When Your Toddler Stops Toddling….

Have you ever wonder what makes a toddler tick? The recipe is simple: 1/3 Eveready Bunny, 1/3 weeble and 1/3 cute. If it weren’t for their endless energy, there really would be little need for Starbucks. The have a cute way of wobbling like weebles but unlike their toy cousins do fall – and often. They fall so often it can be difficult to decide which falls to worry about and which to ignore. Afterall, they can’t often tell us what hurts.

J is no exception. At 19 months of age and barely 3 feet tall, he has mastered the art of being on the go, and falling. Recently, however, a “routine” fall seemed different. He didn’t cry but did not get up as fast. Once he did get up, he seemed to wince when he tried to walk on his left leg and seemed content to just play with trucks on the floor. J’s leg actually looked fine and he did not seem in pain but his parents were concerned by his inability to dart about the house. They consulted J’s pediatrician who told them it sounded like a “toddler’s fracture” – a break in his shin bone. A trip to the orthopedist and x-ray confirmed the diagnosis and J was placed in a green and blue cast for 4 weeks. His parents kept mulling over the fall that broke J’s leg – it really was “nothing”; no different than his typical stumble. Was something wrong with J’s bones?

Rest assured, J’s bones are completely normal. But, like J, his bones are also toddlers and still growing and this is what makes them very vulnerable to breaking without much force at all. Toddler’s fractures are the most common fracture for kids ages 9months to 3 years. These fractures can be so subtle that they may not be visible on an xray. The clue to this diagnosis is not only the age of the child but the child’s inability or refusal to bear weight. The bones of this age group are similar to new branches on a tree and can bend a great deal. Some children will be able to walk with a toddler’s fracture and others will not. A cast is often needed to make the child more comfortable but some children with little or no discomfort are managed with close observation.

Luckily, most falls our toddlers have are minor but that does not mean the won’t cause symptoms. Your child may limp and there may be a bruise in the injured area. Some injuries will hurt and others will not. It’s the impact on the child and duration of symptoms that will help guide you to when to seek input from your pediatrician. For a mild limp and bruise, you can watch your child for a few days and see if the symptoms resolved. Give Tylenol or motrin to help minimize minor discomfort and ice the area if your child will allow. Minor symptoms that are not resolving within a few days to a week should be evaluated for a possible hairline fracture.

Some symptoms, however, are more serious and require more urgent evaluation. Call your pediatrician for advice if you notice any of these symptoms in your toddler, regardless of whether you witness an actual injury:

• Persistent crying with attempts at walking or crawling
• A cut in the skin in the area of the injury
• Refusing to walk or crawl
• Obvious deformity of the injured area
• Redness of a joint, with or without fever

Remember, a toddler has one prime directive to follow: thou shalt not stop moving. So, pay attention to the falls that seem to have caused a short circuit somewhere – and start thinking of what cast color you may want for family photos.

© 2005-2006 Pediatrics Now.
All rights reserved. PEDIATRICS NOW is a trademark of Pediatrics Now.

[back to Metrowest Daily News and Parents & Kids archive]