My toddler is not walking after a fall.
Xrays are negative but could this still be a fracture?
Q) Dear Dr. Gwenn:
Our 23 month old daughter apparently fell down while playing. My wife and I did not see her fall nor did our other three daughters but we knew something happened because we heard her cry and found her sitting on the floor near her play kitchen. We didn't think anything of it until the next day when she absolutely refused to walk or even stand on it, but is otherwise fine if she is sitting.
We went to our doctor and she took X-rays of foot and ankle and said there was no break so it was a sprain, check back in a few days. We checked back after doing our own research and asked if it could be a toddler fracture. The doctor did not seem to want our input, rechecked the same xrays and said there is no break, check back in a week if she is not walking.
I am concerned about waiting too long. We are going on our third day and still there is no change in her refusal to walk or stand. I guess what I am wondering is should we wait and is there something else we should do?
Much thanks.
J&A
A) Dear J&A:
This is a very common problem in toddlers given how frequently they fall while mastering their new skills of standing, walking, and running. The biggest issue for me is the tempo of improvement after the initial fall. If a child falls, has negative xrays, but slowly improves with rest and motrin taking more steps and using the leg more, likely the injury is a sprain. But, if the child is not using the leg at all and refusing to bear weight, that is suspicious for a toddler’s fracture.
Toddler bones are very unique compared to ours – they bend similar to a new branch to a significant degree before they break. So, negative xrays are not always the end of the story.
I’d suggest you ask for a referral to a pediatric orthopedist who may be able to give you a more definite answer based just on the history you emailed to me. Many times in this setting, an orthopedist will assume there is a fracture, or break, and recommend a cast for 3-6 weeks.
Your pediatrician was not technically wrong in telling you to wait it out a week. Sprains are actual small tears in the soft tissues of a body part, in this case the lower leg. That hurts – a good deal in fact. Your daughter will not be harmed by waiting that long – she’s essentially splinting the injury by not using it.
A trial of motrin and ice can be really helpful here. If after a good 1-2 days of ice and motrin your daughter is still not bearing weight at all, I’d suspect a fracture more than a sprain.
This becomes a balancing act between following advice and following your gut.
Best,
Dr. Gwenn
