There is a moderate amount of confusion regarding the treatment of an acute injury, especially in younger children participating in sports. In some respects the younger bodies can take a lot of punishment with no more than a resulting bruise and yet I see a significant number of more severe injuries such as broken bones from what would seem to be a minor event.

So what do you do when a child is hurt playing sports? The first thing to do is obvious; check on the child. Keep them in the position you find them in. My high school coach would scream at us to get up and “walk it off” after an injury. Children rarely feign an injury. If they say it hurts then it hurts. The pain may only last a few minutes and then they are fine, so be it. Give them a few minutes and evaluate the injury. Important things to look for:

·         Immediate swelling – chances for a more severe injury are associated with immediate swelling

·         Immediate discoloration – again associated with more severe injuries.

·         Obvious angulation – enough said.

·         Unable to bear weight – if after 5 minutes they can’t bear weight on their ankle, knee or hip. It warrants an evaluation and possibly x-rays.

·         Any loss of consciousness; especially associated with vomiting, blurred or double vision

·         Any child who experiences a “stinger” (electric shock sensation down the arms after a collision or bending at the neck).

Give the child time to evaluate for themselves if they are ready to walk or resume the game. In addition, any painful injury that is concerning to the parent should be evaluated. Young bones are subject to stresses and fractures that are unique to their age group.

Should you use ice or heat? In the immediate and for 24 hours following the injury ice is recommended. This decreases swelling and helps with the pain. Also compression with ace bandages or similar elastic compression helps stabilize the injury and soothes the pain. This should be applied for 20-30 minutes every 1-2 hours. Ice should be wrapped in a towel and never directly applied to the injury. There are various “instant cold packs” available at pharmacies and sports stores which work well (Gwinnett Urgent Care will gladly supply any coach with cold packs for free). After 24 hours it is time to switch to heat. A wet towel in the microwave until it is warm to the touch but not scalding applied for 20 minutes every 2 hours is recommended. Too much heat can burn the skin and even damage deeper tissues.

Analgesics such as Motrin or Advil (ibuprofen and related medicines) have been proven the analgesics of choice in the pediatric population. Even shown to be superior to narcotics (i.e. morphine) for the relief of pain in younger patients. Follow the package recommended dose or check with your doctor for advice on increased dosages.