Clinical Reference Systems: Pediatric Advisor 10.0
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Bone, Muscle, and Joint Trauma
Description
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
- 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.
- 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
- 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.
- 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.
- 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.
- 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.
Acetaminophen
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
---------------------------------------------------------------
Ibuprofen
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.
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