As a doctor and mother of 3 active kids involved in a wide range of sports, I am vigilant about keeping my kids injury free. From the bleachers, I am always amazed at the flexibility, toughness and skills of these young athletes. I have winced at some training drills and wondered often how injuries aren’t actually more frequent! I think about the treatment they will or will not receive and remind myself that children ARE resilient. They have the ability to recover from injuries in a quarter the time as adults. They can complain of severe pain that magically disappears within a day, and even within a game. Still, what do you do when the child comes home in pain?
The goal of this article is to allow you, the parent, to identify pain that needs medical attention and guide your actions to manage pain that does not. As with every child related issue, communication is key. If there was an actual injury your child cannot recall the details from (a common phenomenon), ask the coach or another parent who saw the injury happen. If there was no injury, try to pinpoint the first time your child noticed the pain.
Key questions that suggest a more serious issue to ask your child are:
Does the pain bother you when you aren’t moving?
Has the pain been getting worse?
It the pain waking you up at night?
A yes to any of these questions merits medical attention. Also, if the painful area is swollen and your child is not moving normally, see a medical professional. This can start with a pediatrician, a physical therapist or a sports medicine physician. (MD or DO)
Symptoms that suggest the pain can be managed by you:
Pain comes and goes
Pain responds to 1 low dose of over the counter pain medication
Pain is not present while not playing sports
Protective behavior (limping or holding arm to side) does not occur when your child is distracted.
Injury related pain that lingers is most often due to muscle or tendon sprains, strains or contusions (bruises.) If you are concerned about a fracture, there is usually bruising in the area and pain with motion. A ligament stretch or tear will be accompanied by swelling and limited function of the joint. The child may recall a popping sound or sensation. These issues should be seen immediately by a sports medicine professional, as improper healing could lead to long term consequences.
Non-injury pain is most likely due to overuse, but can also begin suddenly. This pain occurs when muscle, ligament, tendon or bone becomes inflamed due to excessive repetitive drills, weight training, increased intensity, double workouts, or not resting at least 1 day a week. If the over-activity is associated with both muscle and physical fatigue, balance and form can be off and lead to more severe injuries. Rest is imperative. Don’t be shy communicating with the coach that your child needs rest. Get a doctor’s note if you must.
Growth makes children more susceptible to pain as the nerves, muscles, tendons and ligaments, while developing, can lead to pain sensitivity and trouble with coordination and balance. Growing pains, described as aching and throbbing in the legs, are more symptomatic in the afternoon or evening. They occur most frequently between ages 3-4 and again at ages 8-12. Growth plate injuries are also a possibility and cause pain in a joint with motion or load bearing. Girls are typically growing until age 15; boys to 17.
Initial home treatment should begin with the RICEM protocol:
Rest: I use the term “relative rest” to describe staying active as long as it does not cause pain
Ice: 5-10 minutes 3 times a day. You can never go wrong with ice over heat. Ice is the best treatment for inflammation and pain; heat can increase inflammation. Be careful not to place ice directly on skin as it may cause a skin burn.
Compression: if a joint is swollen, wrapping it snuggly can help with discomfort and limit further swelling (NOTE: for swelling medical attention is recommended)
Elevation: Keeping a sore ankle or knee elevated helps with circulation and lessens swelling
Meds: a low dose of over the counter advil or aleve can help and even heal as it decreases inflammation along with improving pain. Tylenol does not decrease inflammation but helps with pain. Follow directions on the bottle and consider starting with half the recommended dose. For children under 12, use pediatric pain medications.
Pain you can manage should resolve within a few days. If you are uncomfortable with your child’s pain even if symptoms fall under the “pain you can manage” category, see a physician. Urgent care centers are excellent at clearing injuries if you are unable to get to your doctor or a specialist. If pain is low level, but keeps returning over weeks or months, consider physical therapy. If it still continues after 4-8 physical therapy treatments, return to your doctor and ask for testing. The sooner pain is treated and resolved, the healthier, happier and more successful your child will be.