Definition

Injuries to the arm (shoulder to fingers)

Injuries to a bone, muscle, joint or ligament

Excluded: Muscle pain caused by too much exercise or work (overuse). Covered in Arm Pain.

Types of Arm Injuries

Fractures. Fractures are broken bones. A broken collarbone is the most common broken bone in children. It's easy to notice because the collar bone is tender to touch. Also, the child cannot raise the arm upward.

Dislocations. This happens when a bone is pulled out of a joint. A dislocated elbow is the most common type of this injury in kids. It's caused by an adult quickly pulling or lifting a child by the arm. Mainly seen in 1 to 4 year olds. It's also easy to spot. The child will hold his arm as if it were in a sling. He will keep the elbow bent and the palm of the hand down.

Sprains. Sprains are stretches and tears of ligaments.

Strains. Strains are stretches and tears of muscles (such as a pulled muscle).

Muscle Overuse. Muscle pain can occur without an injury. There is no fall or direct blow. Muscle overuse is from hard work or sports (such as a sore shoulder).

Muscle bruise from a direct blow

Bone bruise from a direct blow

Skin Injury. Examples are a cut, scratch, scrape or bruise. All are common with arm injuries.

Pain Scale

Mild: your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.

Moderate: the pain keeps your child from doing some normal activities. It may wake him or her up from sleep.

Severe: the pain is very bad. It keeps your child from doing all normal activities.

When To Call

Call 911 Now

Serious injury with many broken bones

Major bleeding that can't be stopped

Bone is sticking through the skin

You think your child has a life-threatening emergency

Go to ER Now

Can't move the shoulder, elbow or wrist at all

Looks like a broken bone (crooked or deformed)

Looks like a dislocated joint

Large deep cut that will need many stitches

Call Doctor or Seek Care Now

Can't move the shoulder, elbow or wrist normally

Can't open and close the hand normally

Skin is split open or gaping and may need stitches

Cut over knuckle of hand

Age less than 1 year old

Severe pain and not better 2 hours after taking pain medicine

You think your child has a serious injury

You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

Very large bruise or swelling

Pain not better after 3 days

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

Injury limits sports or school work

Dirty cut and no tetanus shot in more than 5 years

Clean cut and no tetanus shot in more than 10 years

Pain lasts more than 2 weeks

You have other questions or concerns

Self Care at Home

Bruised muscle or bone from direct blow

Pain in muscle from minor pulled muscle

Pain around joint from minor stretched ligament

Minor cut or scrape

Care Advice

What You Should Know About Minor Arm Injuries:

During sports, muscles and bones get bruised.

Muscles get stretched.

Here is some care advice that should help.

Pain Medicine:

To help with the pain, give an acetaminophen product (such as Tylenol).

Another choice is an ibuprofen product (such as Advil). Ibuprofen works well for this type of pain.

Use as needed.

Small Cut or Scrape Treatment:

Use direct pressure to stop any bleeding. Do this for 10 minutes or until bleeding stops.

Wash the wound with soap and water for 5 minutes. Try to rinse the cut under running water.

Gently scrub out any dirt with a washcloth.

Use an antibiotic ointment (such as Polysporin). No prescription is needed. Then, cover it with a bandage. Change daily.

Cold Pack for Pain:

For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.

Put it on the sore muscles for 20 minutes.

Repeat 4 times on the first day, then as needed.

Reason: Helps the pain and helps stop any bleeding.

Caution: Avoid frostbite.

Use Heat After 48 Hours:

If pain lasts over 2 days, put heat on the sore muscle.

Use a heat pack, heating pad or warm wet washcloth.

Do this for 10 minutes, then as needed.

Reason: Increase blood flow and improve healing.

Caution: Avoid burns.

Rest the Arm:

Rest the injured arm as much as possible for 48 hours.

What to Expect:

Pain and swelling most often peak on day 2 or 3.

Swelling should be gone by 7 days.

Pain may take 2 weeks to fully go away.

Call Your Doctor If:

Pain becomes severe

Pain is not better after 3 days

Pain lasts more than 2 weeks

You think your child needs to be seen

Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition

Pain in the arm (shoulder to fingers)

Includes shoulder, elbow, wrist and finger joints

Includes minor muscle strains from hard work or sports (overuse)

Pain is not caused by an injury

Causes of Arm Pain

Muscle Overuse (Strained Muscles). Arm pains are often from hard muscle work or sports. Examples are too much throwing or swimming. They are most common in the shoulder. This type of pain can last from hours up to 7 days.

Muscle Cramps. Brief pains that last 1 to 15 minutes are often due to muscle cramps. These occur in the hand after too much writing or typing.

Viral Illness. Mild muscle aches in both arms also occur with many viral illnesses.

Septic Arthritis (Serious). This is a bacterial infection of a joint space. Main symptoms are fever and severe pain with movement of the joint. Range of motion is limited or absent (a "frozen joint").

Pain Scale

Mild: your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.

Moderate: the pain keeps your child from doing some normal activities. It may wake him or her up from sleep.

Severe: the pain is very bad. It keeps your child from doing all normal activities.

When To Call

Call 911 Now

Not moving or too weak to stand

You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

Can't use arm or hand normally

Can't move the shoulder, elbow or wrist normally

Swollen joint

Muscles are weak (loss of strength)

Numbness (loss of feeling) lasts more than 1 hour

Severe pain or cries when arm is touched or moved

Your child looks or acts very sick

You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

Fever is present

Bright red area on skin

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

Cause of arm pain is not clear

Arm pain lasts more than 7 days

Arm pains or muscle cramps are a frequent problem

You have other questions or concerns

Self Care at Home

Caused by overusing the muscles

Cause is clear and harmless. (Examples are a sliver that's removed or a recent shot)

Care Advice

What You Should Know About Mild Arm Pain:

Strained muscles are common after using them too much during sports.

An example is throwing a ball over and over again.

Weekend warriors who are out of shape get the most muscle pains.

Here is some care advice that should help.

Pain Medicine:

To help with the pain, give an acetaminophen product (such as Tylenol).

Another choice is an ibuprofen product (such as Advil).

Use as needed.

Cold Pack for Pain:

For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.

Put it on the sore muscles for 20 minutes.

Repeat 4 times on the first day, then as needed.

Caution: Avoid frostbite.

Use Heat After 48 Hours:

If pain lasts over 2 days, put heat on the sore muscle.

Use a heat pack, heating pad or warm wet washcloth.

Do this for 10 minutes, then as needed.

Reason: Increase blood flow and improve healing.

Caution: Avoid burns.

What to Expect:

A strained muscle hurts for 2 or 3 days.

The pain often peaks on day 2.

After severe overuse, the pain may last a week.

Call Your Doctor If:

Fever or swollen joint occurs

Pain caused by work or sports lasts over 7 days

You think your child needs to be seen

Pain gets worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition

Injuries to fingers

Types of Finger Injuries

Cuts, Scrapes (skinned knuckles) and Bruises. These are the most common injuries.

Jammed Finger. The end of a straightened finger or thumb receives a blow. Most often, this is from a ball. The energy is absorbed by the joint surface and the injury occurs there. This is called traumatic arthritis. For jammed fingers, always check that the fingertip can be fully straightened.

Crushed or Smashed Fingertip. Most often, this is from a car door or a screen door. The end of the finger may get a few cuts or a blood blister. Sometimes, the nail can be damaged. Broken bones are not common with this kind of injury. If they do occur, they are at risk for a bone infection (osteomyelitis).

Fingernail Injury. If the nailbed is cut, it needs sutures to prevent a deformed fingernail.

Subungual Hematoma (Blood Clot under the Nail). Most often caused by a crush injury. This can be from a door crushing the finger. It can also be from a heavy object falling on the nailbed. Many are only mildly painful. Some are severely painful and throbbing. These need the pressure under the nail released. A doctor can put a small hole through the nail. This can relieve the pain and prevent loss of the fingernail.

Dislocations. The finger has been pushed out of its joint.

Fractures. Finger has a broken bone.

Pain Scale

Mild: your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.

Moderate: the pain keeps your child from doing some normal activities. It may wake him or her up from sleep.

Severe: the pain is very bad. It keeps your child from doing all normal activities.

When To Call

Go to ER Now

Bleeding that won't stop after 10 minutes of direct pressure

Looks like a broken bone or dislocated joint

Call Doctor or Seek Care Now

Skin is split open or gaping and may need stitches

Large swelling is present

Blood under a nail is causing more than mild pain

Fingernail is torn off

Base of nail has popped out from under the skin fold

Cut over knuckle of hand

Dirt in the wound is not gone after 15 minutes of scrubbing

Can't open and close the hand or use the fingers normally

Severe pain and not better 2 hours after taking pain medicine

Age less than 1 year old

You think your child has a serious injury

You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

Dirty cut and no tetanus shot in more than 5 years

Clean cut and no tetanus shot in more than 10 years

Pain not better after 3 days

Not using the finger normally after 2 weeks

You have other questions or concerns

Self Care at Home

Minor finger injury

Care Advice

What You Should Know About Finger Injuries:

There are many ways that children can hurt their fingers.

There are also many types of finger injuries.

You can treat minor finger injuries at home.

Here is some care advice that should help.

Pain Medicine:

To help with the pain, give an acetaminophen product (such as Tylenol).

Another choice is an ibuprofen product (such as Advil).

Use as needed.

Bruised/Swollen Finger:

Soak in cold water for 20 minutes.

Repeat as needed.

Small Cuts or Scratches:

For any bleeding, put direct pressure on the wound. Use a gauze pad or clean cloth. Press down firmly on the place that is bleeding for 10 minutes. This is the best way to stop bleeding. Keep using pressure until the bleeding stops.

Wash the wound with soap and water for 5 minutes.

For any dirt in the wound, scrub gently.

For any cuts, use an antibiotic ointment (such as Polysporin). No prescription is needed.

Cover it with a bandage (such as Band-Aid). Change daily.

Jammed Finger:

Caution: Be certain range of motion is normal. Your child should be able to bend and straighten each finger. If movement is limited, your doctor must check for a broken bone.

Soak the hand in cold water for 20 minutes.

If the pain is more than mild, "buddy-tape" it to the next finger.

Smashed or Crushed Fingertip:

Wash the finger with soap and water for 5 minutes.

For any cuts, use an antibiotic ointment (such as Polysporin). No prescription is needed.

Cover it with a bandage (such as Band-Aid).

Torn Nail (from catching it on something):

For a cracked nail without rough edges, leave it alone.

For a large flap of nail that's almost torn through, cut it off. Use a pair of scissors that have been cleaned. Cut along the line of the tear. Reason: Pieces of nail taped in place will catch on objects.

Soak the finger for 20 minutes in cold water for pain relief.

Use an antibiotic ointment (such as Polysporin). No prescription is needed. Then cover with a bandage (such as Band-Aid). Change daily.

After about 7 days, the nailbed should be covered by new skin. It should no longer hurt. A new nail will grow in over 6 to 8 weeks.

Call Your Doctor If:

Pain becomes severe

Pain not better after 3 days

Finger not normal after 2 weeks

You think your child needs to be seen

Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition

Tiny red spots and water blisters on the hands and feet caused by a virus

Rash is seen on the palms, fingers, soles and toes

The diagnosis cannot be made without these

Also can cause small mouth ulcers (sores)

Symptoms of Hand-Foot-and-Mouth Disease (HFMD)

Small red spots and tiny water blisters on the hands and feet. Seen on the palms, fingers, soles and toes.

The diagnosis cannot be made without these.

Small painful ulcers (sores) in the mouth. Look for them on the tongue and sides of mouth. Most children with HFMD have these, but they can be hard to see.

Also, small blisters or red spots on the buttocks (30%)

Low-grade fever less than 102° F (39° C)

Mainly occurs in children age 6 months to 4 years

Cause of HFMD

Coxsackie A-16 virus and other enteroviruses

Not related to any animal disease

Severe Form of HFMD

Since 2012, a severe form of HFMD has occurred in much of the world. It's caused by a new Coxsackie A6 virus.

The rash spreads to the arms, legs and face. The rash is made up of many small blisters.

Children with such a severe rash may need to be seen. Reason: to confirm the diagnosis. Exception: close contact with HFMD within the last 7 days.

Treatment is the same. Drink enough fluids to prevent dehydration.

Peeling of the fingers and toes is common. It looks bad but is harmless. It happens at 1 to 2 weeks. Use a moisturizing cream on the raw skin.

Some fingernails and toenails may fall off. It occurs in 4% of severe cases. It happens at 3 to 6 weeks out. Trim them if they catch on things.

Fingernails grow back by 3 to 6 months and toenails by 9 to 12 months. They will look normal.

When To Call

Go to ER Now

Stiff neck, severe headache or acts confused

Weakness in the arms or legs, such as trouble walking

Call Doctor or Seek Care Now

Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.

Your child looks or acts very sick

You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

Red, swollen and tender gums

Ulcers and sores also on the outer lip

Rash spreads to the arms and legs (severe form of HFMD)

Fever lasts more than 3 days

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

Fingernails or toenails fall off

You have other questions or concerns

Self Care at Home

Hand-foot-mouth disease and no other problems

Care Advice

What You Should Know About HFM Disease:

Most often, hand-foot-and-mouth disease (HFMD) is a harmless rash.

It is caused by a virus called Coxsackie.

Here is some care advice that should help.

Liquid Antacid for Mouth Pain (Age 1 Year and Older):

For mouth pain, use a liquid antacid (such as Mylanta or the store brand). Give 4 times per day as needed. After meals often is a good time.

Age 1 to 6 years. Put a few drops in the mouth. Can also put it on the mouth sores with a cotton swab.

Age over 6 years. Use 1 teaspoon (5 mL) as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it.

Caution: Do not use regular mouth washes, because they sting.

Fluids and Soft Diet:

Try to get your child to drink adequate fluids.

Goal: Keep your child well hydrated.

Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.

Solid Foods. Offer a soft diet. Good ones are mac and cheese, mashed potatoes, cereals with milk and ice cream. Also, avoid foods that need much chewing. Do not give citrus, salty, or spicy foods. Note: Fluid intake is more important than eating any solids.

For babies, you may need to stop the bottle. Give fluids by cup, spoon or syringe instead. Reason: The nipple can increase the pain.

Pain Medicine:

Mouth sores are painful.

Blisters also may be painful, especially on the feet.

To help with the pain, give an acetaminophen product (such as Tylenol).

Another choice is an ibuprofen product (such as Advil).

Use as needed.

Fever Medicine:

For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).

Another choice is an ibuprofen product (such as Advil).

Note: Fevers less than 102° F (39° C) are important for fighting infections.

For all fevers: Keep your child well hydrated. Give lots of cold fluids.

Blisters on the Skin

Blisters don't need any special treatment. You can wash them like normal skin.

Blisters on the palms and soles do not open.

Those on arms and elsewhere sometimes open. The fluid is contagious to other people. Open blisters do not need to be covered. They quickly dry over.

Return to School:

HFMD is easily spread to others.

However, most often, it's a mild and harmless illness.

After contact with HFMD, children come down with symptoms in 3-6 days.

Can return to child care or school after the fever is gone. Most often, this takes 2 to 3 days.

Children with widespread blisters may need to stay home until the blisters dry up. That takes about 7 days.

What to Expect:

Fever lasts 2 or 3 days.

Mouth sores should go away by 7 days.

Rash on the hands and feet lasts 10 days. The rash on the hands and feet may then peel.

Call Your Doctor If:

Signs of dehydration occur

Fever lasts more than 3 days

You think your child needs to be seen

Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition

Weakness means decreased muscle strength.

Paralysis means severe loss of strength. The child can't move a part of the body.

Fatigue means feeling very tired and needing extra rest. Muscle strength is normal.

Symptoms of Weakness (loss of strength)

True weakness always interferes with function. Once a child is walking, weakness is seen more in the legs than the arms. Reason: muscle strength is needed for normal walking.

Leg Weakness. This is what you will see. Examples: trouble standing, walking, climbing stairs, getting off the floor, running and jumping. If severe, the child can't stand or walk.

Arm Weakness. This is what you will see. Examples: trouble feeding one's self, writing/drawing/typing, combing or washing the hair. Other children have trouble lifting objects above the head, turning door knobs or buttoning shirts. If the weakness is severe, the child starts dropping objects.

Face Weakness. Weak face muscles cause droopy eyelids or trouble moving the eyes. A droopy face or crooked smile may also occur. You might notice trouble sucking, swallowing or speaking.

Weakness in Babies. In infants not yet walking, you will see the loss of motor milestones (loss of normal development). These include new trouble turning over, sitting, crawling, and pulling up. In the early months, you will see the loss of head support, reaching or kicking. A weak cry or suck also may be seen.

Causes of New Onset Muscle Weakness

Most causes of new onset muscle weakness are serious. True weakness points to diseases of the spinal cord or its nerves. Nerves carry messages from the spinal cord to the muscles in the arms and legs. Diseases that cause muscle weakness are very rare.

Most children with new onset weakness need special tests to make the right diagnosis. If the weakness gets worse, most children need to be admitted to the hospital.

Specific Causes of New Onset Muscle Weakness

Polio. A severe spinal cord disease that causes paralysis. It is prevented by the polio virus vaccine. Polio is almost wiped out in the entire world. There have been no cases in the US since 1979. Now, it only occurs in 2 countries.

Acute Flaccid Myelitis (AFM). A rare infection of the spinal cord. It acts like polio did. It causes sudden onset of arm or leg weakness in one or more places. The main cause has been an enterovirus. There has been a rise in cases since 2014.

West Nile Virus myelitis. See the Mosquito Bite care guide for details. Also acts like polio did.

Guillain-Barre syndrome. A severe nerve weakness that starts in the feet and moves up the body over several days. It affects the same parts on both sides of the body. It can follow some viral infections.

Tick paralysis. A rare problem from a tick that has been attached for 5 or more days. Often it is hidden in the hair. Once the tick is removed, the weakness clears. It takes a few hours to a day.

Poisoning. Some types of poisoning can cause weakness, often with confusion.

Viral myositis. Muscle pain in the leg muscles is seen with some viral infections, such as influenza. The pain can make some children not want to walk. This is different than weakness. The muscle pain lasts a few days to a week.

When To Call

Call 911 Now

Hard to wake up or to keep awake. Exception: child needs normal sleep.

Awake but can't move

Trouble breathing or slow, weak breathing

Followed a head or neck injury

You think your child has a life-threatening emergency

Go to ER Now

Can't stand or walk

Confused or not alert when awake

Doesn't make eye contact or respond when awake

Crooked smile (weakness of 1 side of the face)

Not able to pass urine

Stiff neck (can't touch chin to chest)

Severe headache

Call Doctor or Seek Care Now

All other children with new onset of weakness

New onset of unsteady walking

Your child looks or acts very sick

You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

Weakness is a chronic problem and getting worse

Fever present more than 3 days with fatigue (tires easily but no weakness)

You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

Weakness is a chronic problem and not getting worse

Fatigue (tires easily but no weakness) lasts more than 2 weeks

Delays in motor development (sitting, crawling, walking)

You have other questions or concerns

Self Care at Home

Normal fatigue during a short-term illness (tires easily and needs more rest, but no true weakness)

Normal fatigue after hard work or sports

Care Advice

What You Should Know About Normal Fatigue (feeling very tired) When Sick:

Children who are sick are often less active.

They become easily tired and need extra rest. They take extra naps and sleep longer hours for many days. As long as your child is alert when awake, extra sleeping is normal.

This is different than the normal fatigue from exercise. Examples are a soccer game, manual labor or a long hike. This type of fatigue does not last long. It responds to a good night's sleep.

Sick children also are less hungry for meals but like to drink fluids. As long as they stay hydrated, this is normal.

Here is some care advice that should help.

Trust Your Child to Choose the Right Activity Level:

When they are awake, most sick kids want to watch TV. Some want to play with their toys. A few may want to play outside. That's also fine.

If they are feeling badly, they may just want to rest. They may prefer to stay in bed or on the sofa for a day or two.

As long as they are alert and able to walk normally, this is normal.

Avoid Trying to Force Bed Rest When Awake:

Most children sleep extra hours when they are sick with any infection. Their body tells them how much sleep they need. Getting enough sleep helps them fight the infection. Let them choose the amount.

Trying to force extra bed rest is not helpful for common childhood illness.

It doesn't reduce symptoms.

It doesn't help the body heal faster.

It doesn't shorten how long the illness lasts.

It doesn't prevent complications.

Bed rest also can't be enforced in children who don't want it.

An old myth was that sick children must stay in bed until their fever is gone. This is not true.

Return to School:

Your child can go back to school after the fever is gone and the fatigue is mild.

Your child should also feel well enough to join in normal activities.

What to Expect:

Being very tired during the first 2 or 3 days of an infection is normal.

Energy is often back to normal within 7 days.

After a major sickness like mono, it may take 2 weeks.

Call Your Doctor If:

Weakness (loss of muscle strength) occurs

Fever lasts more than 3 days

Extra sleepiness lasts more than 1 week

Fatigue (very tired) lasts more than 2 weeks

You think your child needs to be seen

Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.