In almost all cases, it takes a significant force to break the larger bones of our bodies, such as the arms and legs, hips and shoulders. Falls, being hit by a heavy hard object and being involved in a moving vehicle accident are examples. The smaller and lighter bones of a child may even be broken by excessive force if a limb is held tightly while the child is moved abruptly.

Children's bones are relatively soft compared to the harder, more brittle adult bones. Because of this, they tend to bend a little before breaking. This may cause the child's bone to break on one side of the bone but not the other. Adult bones will usually break all the way through.

Many people are confused about the word break or broken and the word fracture. In reality, there is no difference between these terms in the medical profession. Officially, doctors use the word fracture for any broken bone no matter how minor, no matter how "hairline" or how horrendous the break may appear on the x-ray. When speaking to one another or when reporting the fracture in the patient's medical record, doctors will describe the fracture's characteristics so that any other doctor will understand and perfectly picture the break just by the description. The seriousness of the break will be obvious to them by this description, so proper care will then be ordered more easily and quickly.

If your child has fallen, twisted an ankle, or received other trauma that might have injured the bone, they will have significant pain that persists. It does not get very much better with time. There may also be an obvious deformity present. If the limb is bent, or angulated, it is broken; if near a joint, it may be dislocated. Some accidents cause both a fracture and a dislocation. Almost all fractures are accompanied by swelling. Check for pulses past the injury toward the end of the limb, or check to see that the blood quickly refills back in the skin after pressing or squeezing a finger or toe. A lack of circulation past the break is a true emergency that must be seen at the hospital emergency room right away.

First aid measures for injuries that may be fractures include immobilizing the limb or area of injury, elevating it above heart or hip level when possible, application of ice and giving acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) in the child's normal dose as indicated on the package instructions. For the best pain control, you may give both acetaminophen and ibuprofen together as a starting dose. Remember though, acetaminophen is given every four hours and ibuprofen is given every six. Write down the times you give each or you will never be able to keep them straight! When you put ice on an injury, you must put a thin piece of material between the ice and the skin to prevent frostbite. Yes, it may surprise people to know that ice can freeze and damage the skin by causing frostbite. Frostbite is a serious skin injury. Avoid it.

If the injury looks like a fracture, there will be no question about it and you will need to take your child to an urgent care center or to the hospital emergency room. Many urgent care centers can x-ray and splint broken bones just like the hospital and they will be able to refer you to an orthopedic specialist for further care of the injury. This is the standard of care for most fractures whether seen in the urgent care center or in the ER.

If you are not sure whether there is a break, but the patient has persistent pain that just isn't getting much better, and especially if they cannot use the injured part of the body, there may be a fracture and an examination by a physician is needed. This will probably involve ordering x-rays too. Inability to move the shoulder, elbow, wrist, finger, foot, ankle, or toe, or inability to put weight on a foot, ankle, or leg is a good indication that there may be a fracture. Immediate and significant swelling after the injury also raises suspicion of a fracture. Only an x-ray will be able make the determination.

Any major injury, or a failure in improvement of what you thought might have been a minor injury, should be evaluated by a health care provider.