I grew up in a “walk it off” or “rub some dirt in it” kind of house. I think Freud would have something to say about my professional choice given my upbringing. Needless to say, although my parents are great and know a lot about a lot of things, they were a bit off course with the “walk it off” approach to caring for twists, sprains, strains, etc.

What to do the first moments after an injury:

After your child hurts something (e.g., twists an ankle, falls on an outstretched hand and hurts a wrist, or takes a fall/hit in a sport), you have to make a quick assessment.

1. Stop the activity that caused the injury.
2. Take 10 seconds to determine if the injury is an emergency (warranting a rush to the ER). Is the bone sticking out? Is there a huge gash that will need stitches? Does the arm bend in the wrong location–an obvious break? If yes, go to the ER.
3. If it is not an emergency, sit down/rest and support the injured area. Rest the injured arm, ankle, etc. against a firm surface.
4. Apply ice or something cold. In the first few moments after an injury, the body sends all sorts of “help” to an injury in the form of swelling. Ice will help reduce the initial swelling and provide some element of pain relief.
5. Limit movement. There is huge wives tale that if you can move something, then it isn’t broken. I don’t have x-ray vision and neither do you. Just because your kid can move it, doesn’t mean it isn’t injured.

In the first 24 hours:

1. Continue to apply ice (for first 24 hours total).
2. Elevate the injury (this will also help with swelling), preferably above the level of the heart (e.g., so you could lay your child on the couch and put an injured ankle up on a couple of pillows.
3. Try and anti-inflammatory medication to help with pain and swelling (e.g., Motrin/Ibuprofen). Ibuprofen is generally superior to Tylenol for sprains and strains because it has the anti-inflammatory effect in addition to pain management.
4. Assess whether it’s a possible fracture that may require evaluation by a doctor. Now it can be hard to determine if the injury is “broken.” If the pain is disproportionate, if there is pain over touching the potential affected bone, or there is extreme discoloration, you may want to take your child to the doctor.

After a few days:

1. Start to gently use the affected area as tolerated (e.g., walk more on the injured ankle, etc.)
2. Stop the pain medication. If it absolutely necessary to function after a few days, you probably should take your child into the doctor for further evaluation.
3. Apply warm packs to affected area and encourage gentle stretching of the affected area.

Pain is your body’s way of communicating that there are problems. Strains and sprains tend to get better with each passing day. If your child’s injury doesn’t seem to be making a hasty recovery, you may need to see your pediatrician.