Until your child can be seen in the pediatrician's office, emergency room or urgent-care center, use an improvised sling or rolled-up newspaper or magazine as a splint to protect the injury from unnecessary movement.
Don't give the child anything by mouth to drink or to relieve pain without first consulting the doctor. If yours is an older child, you can use an ice bag or a cold towel, placed on the injury site, to decrease pain. Extreme cold can cause injury to the delicate skin of babies and toddlers, so ice should not be used with children this young.
If your child has broken his leg, do not try to move him yourself. Call an ambulance, make the child as comfortable as possible, and let the paramedics supervise his transportation.
If part of the injury is open and bleeding, or if bone is protruding through the skin, place firm pressure on the wound, then cover it with clean (preferably sterile) gauze. Do not try to put the bone back underneath the skin. After this injury has been treated, be alert to any fever, which may indicate that the wound has become infected.
After examining the break, the doctor will order X-rays to determine the extent of the damage. If the doctor suspects that the bone's growth plate is affected, or if the bones are out of line, an orthopedic consultation will be necessary.
Because children's bones heal rapidly and well, a plaster or fiberglass cast, or sometimes just an immobilizing splint, is all that is needed for most minor fractures. For a displaced fracture, an orthopedic surgeon may have to realign the bones. This may be done as a "closed reduction," in which the surgeon uses local or general anesthesia, manipulates the bones until they're straight, and then applies a cast. An "open reduction" is a surgical procedure done in an operating room, but this is rarely necessary for children.
After the surgical reduction, a cast will be used until the bone has healed, which usually takes about half the time that adult bones require, or less, depending on the child's age. Young bones don't have to be in perfect alignment, as long as they are more or less in the right place, they will remodel as they grow. Your pediatrician may order periodic X-rays while the bone is healing to make sure they are aligning properly.
Usually, casting brings rapid relief or at least a decrease in pain. If your child has an increase in pain, numbness, or pale or blue fingers or toes, call your doctor immediately. These are signs that the extremity has swollen and requires more room within the cast. If the cast is not adjusted, the swelling may press on nerves, muscles and blood vessels, which can produce permanent damage. To relieve the pressure, the doctor may split the cast, open a window in it, or replace it with a larger one.
Also, let the doctor know if the cast breaks, becomes very loose, or if the plaster gets wet and soggy. Without a proper, secure fit, the cast will not hold the broken bone in position to mend correctly.
Bones that have been broken often will form a hard knot at the site of the break during the healing process. Especially with a broken collarbone, this may look unsightly, but there is no treatment for this, and the knot will not be permanent. The bone will remodel and resume its normal shape in a few months.