Sprains and Broken Bones in Kids: First Aid, Warning Signs and When to Go to the ER • Living Life as Moms | Mom Hacks, Toddler Snacks, and Kids Activities

Quick answer: after a fall or twist, keep your child still, support the injured limb in the position found and apply a cold pack wrapped in a cloth for 15 to 20 minutes. Go to the emergency room or urgent care if the limb looks bent, swelling is rapid, the pain is severe, your child cannot use or put weight on the limb, or there is numbness or color change. Call 911 for bone through the skin, heavy bleeding or a suspected neck or back injury. In children, a painful joint that looks like a sprain may be a growth plate fracture, so have it checked.

Kids climb, jump, skate and wrestle, so bumps and bruises are part of childhood. Occasionally, a tumble ends in a swollen wrist or an ankle that will not bear weight. Parents often wonder whether to wrap it, ice it and wait, or head straight to the doctor. This guide is part of our family health and safety guide. It explains the difference between sprains, strains and fractures, shows what to do in the first minutes and covers when to go to the emergency room, how doctors treat these injuries and how to help a child heal.

Sources: American Academy of Pediatrics (AAP) HealthyChildren.org guidance on broken bones, sprains and growth plate injuries; American Academy of Orthopaedic Surgeons (AAOS) OrthoInfo on fractures and sprains in children; Mayo Clinic information on sprains and fractures; Nemours KidsHealth on broken bones. This article is general information, not medical advice. A health care provider should evaluate any suspected fracture.

Sprain, Strain or Fracture?

These terms describe different injuries.

Sprain: an injury to a ligament, the tough band that connects bone to bone at a joint. Ankles and wrists are most often sprained.
Strain: an injury to a muscle or tendon, often from overstretching.
Fracture: a break in a bone. It may be a crack, a small buckle or a full break.

The symptoms overlap. All three can cause pain, swelling, bruising and trouble using the limb. Only an exam and often an X-ray can tell them apart.

Why Children Are Different

A child’s skeleton is still growing, and that changes how injuries happen.

Growth plates. Near the ends of long bones lie areas of developing cartilage called growth plates. They are softer than the surrounding bone, and softer than the ligaments around them. For this reason, a force that would sprain an adult’s ankle can injure a child’s growth plate instead. The AAOS notes that growth plate injuries are common in children and need proper evaluation, because damage can sometimes affect how a bone grows.

Buckle fractures. Children’s bones are more flexible, so they may bend or buckle instead of snapping. A buckle fracture, also called a torus fracture, is a common injury of the wrist and forearm after a fall on an outstretched hand. It may cause less dramatic symptoms than a full break, so some children use the arm for a day or two before a parent notices.

Faster healing. In general, children’s bones heal faster than adults’, and many remodel as they grow.

Because of these differences, a child with pain over a bone or a joint and swelling after a fall should be seen by a provider rather than assumed to have a simple sprain.

Signs That an Injury May Be a Fracture

Watch for:

Pain that is severe, or gets worse when moving or touching the area
Swelling or bruising that appears quickly
A limb that looks crooked, bent or out of shape
Inability to move the limb, or to put weight on a leg or foot
Tenderness directly over a bone
A grinding or snapping sound or feeling at the time of injury
Numbness, tingling, a pale or blue color or a cold hand or foot below the injury
A child who guards the arm, will not use it or holds it still against the body

Young children who cannot explain what hurts may stop using an arm, limp, refuse to crawl or cry when you touch a limb. Treat these signs seriously.

First Aid in the First Minutes

Keep your child calm and still. Moving a broken limb can increase pain and damage.
Look for danger signs (see the next section). If any are present, call 911.
Support the limb in the position found. Do not try to straighten a bent limb.
Control bleeding with clean gauze or cloth and gentle pressure if there is a wound.
Apply a cold pack wrapped in a thin cloth for 15 to 20 minutes, never directly on the skin.
Splint if you must move your child. A rolled magazine, a folded towel or a piece of cardboard, tied loosely above and below the injury with soft cloth, can hold the limb steady. The splint should not be tight.
Remove rings or bracelets from the injured limb before swelling grows.
Do not give food or drink until the doctor decides, in case surgery is needed.
Get medical care.

Our family first aid kit checklist lists supplies such as elastic bandages, cold packs and gauze that are useful in these situations.

When to Call 911

Call 911 right away if:

A bone is poking through the skin
There is heavy bleeding that does not stop with pressure
Your child may have a head, neck or back injury, such as after a fall from a height, a car crash or a hard hit during sports, especially if there is numbness, weakness or severe pain in the neck or back
The limb is blue, white or cold, or has no pulse
Your child is unresponsive, confused or having trouble breathing
The leg or hip appears badly deformed

Do not move a child with a possible spinal injury unless the child is in danger. Keep them still and wait for help.

When to Go to the ER or Urgent Care

Go the same day if your child:

Cannot use the limb or put weight on it
Has a deformity, swelling or severe pain
Has pain that persists after an hour or two of rest and ice
Has numbness or tingling
Was injured in a fall from a height or in a high-speed activity
Has pain over the growth plate area, such as the end of a long bone near a joint
Is a baby or toddler who will not move a limb after a fall or tug

Emergency rooms are best for severe injuries and after hours. Some urgent care centers have X-ray equipment and can treat simple fractures. Call ahead to ask whether they treat children and take X-rays.

What Happens at the Doctor

A provider will ask how the injury happened and examine the area. They may ask your child to move the limb gently. X-rays show most fractures, although very small cracks and growth plate injuries sometimes need a repeat X-ray a week or two later. Providers try to limit radiation and use X-rays only when needed.

Treatment depends on the injury:

Sprains and strains are usually treated with rest, ice, compression, elevation and gentle movement as pain allows. A brace or wrap may be used.
Buckle fractures are often treated with a removable splint or a short cast.
Simple fractures are treated with a splint or cast that holds the bone in place while it heals.
Displaced fractures may need the bones to be moved back into place, sometimes with sedation.
Complex fractures may need surgery, pins or plates.

Pain Relief

For mild to moderate pain, your doctor may suggest acetaminophen or ibuprofen, in the right dose for your child’s weight and age. Ibuprofen is not recommended for babies under six months. Do not give aspirin to children. Read labels carefully, and see our medicine safety guide for dosing and safe storage. Elevating the limb above heart level and applying cold packs also reduce swelling and pain.

Caring for a Splint or Cast

Keep it dry. Use a cast cover or plastic bag for baths, and avoid swimming unless your doctor says a waterproof cast is in place.
Do not stick objects inside the cast to scratch. Try cool air from a hair dryer set to cool, or ask the doctor about itching.
Keep the limb raised for the first day or two to reduce swelling.
Check fingers or toes for color, warmth and movement. Call the doctor if they become blue, white, numb or very swollen.
Do not trim or break edges. Ask the provider about rough edges.
Keep sand, powders and lotions away from the cast.
Watch for a bad smell, drainage or skin irritation, which need a call to the doctor.

Most children wear a cast for several weeks. After removal, the limb may look pale or thin, and the skin may be dry. Stiffness and weakness usually improve as your child uses the limb.

Going Back to Activities

Children often feel better before the bone is fully healed. Follow your doctor’s guidance on when to return to school, gym and sports. Many children can go to school with a cast. Talk with teachers about how to manage backpacks, stairs and gym class. Sports usually wait until the bone has healed and strength and motion have returned, with a gradual return.

Caring for a Mild Sprain at Home

If a provider has confirmed a mild sprain, or says home care is fine, the usual approach involves four steps.

Rest. Avoid activities that cause pain for a day or two. Crutches or a sling may help.
Ice. Apply a cold pack wrapped in cloth for 15 to 20 minutes several times a day during the first couple of days.
Compression. An elastic bandage wrapped snugly, but not tight, limits swelling. Loosen it if toes or fingers tingle, turn pale or swell.
Elevation. Keep the limb propped above heart level when resting.

After the first day or two, gentle movement helps the joint recover. Many providers recommend starting gentle range-of-motion exercises as pain allows, and gradually returning to normal activity. Heat, massage and hot baths are usually avoided for the first two days, since they can increase swelling. If pain is not improving after several days, or if your child cannot put weight on the limb, return to the provider.

Nursemaid's Elbow in Toddlers

Toddlers sometimes develop a painful elbow injury after being pulled by the hand or arm, for example while being lifted or swung. The ligament that holds the bones of the elbow in place slips out slightly, which is called nursemaid’s elbow. A child may cry, hold the arm still against the body and refuse to use it, but there is often little swelling. A doctor can usually fix it with a simple movement, and children often feel better within minutes. Because other injuries cause similar signs, the arm should be checked by a provider. To prevent it, lift toddlers under the armpits rather than by the hands or wrists.

Helping Your Child Cope

An injury can be scary. Children may feel frustrated by a cast or sad about missing sports or play. A few ideas can help.

Explain what is happening in simple words, and let your child ask questions.
Offer choices, such as cast color, so they feel in control.
Plan quiet activities such as reading, drawing, board games and audiobooks.
Stay connected to friends with video calls or visits.
Ask the school about accommodations, such as extra time to move between classes, a second set of books or an elevator pass.
Praise progress, and remind your child that healing takes time.

Keep an eye on mood too. If a child seems very sad or anxious for a long time after an injury, talk with the doctor.

Preventing Fractures and Sprains

Use protective gear such as helmets, wrist guards, knee pads and elbow pads for biking, skating and scootering. See our guide to bike helmet fit and safety rules for kids.
Choose safe playgrounds with soft surfaces under equipment, and supervise young children. See playground safety for kids.
Follow trampoline rules, since falls from trampolines are a common cause of fractures. Our trampoline safety guide explains why the AAP discourages home trampolines.
Warm up before sports, and teach good form.
Wear proper shoes that fit and support the foot.
Make sure kids get enough calcium and vitamin D as part of a balanced diet.

Frequently Asked Questions

How can I tell if my child's arm is broken or just sprained?

You cannot always tell without an X-ray. Severe pain, swelling, deformity, or not using the arm are reasons to see a provider.

Can a child walk on a broken leg?

Sometimes. Some children with fractures can still limp on the leg, so walking does not rule out a break.

What is a buckle fracture?

A buckle fracture is a common childhood break in which the bone bends or buckles instead of breaking all the way through. It often occurs in the wrist.