Toddlers Do Break Bones
Author: Dr. Anna Kaplan
There is no chance your toddler will never fall down. Luckily toddlers have supple bones which do not break easily. Even when they do break, they heal quickly.
Toddlers do not sprain ankles or other joints. A toddler will sustain a fracture, or a broken bone, before a sprain.
If you see an accident, you will have an idea what your child may have injured. If you see any bones or joints out of position, lots of swelling, or your child is in severe distress, you need to get him or her immediate care. If it was a bad enough accident, you may even need to call 911. Obviously, more severe injuries occur in car accidents, falls from heights, or anything else where there is a big impact.
This is not what usually happens with an average fall. Usually your child will take a spill and start to cry. It is a misconception that a bone can only be broken if a child can't move an arm or leg. It is also a misconception that you will see something immediately. A bone can be broken and you may not see anything unless the bone is out of position.
A very common fracture in young children is just above the wrist, in the big forearm bone called the radius. When someone falls down and lands on an outstretched hand and arm, the radius can break. If it is broken badly due to significant force, it can be deformed, and you can likely see it is broken. But in toddlers you may not see anything. By some accounts, 40% to 50% of broken bones in children are near the end of the radius.
Children can have a "torus fracture" where the bone is more or less collapsed onto itself without a complete break. This is totally stable and heals well. A greenstick fracture is a partial fracture which also heals well. With these types of fractures, there may not be any or much swelling or bruising. The child will not want to use his arm, and will have tenderness if you push on the area. But he will be able to move all his joints. These fractures still need casts, but sometimes for only three to four weeks.
A "toddler's fracture" is an isolated fracture in the large bone of the lower leg, called the tibia. It is also called a "childhood accidental spiral tibial fracture (CAST)." It usually happens when a child's foot gets caught while the child is falling, putting some torque on the leg. It is hard to see on X-ray and may not be diagnosed until a week or so later on a repeat X-ray, or with a bone scan. If no one saw the fall or injury, all you may know is that the child does not want to bear weight on the injured leg. There will be some tenderness and warmth over the area. Once diagnosed, the fracture means that the child needs a cast, which will only stay on for three to four weeks.
Since a similar fracture can occur when a child has been abused, sometimes doctors will be suspicious of this injury. However, a CAST fracture occurs lower in the bone than those associated with child abuse. Also, as an isolated incident with no other bony injuries, most doctors recognize it as an accident. However, whenever a doctor sees an injured child they must always at least think of child abuse, or they will miss it when it happens.
One condition that is not actually a fracture, but more of a dislocation or slippage is called "Nursemaid's elbow." If you pull your child up by the hand or if your child hangs from something with all of his or her weight dangling, he or she can sustain an elbow injury. The child will refuse to use his or her arm. You will see nothing in the way of swelling or deformity. You may not even know what part of the arm is injured.
Based on the history and the way the child holds his or her arm, most doctors will know what this is. They can manipulate the child's radial head at the elbow back into place in a matter of seconds. Your child may cry, but before he or she really gets started, the radial head is back in place and the pain is gone. A toddler will start to use his arm almost immediately. The doctor will give you a sling which you should try to get your child to use. Once the radial head has moved out of position it is easier to do it again. It is best not to swing young children around by the arms because of this problem.
Most fractures in toddlers will be easy to treat. However, any severe trauma can cause damage in children like it does in adults.
