In 2001, our family was on an idyllic vacation at my aunt’s Italian villa when my son (then four) fell backwards off a small plastic kiddie slide. His left foot got caught in the rungs of the ladder on the way down, but it didn’t appear to be serious (no jutting bones, no odd angles). My relatives cautioned us to avoid the spotty treatment at the local infirmary and advised taking him to a Canadian doctor when we returned home in three days. After a severe chastising from our pediatrician, we learned the bones near his toes were cracked and I spent a day in the fracture clinic feeling terrible about making him hobble around Disneyland Paris. Here’s what to do in the event your child breaks a bone.

a common event

About one in four kids will experience a fracture — technically speaking, that’s when there is more force applied to the bone than it can absorb — during childhood, says Dr. Benjamin Alman, head of orthopedic surgery at The Hospital for Sick Children in Toronto. The most common types of fractures involve the bones of the arms, legs as well as the clavicle (collarbone), says Dr. Alman.

If your child has suffered an accident and the bone isn’t protruding or obviously misaligned, it may be hard to determine if there’s a fracture. Take him to the doctor or hospital if he has swelling or pain along the extremity and if he avoids using the injured limb. If it is an open fracture in which the bone exits through the skin (do not try to push it back in!) or if your child feels any numbness or the area turns white or blue, go immediately to emergency.

care for a break

En route to the hospital it’s best to keep your child as still as possible. You can immobilize the injured area with a makeshift splint:Put soft padding around the limb in the position you found it and place something firm, such as a long ruler, next to the area, making sure it extends past the joints above and below the injury and keep it in place with first aid tape. You can gently apply crushed ice to the area to help alleviate the discomfort, but resist the urge to offer a pain reliever or feed your child until she has been assessed. If the fracture needs a “reduction” — a procedure to align the bone fragments — she may require stronger medication or surgery. A full stomach or use of pain relief medication may delay treatment. Depending on the severity, your child may require a splint, cast, reduction or surgery.

on the mend

Casts immobilize an injury and help it heal, something that kids’ bones do faster than adults: most children will be out of their cast after four weeks but depending on the site of the break, it could be longer. Plaster casts are the old-school standard but synthetic fiberglass models weigh less, are water resistant and come in cooler colours. However, their cost may not be covered by your provincial health plan. Your doctor may decide all that is needed is a splint — made of plastic or metal or molded out of plaster or fibreglass and held with straps — which supports the broken bone from one side. In addition to ensuring the cast doesn’t get wet or dirty, your child should never put anything inside the cast, no matter how much it itches.

Once a cast is on, it usually eases pain, but if your child complains of more pain or numbness in his fingers or toes or that they are pale or turning blue, white or purple, call the doctor immediately. It may mean the area has swollen and requires more room and possibly a bigger cast. The doctor should also be called if there is a foul smell from the cast or a burning sensation (could be sign of a pressure sore), or if the cast becomes soft, cracks or breaks.

badge of honour

Having a broken bone is not fun, but the experience can be made more bearable if your child uses the cast as an autograph book or art project. Dr. Alman even recalls one patient who painted his hip cast orange and green and went out for Halloween as a pumpkin.

fracture definitions

GREENSTICK: the bone breaks on one side only, not all the way through and the other side bends.

BUCKLE: the bone is buckled, twisted but not completely broken.
BEND: a bone that is bent but not broken.

COMPLETE: the bone has broken all the way through into two pieces.

COMPOUND: the bone is broken through the skin.

Freelance writer Wendy Jacobs wishes she had painted her son’s cast to look like the Leaning Tower of Pisa.