facial fractures in children

[cgcw]

DH & DS3 were goofing around Saturday afternoon in DS8's bedroom. DS3 was on the top of the bunk beds and reached out to grab something from DH's hands. Well, he didn't make it and ended up falling, head first off the top bunk bed. On the way down, he scuffed his face on the ladder. While he didn't look like he needed stiches, he immediately complained about pain, not only in the cheek area but around the eyebrow.

So, off to the ER we went. They x-rayed him and the doctor said he was fine. Just keep some neosporin on the abrasions and he should be fine in a couple of days. He does look like he was in a fight but the swelling has gone down alot. The bruising is setting in though.

Tonight, we not only get a call from the hospital but also from the pediatrician. They said there is a suspicious area in the orbits and now they want to do a cat scan. Neither of the doctors I spoke to were able to tell me what, if anything, would be done if there is in fact a fracture. One of them (the one from the hospital) almost sounded as if there wouldn't be much they would do if in fact there is a fracture someplace.

I'm hesitant to put my son through a cat scan if regardless of the outcome nothing would be done. But, I also suspect that they won't really say that until they know exactly what kind of damage there may be. The hospital doctor told me there are two ways to do the cat scan -- one would be to knock him out and the other would be to strap him down. I know my son well enough to know he would not like to be strapped down and it would be very tramatic for him.

So, what's a mother to do?? Has anyone been through anything similar to this?? Any words of advice?? Thanks for any help!!

Cindy

 

[bsnyder]

I don't know the answers to your questions, but just wanted to tell you I'll be hoping that everything's alright with DS!

 

[dandave]

Poor thing! I hope that everything is alright!

I found the following. It sounds like they may need to make sure that the eye is OK, even if they can't do anything about the fracture.

http://emedicine.com/EMERG/topic202.htm

 

[browneyes]

Cindy, fortunately, I haven't been through this. {{hugs}} to you and your ds. If I was given the choice for my kids to be knocked out or strapped down, I'd definatey go with the knocking out. Is he still in a lot of pain?

 

[Judy from Boise]

The hospital doctor told me there are two ways to do the cat scan -- one would be to knock him out and the other would be to strap him down.

I dissagree that these are the only two options ! A 3 yo with good preperation can understand to hold "very still like a statue" for the amount of time a head ct will take. If you think your child is capable of cooperating, insist that a child specialist do some education and allow him to see the machine etc.

 

[mrsv98]

Well, I wasn't a child, but I did break my cheek bone when I was in my early 20's. I was riding a horse who was stung by a bee and reared, hitting my face with her head (yes, I was wearing my helmet!) My cheek bone was fractured and I had a dent in my face for about 8 weeks. The doc checked it out but really couldn't do anyting about it. What he did check for and what your DS's doc may want to check is to make sure that the muscle around the eye is not trapped by the fracture. As long as everything looks ok, then it is just left to heal on it's own. My fracture was a good 15 years ago and CT scans were not routine as they are now or I am sure I would have had one. I don't remember it being particularly painful, but I was self-concious while it was healing. ~*~*PD~*~* for your DS!

 

[crazymomof4]

I hope I can be a little help. A year ago last month my, then 20 month old, DD tripped on a bathmat and hit her forehead on the leg of a wooden washstand. I picked her up and calmly (I've been through a lot of bumped heads) said to my husband, "Well she's gonna have quite an egg on her head." Just as I said that she went stiff and then lost consciousness. She was out for about a minute (seemed longer), ambulance ride to the ER and ultimately a CAT scan. They wanted to do the scan to check for any slow bleeding in the brain that may not show symptoms until we got home w/ her. Anyhow, they gave us the same choice and I, too, knew she would not lie still enough, so she had to be put under. They have to start an IV and that is tough to watch. Fortunately, we were in a special pediatric section of the ER and the nurses knew all the tricks to help keep her calm and they worked fast. It was scary watching her become unconscious, since that was the reason we were there. They put a tab on her big toe that measures the amount of oxygen in her blood to make sure her breathing is adequate while under anesthesia (not invasive, it can take readings from the surface of the skin but doesn't break the skin = painless) and also a heart monitor. They let me hold her through all of this and even put me in a wheelchair w/ her in my arms to go to the CAT scan area on another floor. I layed her on the scan table (she was totally out) and then watched the proceedure through a glass wall. I never took my eyes off of her and the scan was very brief, maybe a minute or two and it was done. I picked her up and we were wheeled back to the ER where I held her as she regained consciousness. She came to as if she were waking from a deep sleep, groggy, but no adverse reactions from the anesthesia. She just snuggled on me until she was fully alert (about an hour). The scan came back normal and a year later she only has a dimple in her forehead at the point of impact when she raises her eyebrows.
All said, I would say the toughest part was starting the IV. After that you are glad the child is out bc. they would freak out if they were awake for the scan.
Ask your pediatrician if he can recommend a facility for the scan that is very familiar with handling children. Let all involved know that you will NOT leave your child and request that you hold him through as much of it as possible. They may not offer it, so if there is anything you feel you want, tell them and they will probably accomodate you. You know your child and you know what will make both of you feel more comfortable.
I remember my husband and I getting ready to leave the ER, frazzled and emotionally drained. We looked at our Catherine as she happily watched "Sponge Bob" while swinging her legs off of the edge of the bed. We both agreed that she was not even phased and even thought the experience was fun! KIDS!!!!
If you have any more questions post here or PM me.
My best wishes to you and your little guy.

 

[Dan Murphy]

Just a word, Cindy, that I hope all goes well for your little guy, and you too. {{Hugs}}

 

[RNMOM]

Hope this helps. There are a series of small bones that make up the cheek and eye socket. If there is a facture in any of them they can cause the eye to move out of place and cause all kinds of visual and sensory problems. They would also be looking for any damage to the structure of the brain casing and sinuses. There are so many things that can get damaged and thankfully it happens very rarely.

My DS at 3 had a quick sedation for a cat scan also and did very well. Hope all is well and goes smoothly.

 

[Cindy B]

I would do the CAT scan as well.. especially with facial fractures...


There are too many things that can go wrong, especially vision, and other stuff.


Spoken by a mom who has gone through 3 broken limbs, and my son getting hit by a car.

 

[LuvN~Travel]

Depending on the actual problem, if he has a fracture or not, and what kind if he does, there are things that can be done. However, your chief concern now is getting him to lay still for the CT. Kids can be trained to be still while having them. Our daughter has a craniofacial abnormality, and on our support group, several parents have worked with their kids about laying still. Make it a game for him. If he can't, they'll probably give him something orally if he's still small, i.e. 1-4 years, but if he's bigger, they may use anesthesia. If he doesn't have any breathing problems, they may just be able to use a mask to put him under.

Good luck on whatever happens, and big hugs for the little guy.
Kim

 

[dianeschlicht]

I too would rather be safe than sorry later.

 

[cgcw]

Thanks for all of the replies. I'm going to call the pediatrician again this AM to figure out what to do. If it were my older DS, I wouldn't worry so much because I'd at least be able to explain it to him. My DS3 is terrified of the doctor so I know whatever happens, it's probably going to be tramatic.

The one bright spot is that DS8's best friend's Dad is the chief technicial over at the hospital. He happened to be there Saturday when we were and I think just seeing a familiar face calmed my DS down. I'm hoping that I can call him and arrange for him to do the procedure. Maybe if "Dr. Justin's Dad", as my DS3 calls him, is there he would be able to lay very, very still.

Thanks again.