A common toddler and child injury is when the fingers or hand get crushed by a door or a falling heavy object. Such injuries usually don’t require an after hours call to your doctor or a trip to the ER. Here is what you can do to assess and treat your child’s injury until your doctor’s office opens.
Ice the Injury
Ice the injury for at least 20 minutes. You can soak your child’s hand in a bowl of water with some ice cubes or put water and ice cubes in a plastic baggie (or a bag of frozen berries or veggies works too) and hold this around the fingers or hand. Even if your child protests, it’s probably worth doing to lessen the long-term pain and swelling.
Treat the pain
Give your child ibuprofen (click here for dosing). This will not only help the pain, it will decrease the inflammation to the tissues. If you don’t have ibuprofen, you can use acetaminophen (click here for dosing).
Observe your child
Before rushing to the ER or paging your doctor, observe your child for a few hours. If he begins using the hand (probably cautiously for the first few days) at least somewhat, then you don’t have to worry that anything is broken. Even if there is a tiny break in a bone, you don’t need to find out right away. It can wait until your doctor’s office opens the next day, unless it is severe (bent out of place – see next paragraph).
Examine for broken bones
Some swelling is expected. If any of the fingers or parts of the hand seems severely swollen and bent out of shape, and your child is in extreme pain, then there is probably a broken bone. You should go to an ER right away (or your doctor’s office if during the day). If there is swelling, but nothing is really bent out of shape, then there may be a small break, but you can wait until your doctor’s office opens (if a little break is there, it can wait several hours to be assessed).
It is common for the nail to break, swell, bleed or bruise. This usually doesn’t indicate any bone is broken. If the nail is pulled completely out (or almost out), then an ER doctor (pediatricians usually won’t do this procedure in the office) can sew the nail back into place to save it. If this is not done, a new nail may or may not grow back in eventually. The choice to have the nail sewn back in is an individual call. There’s no need to page your doctor to discuss this. If the nail is partially out, and you don’t go to the ER, then apply antibiotic ointment and put on a band-aid or tape on gauze to secure the nail so it doesn’t accidentally get pulled out.