2 year old with a broken leg...BTDT advice? archived

My 2 year old tripped over a ball and has a classic "toddler's fracture"--a cracked tibia (shin bone). After a few hours at the ER last night, my poor guy is in a splint/soft cast up to his hip. We've already called Dr. Liggio (so happy to see good comments about him here) and I'm hoping we can get in tomorrow to get a cast. Any thoughts/advice on that experience? This is my first broken bone ever--and my husband, who played hockey for 20+years, has not broken a bone either--only dislocated his shoulders. So we're kind of shocked and not sure what to expect.

Can anyone offer any advice? He's EXTREMELY active...how on earth will we keep him entertained for 4-6 weeks in a full leg cast? How do we bathe him? do you think they can do a waterproof cast of that size?

Thanks.

Put the leg in a couple of plastic bags as best you can and be as careful as possible to not get it wet. Use a washrag instead of a bath where and when you can. He will adapt to his cast and he will determine his entertainment. Its really important for the leg to heal correctly.

Dobler88:

I am so sorry to read of your toddler's misfortune. What a terrible experience for one so young and active to have to experience. As a somewhat older person who is going through the mending process after what I have been told is a severe foot/leg injury, I can only tell you what has worked for me and what I wish had been available.

The biggest problem I have faced is the necessity of not putting any weight on my foot. This means that I have to use a walker to get around for short distances and a wheel chair for moderate distances. Handling stairs even now remains out of the question. Unless you are prepared to carry you child everywhere around the house while the leg heals, you need to think of finding a location in your home on the first floor of the house where they child can stay most of the time while healing. It is also important to have your child's favorite distractions within easy reach. Play dates with friends in your child's temporary living space could work as long as sedentary activities are planned.

You also need to think about how the child will get around outside the home. If the child can fit in a stroller and if there is some means of keeping the injured foot elevated while in the stroller, this could work well. Otherwise, you need to consider other possibilities with your doctor.

Baths and showers are not possible for me right now because of the mechanics involved in entering and leaving shower stall or bath-tub, this would be true even if my cast and later my boot were water-proof, which they are not. However, you have the advantage of being able to lift and support your toddler during bathing so either might be possible if you have an appropriate tub or shower seat for the child to sit on and can provide the support needed to keep the child safely seated during bathing. That said, sponge bathes will likely work best and shouldn't be that hard to do.

Please let me know if I provide any further assistance.

My sister had a cast for most of her toddlerhood (she had corrective surgery for a club foot) and you will be amazed at how your little one will find a way to be super active with it. I am sure there have been developments in casting in the last 25 years, but the casts were done in a way so that they were supportive and durable for an active toddler. My sister was able to figure out how to walk on a bent leg cast in no time at all and I am sure your little one will figure out how to get around and do all the things he loves to do as soon as he gets used to it. At his age figuring out the world is what he is best at!

My mom always said do not feel too sorry for babies in casts, they are resilient! Feel sorry for their family for they are the recipients of many bruises and bloody noses from accidents during playtime. It is amazing how painful a crack to the nose is from a baby's cast! (That's how I got the bump on my nose.)

I am sure your doctor will be able to give you good advice as well.

Sponge baths for the most part.

They also make dry shampoos so that you can wash his hair. I know there is one called "Pssst" that comes in a spray-on can, and another type that is a gel that you comb into the hair, let dry and then brush out. There is a pharmacy in Summit called "Liss's" (on Springfield Ave) that carries these products as well as other preparations for bedridden or mobility-impaired people. There may be local pharmacies that carry the same stock, but that's where I get what I need for my mom (who is in her 90s). I couldn't find what I needed in CVS or Walgreens, and I tried several different stores in each chain.

As for keeping him amused, what does you child normally like to do? Maybe you can adapt some of it to his restricted-mobility state for a while. There's a pretty big different between "just two" and "almost three", so if you give us some ideas of favorite activities, maybe we can think of ways for him to keep enjoying them. If he likes painting and things, I'd suggest a cheap plastic tablecloth that you could throw over the bed or couch where he'll be to protect it and still let him have fun with the art supplies. Play-doh? that's usually a favorite.

Dr Liggio gave my daughter a waterproof cast on her arm.. we have pictures of her on a surfboard (in the water) with the cast on...depending on the type of cast your kid's particular fracture requires..you might wind up with something that is very easy to deal with.

First, Liggio is the BEST! We've had 4 casts...3 broken arm/wrists and one broken thumb...all on one kid. We've also had stitches twice and a neck injury. She's a clutz, but that's a whole other story. We got waterproof casts each time. DEFINITELY get one for your won sanity. At Liggio's, it costs a tad extra depending on half leg/full leg, but it should run around an additional $50 for the full leg. That's WELL worth it to me. Waterproof means fully submersable.

Second, when my son was a toddler, one fo his friends broke his leg. They did the stroller thing a ton. Liggio will advise you on how much mobility is alllowed. Trust him and try to keep within his parameters. Also know that most kids will not do something that is causing them pain. In other words, if he feels comfortable doing x, y, or z, it's probably okay.

Third, you'll probably need copies fo the xrays from the ER. Call them first thing in the am so they can get them ready. Liggio needs them. He does have the equiptment at his office, ut I'm not sure your ins covers 2 sets.

Good luck!! And give us an update!

Mamma (DYFS has not visited us yet thank GOD!)

Thank you all SO much...
he just turned 2 at the end of july, so he's "just two" if you know what I mean..his brother and I went to toys r us and got him some dvds, play dough, a little tray that can go around him so he can color, more crayons, activity books, etc., and a few other things. I think with this tray, he can do legos, thomas trains, etc. He's already using his splint as a track for his trains, bless his heart. But he's skittish still, so he won't let me do the tray. Right now, he's sitting next to me playing with the dvd, so he's doing ok. He freaks out every time I pick him up to move him. I think it's more fear than pain--it's a break on his mid-shin area so it's fairly easy to move him without jostling it.

OMG, I am SO HOPING I can get a waterproof cast. I would pay quite possibly any amount of money for that! But I think if he has to have a full leg cast at first I might not be able to do that. I was just thinking about the dry shampoo--this guy has a ton of hair so I am going to pick some up when I can.

All in all, he's doing better than I thought he would...Mamma, thanks for the reminder about ER x rays. I was wondering about copies of x rays--they showed me them on the computer so I don't even know if there ARE hard copies!

And I guess I'd better get a single stroller! He will sit in it, so I'm hoping we can at least go out and about.

Our daughter had a hairline fracture of her femur when she was about 26 months (so very similar to your little guy). It's been a few years, but here is what I can recall

1. I think we may have also used Dr. Liggio (we were very happy with him). My daughter got to choose from about two dozen colors for the cast, and picked bright green. We bought yellow sticky dots at the office supply store, and played "Dorothy the Dinosaur"

2. Given the femur, we actually had a cast that went from ankle to waist (wrapping around one side). The orthopedist had to teach us special diapering techniques to use with the cast in the way. In our case, a waterproof cast was not an option, I think, so we did lots of sponge baths, washed hair at the sink, and have the cast a couple of shots of Febreeze when it got less than "fresh"

My daughter may be the only child in history to go on vacation to Bermuda and never go to the beach. We were just too afraid of sand in the cast. We have wonderful pictures from formal night on a cruise, with her dressed up in her finest and sporting a big green cast!

3. In our daughter's case, the recommendation was to cast the leg with a bend, to make it easer to sit in a chair (with a prop behind her), rather than to cast it straighter. With a shin fracture, your answer may differ.

Walking just wasn't an issue...she didn't even try. So we went back to strollers and carrying full time for the 4 weeks or so that she was in the cast. When the cast came off, she had a week or so of basically learning to walk again, starting with cruising the furniture, etc., but was quickly back to normal.

3. Constipation...I hope you don't have this problem, but when an active two year old quits walking, things can get backed up. Badly. You may want to ask your doctor about this in advance.

4. We didn't come up with great answers for the excess energy, but our daughter dealt with it pretty well. One thing we did try, with a little success, was getting a "sit n spin", which we could set her on. She wasn't very good at the arm motions for major spinning, but did have fun with it.

5. Taking the cast off was scary for my daughter, because the little cast saw is noisy, etc. No advice other than letting him know what it will sound like.

I'm sure I'm forgetting something, but feel free to ask more! Best of luck.

Dobbler, my daughter broke her arm at 2.5 years. She had full arm cast up to shoulder and was allowed to have the waterproof one. And 2 days later, we headed to the beach for 2 weeks. The sand was fine...she swam, etc. I know the leg is different, but I am praying for you that the waterproof cast is an option!! And don't fret about sand!

Could you make him a mini sandbox in a plastic tub (like the low-sided storage containers? you could just put the top on when he's not playing with it).
Kids that age like to play with trucks/animals/trains in sand and this might keep him occupied for some stretches of time. You might have to vaccuum a lot, but if it engages him it could be worth it.

My daughter was in middle school when she injured her leg and was bedridden and then on crutches, so that was a different story. She spent a lot of time on the phone and the computer when she couldn't move around much. Would your son like to listen to music CDs? I know you don't want to have him staring at the TV for long stretches, but the occasional DVD might amuse him, especially if it's during the time you're trying to take care of his hair.

Would this be a possible time to get a low-maintenance pet that he could look at? Like some goldfish, or maybe a guinea pig? It would be more work for you for his recovery and beyond, but do you think that might give him something to focus on that wouldn't be TV or VCR-related? If you get fish, you could get some snails to keep the tank clean and he could watch them move around the tank. We've always had pets, so this would be something I'd consider, but not everyone wants the responsibility of taking care of animals. Just throwing it out as a suggestion.

Does he like puzzles? I'm thinking of the wooden ones, with the pieces on pegs that you fit in to a board. Sometimes they have related pictures painted on the board when the pieces should go (like an egg under the chicken piece, a tadpole under the frog.....)

Dobler88, It is interesting reading this from a parent's point of view. Mine was a child's. I was about 3, rode on the back of a bike and got my foot caught in the spokes of the wheel. My older brother picked me up and rushed me home to Mom and Dad. I was alone in the car and hospital with Mom and Dad. The attention I received was what I remember most. The cast was only knee high yet my Mom carried me everywhere. I have especially fond memories of the bath with my foot hanging outside of the tub and her careful sponge bathing. Especially the detail to my hands and in-between my fingers. What a Mom. Love her! And Dad! I remember the loving care to my well-being. It's still with me to this day.

Oh, and my Mom positioned me in different places to view what was going on. Front yard, back yard, were my fondest memories. Also, the feeling of sadness when I would say after she put me in the front yard. "I think I want the back yard." And realized what I said meant she then had to move me and the chair. It was definitely a learning experience of compassion for my caretaker. I know I didn't have THAT before.

Our son broke his shin bone (hairline fracture) when he was just under 2. He had tripped over a curb. He only had a knee high cast, but he was back walking, running and jumping wearing the cast in no time. As long as it is a simple fracture it should heal real fast. But still, a couple of movies and other couch entertainment should help make the time go past.
I had my first lower leg cast when I was ten and more since. The itching is the worst, by far. It gets worse when you get water under the cast in the shower, so make sure to really seal it of. Plastig bags and rubber bands work great, but don't do it for to long or with to tight a rubber band or it will affect blood circulation.
Shirt hangers are great for scratching inside the cast, just make sure they have no sharp ends.

Good luck and remember, in most cases the kid will take it easier then the parent.

Thin knitting needles also work well to scratch inside a cast, but my doctor was very upset with me when I did that with my broken arm - kept insisting I could have done some damage with it. It felt really good. If you do anything like this, be careful and be very, very gentle.

oneofthegirls, thank you for the child perspective!
we are off to have it casted today..still waiting for an appointment. He's sleeping remarkably well (especially given that he's not a great sleeper to begin with it). He even pushed his brother yesterday. I never thought I'd be happy to see that!

good points re the itching!

cody, I used one of your ideas--the sandbox---only instead of sand, I used rice! Rice is big enough not to fit inside the cast--I was nervous he'd get in there...

the thing that's upsetting me the most is that he is still so scared to be moved. He cries when we move him from couch to crib..but it's getting better. He also has some fitful sleep with the medicine they gave him..but I can tell he's still in a bit of pain and he needs it...

Even with the medication, he could still be in a lot of pain and depending on how you are moving the child, it could really be painful for him. When you do see the doctor, be sure to ask about safe/effective levels and frequency of medication and the least jarring way of carrying him among other things.

I note in an above post that you mentioned your child was having problems with constipation. This is known to be a common effect of taking some pain medications. In my case, I was perscribed a stool softener to be taken on days when I needed the pain medication. Ask if your child might need one, should constipation remain a problem.

My daughter had a fracture at 18 months, also the tibia. I don't remember what we did about bathing, but I'm thinking we must have done sponge baths. She was also very active, and within a few days she was climbing and walking even with the cast on (the orthopedist must have OK'd it).. She was only in the cast for 3-4 weeks or so.

Hope he has a quick recovery!

If the x-rays were shown to you on the computer, they can very likely put them on a DVD for you, so ask about that. I recently had to carry medical files from one of my cats from one vet to another, and almost all of it was on DVD, including x-rays. Oddly, the only things that were recorded on paper were the doctor's exam notes!

Good luck with your little one.

Actually, I think I mentioned constipation as a potential side effect, not the OP. In my daughters case it had nothing to do with pain mends, since Tylenol was all she ever had...I think it was the relative lack of physical activity.

Best of luck with the casting!

Re medical records, including x-rays: My doctor has already obtained these from the hospital emergency room before my first visit. Be sure to call your orthopedist and ask if this is a possibility before you begin worrying, as I did, about how you could possibly obtain and transport them.

well. We got some very bad news. His tibia is not broken--his femur is. He has to have a full spica cast (to the waist) or 6 weeks and will be completely immobile. I am in shock. I don't understand how the ER misdiagnosed it. I thought it was odd that they told me the femur first--and then the PA told me his tibia. But then his xrays all say "femur," and the radiologist report said they are normal, but, dr. liggio showed me the break and, after he showed me how to carry him, I can see the difference--he clearly is in pain in his UPPER leg, not his shin. I feel horrible--I've been carrying him the wrong way since sunday, watching out for his shin.

He has to be sedated to have the cast put on--tomorrow. But, hey, it's going to be waterproof, so there's that!

I really just don't understand how the ER could miss this. It was labor day weekend, and busy, but how could they get it so wrong?

Whoa, that's bizarre. Dobler, I'm SO sorry. Your poor baby, and I'm really sad for both of you to have to get him through six weeks of immobility. :sad:

Poor little kid! Hope that the new cast will make him more comfortable.

Poor little guy...that stinks LOL

I'm glad you got to Liggio ASAP. He is such a gentle, nice doctor. You are in good hands!

Let us know how it goes...we'll all be sending "get well vibes" your way! XOXO Mamma

dobler88,

Sorry to hear it. The misdiagnosis seems like quite a mistake, and the extra day or two waiting for the cast due to the holiday only made it worse for all of you. The good news is that the worst should be over once the cast is on. (seems strange to take two plus days to get a cast on a toddler, even given the holiday!)

I wish Dr. Liggio had offered us waterproof when we had the same femur cast a few years back! Maybe he did...my husband was actually the one at the doctor's for the cast, as I had a bad work conflict, and reluctantly missed it. I'll echo that Dr. Liggio is wonderful.

We were lucky in that my daughter's immobile time was in the break between preschool sessions, but unlucky that it coincided with our big family vacation. Happily, they cleared her to travel.

Let your little guy pick a really cool cast color, and make sure that Dr. Liggio shows you how to diaper around it effectively (my memory is it involved a larger than usual diaper, wrapped around the cast, with a smaller one, and a sanitary napkin tucked inside...at least for a toddler girl). Once the cast comes off, it makes a cool momento (although we finally threw ours away, I think)

My memory is that once the cast was on, our daughter was just fine, found plenty of ways to enjoy herself, etc., so that the immobility wasn't as much burden as we had expected. Hoping you find the same, and sending good wishes your little guy's way. Best of luck!

Oh the poor little guy! At least you know how to handle him now without causing pain. Good luck with everything. Does he like movies? You can get them at the Redbox for only $1/day. Hopefully he has some good pain management meds, too.

We actually had an ER visit 2 weeks ago during which our ped wanted a certain test done and the ER dr. did it but acted as if we did not really need it. Initial test came back negative and he said I told you so, basically. 2 days later he called me at 10 pm letting me know that my pediatrician's initial thought about diagnosis was correct and my 15 month daughter needed to be put on major antibiotics ASAP. Obviously the test results did not come back for a couple days, but I was annoyed that the ER doc was so negative about my doc to me. And then he had to eat his words. He did apologize when he called me and said he felt really bad. I guess the ER docs are just trying to handle what they can at the time.

When our son broke his tibia, the ER said they couldn't see a fracture. 'It's just a bruise'. Our doctor said that's quite common with kids that the fractures don't show on the x-rays or are really hard to diagnose. He did it mostly by feeling the leg. However on the x-ray after it had all healed one could clearly see a line where the bone had grown back together.

Oh no! I'm so sorry. Which ER did you go to, btw? My son had a toddler fracture at age 2 as well, but his cast was only up to his knee. Dr. Liggio was great, and gave us a waterproof walking cast for an extra $27 IIRC. Although in retrospect, it was worth 10x that much just for the conveneience. (Pic: http://farm4.static.flickr.com/3060/2810184154_48f124940d.jpg).

Obviously my son's stintwas a lot easier to manage than yours is likely to be, but what stood out for me the most about that time period was how easily and quickly my son adapted. He never complained, and he found a way to have just as much fun as his friends one way or the other. Kids can be amazing that way. Hugs to your son!!

Poor little guy - it's a good thing kids are so resilient, but that doesn't make it easier to watch your child go through something like this. I don't see how they'd confuse a femur with a tibia, either. I hope the casting goes well for him and I know you'll find a special something to cheer him up.

Great idea with the rice - very clever!

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