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Fri, 31 May 2002 09:02:57 BST

Dave,
Children presenting to you in this way need to be assessed by 
someone who understands paediatric injury if they are anything more 
than a minor sprain. I would suggest that you do not try any 
manipulation. I would STRONGLY suggest that you do not tell the 
parents that you are sending them for an Xray (as this tends to make 
the parents rather upset at the ER staff when they don't get an Xray, as 
Xray is usually not necessary in this condition).

Better than trying to examine (which can be difficult  in this age group 
even for the experts!) is to put the toddler in a calm child friendly 
environment (lots of colour and interesting toys) and watch what they 
are doing over a short time (say 20 - 30 minutes). If they start using the 
arm normally you can advise the parents simply to consult a doctor the 
next day if they think that there is a problem. If the child is not using 
the arm normally they need to be sent for a medical assessment.

You also asked about immobilisation. This is usually pretty impossible 
in this age group and they usually seem most comfortable with the arm 
just hanging by their side. The objective of splinting in pain control, so 
as the patient is best without a splint don't even try. Putting the arm in 
a sling is painful and I bet a nice sling  will not stay on the average 
toddler for more than 10 seconds!

Tim.

> Hello All,
> 
> I am new to this list and I thought I would take this opportunity to
> ask a question that I still have not gotten a straight answer for yet.
> I work in a Theme Park setting and I deal mostly with children, I have
> had instances in the past where a parent has brought in their child
> having pain after lifting them by the arm. The parents all claim that
> they heard or felt a "pop" prior to the child having pain in the
> affected extremity. I was wondering what the best course of treatment
> should be if you are presented with something of this nature. Given
> that the child is reluctant to let you touch or move the injured
> extremity, would your best course of action be to immobilize the area
> completely and send them for and x-ray or try and determine the range
> of motion and then decide how you are going to splint? Another
> question is if it is in the elbow, do you splint the elbow in a
> straight position or do you splint it with a bend at the elbow and
> then put them in a sling? I know this may seem like something that is
> obvious but as I have said before I never really have gotten a
> straight answer yet, thanks for any help you can give me.
> 
> Dave

Timothy J Coats MD FRCS FFAEM
Senior Lecturer in Accident and Emergency / Pre-Hospital Care
Royal London Hospital, UK.

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