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News — Think of kids as little scientists who like to experiment. Every developmental milestone they achieve brings a new layer of curiosity. Children like to see cause and effect without knowing the risks, and as a result, they can get into trouble and sustain injuries.

When children sustain an injury of any type, it’s difficult to see them experience pain or discomfort. But when that child is an infant or toddler, it’s often difficult to ascertain what happened and where the pain is because the child lacks full verbal communication skills.

Here’s a staggering statistic, courtesy of the Centers for Disease Prevention and Control: 45% of playground injuries are considered severe—fractures, dislocations, and concussions. So it’s important for parents and caregivers to be aware of the physical cues that accompany common pediatric injuries.

Children’s Hospital Los Angeles physician Bianca Edison, MD, MS, a pediatric sports medicine and orthopedic physician at CHLA’s Jackie and Gene Autry Orthopedic Center, explains which of those cues parents should look for to determine whether their child’s injury needs urgent or emergency medical care.

Head injuries

Head injuries are common with young children. Dr. Edison says it’s important to be aware of the red-flag symptoms that can follow a head injury. “They include severe crankiness above and beyond what the child normally displays, multiple vomiting episodes, slurred speech, different pupil sizes, and a sudden change in the way the child walks,” she says. “These symptoms are of significant concern and need immediate medical attention.”

Dr. Edison says statistics can help parents decide if their child needs medical attention: If the child is less than 2 years old and sustains a fall of more than 3 feet, or is over age 2 and has sustained a fall of more than 5 feet, a trip to the emergency room is in order.

Additionally, feeling a dent or depression along the head of your child following a fall, possibly indicating a skull fracture, is also cause for an ER visit. If you see bruising around, behind, or under the eyes, or clear or bloody fluid draining from the nose or ears, you should take your child for an urgent evaluation.

Other significant findings that would demand an immediate visit to the ER, as well as shared decision making between the family and the care team as to the need for a CT scan of the head, include:

• Loss of consciousness
• Agitation
• Extreme sleepiness or significantly slowed response
• Severe, worsening headache
• A car crash that ejected the child from the vehicle, or a bicycle accident in which the child was not wearing a helmet
• Multiple vomiting episodes or any seizure-type activity

“These symptoms or situations indicate or may produce increased pressure in the brain, swelling of the brain, or actual bleeding in the brain,” Dr. Edison says.

Eye injuries

For an eye injury, Dr. Edison says to look for a nosebleed in association with a black eye or bleeding within the whites of the eye. Go to the ER if your child has two black eyes resulting from a head injury; blood is seen in the eyeball; a fracture or depression can be felt in the orbit (the bones around the eye); or your child experiences sudden and persistent vision changes, such as seeing double or blurred vision or having difficulty moving the eyes.

“Ask the child to follow your finger,” Dr. Edison says. “If one eye follows it and the other eye stays straight, or if there’s pain with the movement of one of the eyes, there may be more significant trauma to the injured eye, or there might be an infection brewing within it.”

Mouth/Tooth injuries

When children are still learning how to walk or run and coordinate that movement with their growing bodies, they often fall and injure their mouths and teeth.

If a primary tooth (known as a baby tooth) falls out, it’s not an emergency, but a dentist should examine the child within 24 hours. But an injury to permanent teeth is a dental emergency, Dr. Edison says. She explains that if a permanent tooth comes out, gently rinse it off with saline (salt water) or warm milk. Always hold the tooth by the crown only, never by its roots, because that can damage the nerves. Once the tooth has been rinsed off, re-implant it the best that you can, ensuring correct orientation.

“You should do this within five to 20 minutes of the tooth falling out so the roots of the tooth don’t  die,” Dr. Edison says. An adult should always hold the tooth in place with a moist napkin or paper towel. Dr. Edison adds that a child should not be in charge of this task as they may not hold the tooth still, or the tooth could become dislodged and the child could choke on it.

If re-implanting the tooth is difficult, place it in saline or warm milk and then seek emergency treatment. “All missing teeth should be accounted for,” Dr. Edison says, “and follow up with your child’s dentist to ensure there’s not an underlying injury.”

Fractures

The most common injury among toddlers and infants is fractures—from falling off beds, changing tables, sofas, coffee tables, play structures, or even from a standing height. “All it takes is the right angle and the right force to the bone for a fracture to occur,” Dr. Edison says.

Common locations for fractures in toddlers and young children are the elbow, wrist, collar bone, lower leg, and finger.

How do you know if your child has a fracture? Some indicators include immediate swelling at the site of the injury, deformity, and reluctance to use the injured body part (holding an arm close to the body or not putting weight on the leg).

Dr. Edison names five other signs that should prompt an immediate visit to the ER, known as “the five P’s,” she says:

• Pain (extreme discomfort and sensitivity)
• Pallor (unhealthy pale appearance to the overlying skin)
• Pulse (weak or not detectable)
• Parasthesia (numbness or tingling)
• Paralysis (inability to move the injured body part)

With a suspected fracture, always take your child to a facility that has a radiology center and someone there who can read the X-rays as soon as they are taken.

It’s important that parents understand that although prevention would be ideal, preparation is essential. “Kids are active and curious and injuries will occur, no matter how many safety precautions are put in place,” Dr. Edison says. “That’s why it’s important to know what to do when something happens.”