of Chapel Hill cared for their 11-year-old immediately after his fall from a Rip Stick in front of their home.

"We iced his shoulder, gave him Motrin, and he was much better that night and the following morning," Jenny explains. It wasn't until their son called from school the next day complaining of increased pain that the extent of the injury became obvious. "We took him to an urgent care orthopedic clinic and discovered he had fractured his humerus," Jenny says.

It is not uncommon for a broken bone to be detected after the first few days, Mankin says. "If a child still has significant pain on the bone after two or three days, there is a good possibility that the bone may be broken," he says.
The lining of children's bones is very sturdy, according to Mankin. "Children may still be able to walk or use a limb, even with a break in it," he says. Six weeks is an average healing time for most breaks, while mild sprains and strains can often be iced, rested and healed within days.

An ounce of prevention

Being aware of risks is the first step in preventing childhood injury. Dr. Courtney Mann, medical director for WakeMed Children's Emergency Department, urges parents to closely monitor use of protective gear and equipment.

"You never outgrow the need for seatbelts and helmets," Mann says. "We can fix a broken bone, but you only have one brain, and it doesn't heal well."

Knee pads and wrist guards are also useful, but Parkerson at Raleigh Pediatrics reminds parents to be sure gear fits properly each season. "If equipment is the wrong size or worn out, it won't protect a child from injury," she says.

Periods of rest between sports seasons can help children avoid overuse injuries, according to Dr. William Hage of Triangle Orthopaedic Associates in Durham. "As kids are growing, their growth plates are fairly prone to injuries like stress fractures and inflammation," Hage says. "After an injury, it's important to ease back into sports and have coaches ensure proper techniques to avoid further injury."

Some parents may be concerned about exposing children to radiation when a child's injury requires diagnostic equipment. Dr. Margaret Douglas at Wake Radiology says that current imaging guidelines make it easy for providers to minimize exposure for children. "The vast majority of X-rays, like those taken for suspected wrist or ankle fractures, expose children to only a very small dose of radiation," Douglas says.

Mann also stresses staying keenly alert when kids are swimming. "Parents can listen closely for most signs of injury like a crash or a plea for help," she says, "but drownings are silent."

Even if children are competent swimmers, panic can set in when they find themselves in difficult situations. "Never overestimate your child's ability to swim," Mann says. "Constant supervision is a must."

Focusing on prevention and being prepared for first-aid situations can help parents stay calm when their children get hurt. List important phone numbers like the pediatrician's office, Poison Control (800-222-1222) and 9-1-1 next to a fully stocked first-aid kit and rest assured that medical professionals are just one phone call away.

Mary Parry is a freelance writer and mother of three from Chapel Hill.

Understanding Head Injuries

Signs of Concussion:
Head injuries that result in any of the following symptoms should be evaluated, according to Dr. Courtney Mann, medical director at WakeMed Children's Emergency Department.

* Loss of consciousness
* Persistent headache or vomiting
* Unusual behavior
* Significant bruising on the head, particularly on areas other than the forehead

If not managed appropriately, concussions can lead to problems for children, ranging from subtle to severe, such as persistent headaches, mood disturbances, coma and even death.

When to Resume Play:
"Recovery time is linked to the severity of the injury, so it's important for parents to seek the advice of their pediatrician before resuming active play," Mann says.

Top Childhood injuries

* FALLS - Falls are the leading cause of nonfatal injuries for all children from birth to 19. Every day, approximately 8,000 children are treated in U.S. emergency rooms for fall-related injuries. This adds up to almost 2.8 million children each year.
* ROAD TRAFFIC INJURIES - Every hour, 150 children from birth to 19 are treated in emergency departments for injuries from motor vehicle crashes. More children ages 5 to 19 die from crash-related injuries than from any other type of injury.
* DROWNINGS - Drownings are the leading cause of injury death for young children ages 1 to 4, and three children die every day as a result of drowning.
* BURNS - Every day, 435 children birth to 19 are treated in emergency rooms for burn-related injuries, and two children die as a result of being burned.
* POISONINGS - Every day, 374 children in the U.S. from birth to 19 are treated in an emergency department, and two children die, as a result of being poisoned. It's not just chemicals in your home marked with clear warning labels that can be dangerous to children.
* SPORTS INJURIES - More than half of the 7 million sports and recreation-related injuries that occur each year are sustained by youth between ages 5 and 24.

Source: U.S. Centers for Disease Control and Prevention, www.cdc.gov/safechild

Be prepared

Maintaining a first-aid kit at home helps parents be ready for an assortment of childhood injuries. Most ready-made kits come with bandages, tweezers and antibiotic creams. "Add Steri-Strips to your kit," suggests Dr. Nicole Parkerson of Raleigh Pediatrics. "Those can close a lot of really mild lacerations."

Benadryl is also helpful to keep around, according to Dr. Lisa Ferrari of Durham Pediatrics. "I recommend keeping it at home and bringing it with you when traveling," she says. "It can be a lifesaver."

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