First-Aid Tips for Playground Injuries with Lisa Diard, MD

Podcast Transcript

John Horton:

Hey there, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

Playgrounds are magnetic when it comes to attracting children. Kiddos just can't stay away from those swings and slides and climbing walls. But as fun as playgrounds may be, they're also the source of many boo-boos. Playground injuries send more than 200,000 kids a year to U.S. emergency rooms. That's an average of one visit every two and a half minutes. So, what should you do when a child gets hurt while playing hard? That's what we're going to talk about today with pediatrician Lisa Diard, one of our go-to experts at Cleveland Clinic when it comes to taking care of kids. We're going to cover first aid tips for 12 common playground injuries. It's best we get moving, too. Judging by those injury stats, someone would be needing medical attention any second now.

Dr. Diard, thanks so much for stopping by our podcast playground to talk shop today.

Dr. Lisa Diard:

Thank you, John.

John Horton:

I have to say, the numbers involving playground injuries are pretty staggering. It kind of makes me realize why my household went through so many Band-aids® while the kids were growing up.

Dr. Lisa Diard:

You're right. With active, curious children, the freedom of a playground on a beautiful day presents a lot of bumps, bruises, scrapes.

John Horton:

Well, we took care of more than our fair share of them, so we've got a lot to go over today. So, I'm going to kind of jump right in, and I'm just going to guess, but rub some dirt on it probably won't be one of the recommended methods of treatment. So, let's kind of figure out what we should be doing and let's start with taking care of cuts, which seems like the most basic of playground injuries.

Dr. Lisa Diard:

Yes, I think the first thing to consider is, get the bleeding under control. You want to apply some pressure for about five minutes. When the bleeding has stopped, rinse it well with warm soapy water and really, we want to do that for as long as five minutes, and then, you can cover it with a little bit of antibiotic ointment and a Band-aid or gauze.

John Horton:

What do you do if it's more serious? Obviously, there's those little scrapes that you get, but if it's something that seems like a deep cut or a big one, how do you know when there should be stitches or there's something more going on?

Dr. Lisa Diard:

Well, if you can't stop the bleeding, obviously, we need to seek medical care. If the wound is gaping open, that would be another red flag. Or if the wound is longer than about a half inch, that might need some stitches. Also, if the wound is in a cosmetically sensitive area like the face, that should be taken into consideration as well.

John Horton:

Great advice. We are on our way here. So, let's move on to I guess boo-boo number two, which would be blisters.

Dr. Lisa Diard:

Yes. Well, the key thing with blisters is, do not pop them or pull the skin off. The skin is protection against infection, so we would just want you to rinse the area, wash it gently with warm soapy water. You can again apply some antibiotic ointment, cover with gauze. If the blister pops, it leaves the skin intact. Again, it serves as a Band-aid, a prevention to infection.

John Horton:

All right. Our next one, a split lip, which happens in falls and bumping into things and everything like that. What should you do there?

Dr. Lisa Diard:

Well, often, the mouth bleeds a lot. First of all, don't be alarmed by the amount of blood. What I would probably do first is rinse the area so you can identify the source of the bleeding in the mouth and then apply pressure - and that might need five to 10 minutes of pressure. Then, you can again put a cold pack, maybe not ice, but maybe a cold washcloth on the area to reduce any swelling.

John Horton:

Two things there when you said it. I know you said, "rinse the area," I take it's important not to scrub at it.

Dr. Lisa Diard:

Oh, correct. Sometimes, these wounds are inside the mouth, so it would just be gentle, rinse, so a parent or child can identify where the bleeding is coming from because sometimes, there's so much blood in the mouth, you can't tell where to apply the pressure.

John Horton:

You had also mentioned using a cold pack instead of ice. Why is that?

Dr. Lisa Diard:

Ice can cause burns. We call those chill veins. So, we tend not to want to create burns when we're trying to fix a problem. So even if you have a baggie and you put ice in it, we will want you to wrap that in a towel. So, it's just more of a cold pack but not an ice on the wound.

John Horton:

With all this info, I feel like I'm going to be a paramedic by the time we're done. Let's move on to the childhood injury that everyone thinks of the black eye. I'm guessing you're not going to start with "put a steak on it.";

Dr. Lisa Diard:

No, absolutely not. But again, that is a cold compress, so maybe a cold washcloth will be held on the eye, and you can take it off for 20 minutes, on for 20 minutes several times throughout the day. There are some red flags with black eyes, when we would worry about something more and we would want the parent to seek medical attention - if both eyes became bruised, if the child had a bloody nose with the black eye, if there was any bleeding in the white of the eye or the colored part of the eye, or vision changes or severe pain in the eye.

John Horton:

All good things to go see the doctor for. You had mentioned, "put a cold, wet rag on your eye." Should you avoid using those chemical freezer packs, too?

Dr. Lisa Diard:

Oh, absolutely. The skin around the eye is very sensitive and very thin, and those chemical ice packs can burn.

John Horton:

Oh, wow. You don't even think of all the little things that can happen. You just have these natural items you go grab, and it sounds like there's reason to hold off a little bit. Let's move on to friction burns, which I think all of us got in climbing ropes in gym class or coming down trees. What should you do with that?

Dr. Lisa Diard:

Yeah. Wash them well with some lukewarm soapy water. Again, you can put a little bit of antibiotic ointment and cover them.

John Horton:

Should you ice a friction burn?

Dr. Lisa Diard:

No. Again, ice can make a burn worse. Ice can burn. So, we recommend lukewarm water.

John Horton:

I got to tell you right now, I'm amazed my kids made it through childhood. This is too late for me, but hopefully, it'll help other people.

Now we're going to get to one that I know people are squeamish about and this would be if you're dealing with a broken bone. First of all, how might you know it's broken other than the obvious if something's sticking out?

Dr. Lisa Diard:

Right. So, you're right, the obvious is something sticking out or if you see a distortion of a joint - clearly, that would probably be a break. But also, I think the level of pain. So severe pain, whether the injured area is in motion or at rest. Constant pain. Or if you heard a crack during the injury, that might suggest a break. With a break, you don't want to move the area. You might want to try to splint it, if possible, like a firm piece of cardboard, or gently wrap around the cardboard and the limb and then go to the emergency room.

John Horton:

I take it getting help ASAP is really critical with a broken bone.

Dr. Lisa Diard:

Absolutely, yes.

John Horton:

Is it something where, if you don't get in right away, you run the risk of it not healing quite right or being off?

Dr. Lisa Diard:

Yes. Poor healing, continued pain. There's sometimes, can be an introduction of infection if there's damage to the skin around the bone.

John Horton:

OK. Now let's move on to the cousin of broken bones, which I guess is a sprain - and I always feel like when you had something really bad, it was either a break or a sprain. First of all, how do you tell the difference?

Dr. Lisa Diard:

A sprain is usually around a joint. A person might be in pain when they're moving the area of concern, but at rest, typically not as much pain. Usually, with a break, it's tender over a bone. With a sprain, the tenderness might be around a joint but not over a bone. And sometimes, with a sprain, a child or parent might relate that they heard a pop.

John Horton:

For treatment then, when they come limping in after something happens, what should you immediately do?

Dr. Lisa Diard:

The best thing to do, we use a pneumonic called RICE. That is Rest, Ice, Compression and Elevation. And again, the ice would be wrapped in a cloth because we don't want to put ice right on the skin because again, it can cause burns. And we would do compression maybe with an ACE wrap, but not too tight. I always tell my patients, "You've got to have pink toes and pink fingers, otherwise the wrap is too tight."

John Horton:

It's bad if they go purple.

Dr. Lisa Diard:

Yes, very bad.

John Horton:

All right. The next topic here is head injuries, which I feel like is something that's been talked about more and more as we've learned more about this seriousness of concussions, especially in youth sports and just kids playing in general. What are the signs of trouble that would indicate a child had a concussion?

Dr. Lisa Diard:

Sure. So confused or dazed. So, if the child bumps their head, gets up, starts playing, but then seems confused, dazed, maybe a wobbly gait, complaints of headache or any nausea or vomiting or changing vision, those are some red flags. Also, if the child seems fine, especially for the little ones, if they fall more than 3 feet — so if they're climbing at the playground and they fall more than 3 feet to the ground, regardless of how they're acting, we will want the child to be seen and examined. Any loss of consciousness also is important.

John Horton:

Should you keep somebody awake? I know that was always the thing you heard. If you got hit in the head, you needed to stay up, and if you feel like napping, that was a bad sign.

Dr. Lisa Diard:

No, you don't need to keep the child awake. But if they are sleepy, that's unusual. That would suggest a concussion and you would need to take them to the hospital. But on your way to the hospital, you do not have to keep them awake. In fact, it's been shown that rest is good for concussions and allows the brain to heal.

John Horton:

Great information. Let's go on now to splinters, which, I know, I had more than my fair share of growing up. What tips do you have for removing those?

Dr. Lisa Diard:

Sure. So, if there are small painless splinters in the superficial skin, you can leave those alone because through the natural shedding of the skin, those will work their way out on their own. If they're small but painful little splinters that you commonly see from fiberglass or stinging nettle plants, you can try removing those with masking tape. Just tape the area, lift the tape up, and often, those are pulled right out. But for the deeper, more painful, larger splinters, I would recommend using tweezers. You would just pour some rubbing alcohol on the tweezers. You grab the end of the splinter tight and pull out the splinter. We don't suggest washing the area because the splinter can expand with water and make it more difficult to get out.

John Horton:

What about using a sterilized needle or pin to kind of dig in there a little bit? I remember my parents doing that with me and I did the same thing. Is that a bad thing to do?

Dr. Lisa Diard:

I think, with much caution. So, if feel like this splinter is just under the surface of the skin and you're not going to be digging deep, you can definitely use a little needle to try to pull up the edge so your tweezers can grab it better. Definitely pour some alcohol over that needle. But if you feel like that splinter is pretty deep and you're going to be digging, I will not recommend you attempt that. That's to go to the doctor.

John Horton:

Well, I don't think I would've let them go that deep when I got them. You had mentioned not washing it because it might puff up or things like that. I take it you should put something on it though just to avoid the risk of infection.

Dr. Lisa Diard:

So, I think that after you remove the splinter, definitely wash with warm soapy water and you can put a little bit of antibiotic ointment. But before you remove it, the water will cause the wood to expand and make it more difficult to get out. So, I would suggest you cover it. You can put a little bit of antibiotic ointment on while you're waiting to go see the doctor.

John Horton:

All right. Moving on to a bloody nose. I think we've already talked about how the face bleeds a lot and bloody noses can be pretty intense. What should you do if your kid comes in and it's gushing out?

Dr. Lisa Diard:

So lean forward. Everybody’s, I think, instinct is to lean back, but we want you to lean forward. We want you to pinch both nostrils, hold it tightly for 10 minutes. You can also apply ice to that bridge of the nose, but the key is still pinch the nostrils together and that should work. If the bleeding lasts longer than 15 minutes or it's very profuse rapid bleeding, it's time to go to the hospital.

John Horton:

So why do you lean forward? Like you said, I think everyone's first inclination is you lean back like you figure you want gravity to start helping you not have the blood come out. Why do you want to lean forward?

Dr. Lisa Diard:

If you lean back, blood will drip in the stomach and blood will cause vomiting and then the force of the vomiting can increase the bleeding of the nose.

John Horton:

All right. If a kid comes in with something in their eye, how should you go about treating that?

Dr. Lisa Diard:

Probably the most important thing is rinsing the eye with water. And that can be approached in a couple ways, depending on the age of the child. If it's an older child, they might be able to lay their face in a little tub of water, lay the affected eye in the water, and open the eye underwater. And by opening the eye, the water will naturally rinse the eye. If it's a younger child, I would sit them on my lap, have a pitcher of water, have them lean back and pour the water over the eye and hoping that they'll open and that they'll rinse as well. For maybe something you see in the corner of the eye, you can moisten a Q-tip® and just try to remove it if it's just in the corner of the eye.

John Horton:

And I think the biggest rule is, don't rub.

Dr. Lisa Diard:

Correct. And that can be very hard for a child, but that can cause more damage. So don't rub.

John Horton:

When should you go see an eye doctor if something does get in there and you're worried about it?

Dr. Lisa Diard:

Sure. If you're successful in removing the little bit of material that got in the eye, and I'm kind of thinking of dirt or sand because we're talking about a playground, usually they feel better right away. Within an hour, the eye is less red, less painful, less tearful. So, if two hours goes by and there's no improvement or there's more pain, change in vision, or if clearly there was a sharp foreign object in the eye, that is when you need to seek medical attention.

John Horton:

Well, we have just about run the entire gauntlet here. So, we are on our 12th and last item, which is, if you knock out a tooth, what should you do?

Dr. Lisa Diard:

So, if it is a permanent tooth, we want you to put the tooth back into the socket, you'll hold the tooth opposite the root and you'll just place it right back in and pressing it on your thumb, and then, have the child bite down on it and then go to urgent dental care. If it is a baby tooth or you can't put the permanent tooth back into the socket, we want you to try to put it in some cold milk, maybe fill a little plastic baggie with a little bit of cold milk, put the tooth in there and you can even put the baggie in a little cup of ice and transport that with the child to the dentist. If you do not have milk available, then wrap the tooth in a moist wet rag and transport it.

John Horton:

I take it timing is of the essence if that does happen.

Dr. Lisa Diard:

Correct. Certainly, we would want you to see a dentist as soon as you can and there are often emergency dental services available.

John Horton:

All right. Let me just say, the human body is amazing because I cannot believe a tooth could just pop out and you can literally just stick it back in and it will be fine. Is it really that easy?

Dr. Lisa Diard:

Yes, it is. And often, they are fine, but that's where the dentist's expertise comes in to assess the damage.

John Horton:

All right. Well, we have covered a lot of ground here, Dr. Diard, and I feel like your tips are going to help any of us get through 99 percent of the injuries that could happen on a playground or when the kids are just out running around. Before we part ways, though, is there anything we missed or something else you'd like to add?

Dr. Lisa Diard:

I think we covered a lot. One thing, though, is, just briefly, sunscreen is so important because there are not only blisters from shoes but also blisters from sunburn. So, I recommend good sunscreen. And insect repellent because bees, wasps, ticks — prevention is always best.

John Horton:

Well, it's a little bit extra. It's like a baker's dozen that we gave everybody now, so more than what they asked for. Thank you so much for taking some time out of your schedule to come in today and I look forward to having you back on the podcast.

Dr. Lisa Diard:

Thank you, John, so much. It was good to see you.

John Horton:

Kids get hurt while playing. That's just a fact of childhood. But with these playgrounds first aid tips from Dr. Diard, odds are your little one will be back in action almost before their tears dry. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.