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    Big Boo-Boos – How to Know When Your Child’s Injury Needs Medical Attention

    Dr. Taniza Karim Pediatrician, Deaconess Clinic Boonville 01/18/2016

    Bumps and bruises, bangs and scrapes are all part of being a child.  But as children play, sometimes more serious injuries can happen, and parents have to decide if a trip to the doctor, urgent care or emergency room is needed.

    Cuts and Wounds
    Stitches are needed in certain cuts and wounds to prevent infection, to help with healing, and to prevent scarring.
    If the injury is small enough that you’re not initially sure about seeking immediate medical care, first wash the wound well and apply pressure with clean gauze to stop the bleeding.  Look closely at the wound.  If it meets the criteria below, call your doctor or plan to go to urgent care.  Also, don’t apply antiseptic or ointment until after a doctor has examined the wound.
    Stitches or wound adhesive (often called “liquid stitches”) are needed on cuts or wounds that may include:

    • Cuts on the face (to reduce scarring)
    • Wounds that are more than a ¼ inch deep that are longer than ¾ of an inch long
    • Wounds that go down to fat, muscle, or bone
    • Wounds that have jagged edges or gape open
    • Wounds on hands, fingers or joints that open when the body moves, as they aren’t likely to close and heal well
    • Wounds that continue bleeding after 15 minutes of pressure

    If you’re dealing with a large gash or significant bleeding, go straight to the emergency department.

    Sprains and Strains, and Possible Breaks
    Active children commonly experience sprains and strains.  A strain is the result of stretching, twisting or tearing of a muscle or tendon—sometimes referred to as a pulled muscle.  A sprain is an overstretching of ligaments that hold bones together.  Sprains often result from falling and landing on an arm to catch oneself, or from jumping or falling and landing on the side of the foot.
    Both can be painful but with proper treatment usually heal with no lasting problems.   Minor strains and sprains usually need rest, anti-inflammatory medication (like ibuprofen), ice and elevation. 
    However, if what is believed to be a strain or sprain worsens over 24 hours, or continues swelling or bruising, your child should be seen by a doctor—pediatrician, family medicine or at urgent care.
    Here are general guidelines on when an injury may be more serious, such as a broken bone:

    • Severe pain
    • Symptoms don’t improve or even worsen with home treatment.
    • Significant swelling or redness
    • If the injured area looks dislocated, crooked or has lumps
    • Numbness or loss of sensation in any part of the injured area

    Hits to the Head, Concussion Concern
    When kids play, they seem to constantly be banging their heads.  Yet most of the time it’s not serious, and an ice pack and hugs will make things better.
    However, there are certain symptoms that should warrant a trip to the doctor or emergency department:

    • Vomiting, especially over a few hours
    • Loss of consciousness, being non-responsive
    • Altered mental status, such as confusion and being disoriented
    • Being very lethargic and groggy
    • Weakness, numbness in some part of the body, or poor coordination
    • Prolonged crying
    • Severe headache
    • Eye changes, such as eyes not coordinated, pupil(s) being dilated, or blurred/double vision
    • If your child exhibits any of these symptoms, get medical attention immediately.

    My colleagues at the Deaconess Concussion Clinic have shared additional information about concussion signs and symptoms.

    Where to be Treated
    I often tell my patients that it’s better to error on the side of caution, and if you’re wondering if you should go to the doctor or emergency department, you probably should.

    However, when in doubt, call your child’s doctor first, or even check with a nurse triage line (check the back of your insurance cards—some companies offer this).  They can give you some direction.

    Patients of Deaconess Clinic pediatricians can not only call their doctor’s office during open hours to talk to a nurse, but can also utilize the after-hours pediatric clinic.  When the after-hours clinic is closed, patients (or their parents) can speak to a phone triage nurse for helpful information as well.

    Additionally, if you’re concerned about a broken bone or other orthopedic injury, local orthopedic offices like Orthopaedic Associates offer walk-in urgent care.

    Overall, a childhood full of excitement, fun experiences, physical development and growth will lead to some bang-ups and injuries, so knowing when to seek care is important.


    Learn more about the author

    Taniza Karim, MD
    Specialty: Pediatrics
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