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Clinical Reference Systems: Pediatric Advisor 10.0
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Bone, Muscle, and Joint Trauma


This guideline covers injuries to bones, joints, or muscles. Fractures (broken bones) need treatment by a physician. Stretches and tears of ligaments (sprains) are due to sudden twisting injuries and require medical attention (unless they are very mild). On the other hand, most stretches and tears of muscles (strains) are due to overexertion and can be treated at home. A muscle bruise (called a "charley horse") is the most common injury in contact sports and can also be treated at home. Bone bruises usually follow direct blows to the bone in exposed areas (for example, the elbow, hip, or knee) and are usually minor injuries.

See also:

Finger and Toe Trauma

Tailbone Trauma

First Aid

  1. Suspected fracture
    • Shoulder or arm: Use a sling made of a triangular piece of cloth.
    • Leg: Use padded boards, pillows, newspapers, etc. to splint the fracture. At a minimum, carry your child and don't permit your child to put any weight on the leg. Transportation can be by car.
    • Neck: Protect the neck from any turning or bending. Do not move your child until a neck brace or spine board has been applied. Call a rescue squad for help.

  2. Suspected sprained ankle (or knee)

    Immediately treat the injury with compression and ice to reduce bleeding, swelling, and pain. Apply compression with a snug, elastic bandage. While some mild sprains can be cared for at home, most injuries to ligaments need to be evaluated by your physician. Transportation can be by car.

Home Care

  1. Mild sprain of ankle or knee

    Treat most sports injuries with R.I.C.E. (rest, ice, compression, and elevation) for the first 24 to 48 hours.

    • Apply compression with a snug, elastic bandage for 48 hours. Numbness, tingling, or increased pain means the bandage is too tight.
    • Apply crushed ice in a plastic bag for 20 minutes. Repeat every hour for 4 hours.
    • Give acetaminophen or ibuprofen four times a day for pain. Continue for at least 48 hours.
    • Keep injured ankle or knee elevated and at rest for 24 hours. After 24 hours, allow any activity that doesn't cause pain.

  2. Bruised muscle or bone

    Put an ice bag on the area or massage it with ice cubes for 20 to 30 minutes. Repeat this three to four times the first day. After 48 hours apply heat with a heating pad or hot compresses for 10 minutes three times a day.

    Give your child acetaminophen or ibuprofen four times a day for severe pain. Don't give aspirin to anyone with an injury that has bleeding or bruising. Because aspirin is an anticoagulant, one aspirin can increase the tendency to bleed easily for up to a week.

    Rest the injured part as much as possible. The pain usually starts to ease after 48 hours, but there may be some discomfort for 2 weeks.

  3. Strained muscles (pulled or sore muscles)

    These guidelines apply if several muscles hurt after a strenuous practice, athletic game, or long hike. Most muscle injuries can be cared for safely at home.

    • Massage the sore muscles with ice for 20 to 30 minutes. Repeat this three to four times the first day.
    • Give your child acetaminophen or ibuprofen four times a day for at least 48 hours.
    • If stiffness persists after 48 hours, have your child soak in a hot bath or if the pain is in one particular area, use a heating pad or hot compresses. Apply heat for 10 minutes three times a day until improvement occurs.

    Your child should learn about stretching exercises and return to exercise gradually. Next time, your child should be in better condition before going full throttle. Getting back in condition takes at least 7 days.

  4. Acetaminophen and ibuprofen dosage charts

    Acetaminophen is readily available for children. Ibuprofen is especially helpful for injuries. Ibuprofen tablets and liquid are available without a prescription. Some of the brand names for ibuprofen are Advil, Medipren, and Nuprin. Give the correct dosage for your child's weight.

                                Tablets per Dose by Weight 
                             over   over   over    over   over
                              28     42     56      84     112 
     Type       Strength      lb     lb     lb      lb     lb
--------------  --------     ---------------------------------
Chewable        80-mg          2      3      4     5 to     8
 acetaminophen  tablets                              6 

Chewable        160-mg         1    1+1/2    2       3      4 
 acetaminophen  tablets 

Adult           325-mg        --      --     1      1 to    2
 acetaminophen  tablets                             1+1/2 
                             Tablets or tsp per Dose by Weight 
                             over   over   over   over   over
                              36     48     60     72     96 
     Type        Strength     lb     lb     lb     lb     lb
--------------  ----------   ---------------------------------
Ibuprofen       100 mg per   1+1/2    2    2+1/2    3      4 
 liquid         5 ml (tsp) 

Ibuprofen       200-mg        --      1      1    1+1/2    2 
 tablets        tablets 

Call Your Child's Physician Immediately If:

  • The bone is deformed or crooked.
  • Your child won't use an arm normally (especially if the injury occurred after someone pulled on the arm). Young children who won't straighten the elbow or turn the palm up usually have a partial dislocation of the elbow.
  • Your child won't stand on the injured leg.
  • The pain is severe.
  • Your child can't walk without pain and a limp.

Call Your Child's Physician During Office Hours If:

  • The pain is not improving by 3 days.
  • The pain is not gone by 2 weeks.
  • You have other concerns or questions.

Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Copyright 1999 Clinical Reference Systems