Bad Ankle Pain in a Four Year Old?

No you don't go to the ER with a sprained ankle. It's awfully hard to see our kids in pain, but really, she ran around on it so it's not broken. You did the right thing with pain relief and peas, and I think probably it was made worse with the hot bath and the running around in the park. The key to sprains and similar injuries is RICE - Rest, Ice, Compression, Elevation. This is what the ER would tell you. So an ace bandage or ankle brace would be good (from the regular pharmacy - ask the pharmacist if you need help), as would keeping her foot elevated to reduce the swelling. Pain relievers are fine if there is no question of bleeding.

I'd see how she is in the morning, and make a decision about school then. She may need to stay off it for a day. If it's really not doing well or there's excessive swelling, call the pediatrician and ask if she should be seen for an X-ray. But again, this is not an ER situation. Hard as it is to believe, even a broken bone isn't a dire emergency other than the discomfort angle. And I'm guessing nothing is broken if she ran around for two hours.

RICE.

At some point, if she needs to be seen, I'd take care of that and then report it back to the school just because the injury took place on school property. They'll record it, and probably their insurance policy will cover your out of pocket expenses (copay, etc.).

Sorry to say that childhood is full of injuries, and you just need some experience in learning to figure out what's worthy of a visit and what's a "deal with it at home" problem.

If it's still hurting and has any swelling in the morning I would take her in. I understand the mom instinct to take her to the ER. But I don't think waiting till the morning to see is bad. Good luck and hope it feels better soon!

If she is swollen and bruised in the morning I would take her for an X-ray. The pediatrician won't be able to tell if it is broken without an X-ray anyway. If it is still sore but it is not swollen or bruised and she can walk okay, I personally would give it a few days. I think it is unlikely something is broken since she was able to play for hours afterwards without an issue. It could be just a pulled muscle which can be pretty painful.

Edit - remember going to the ER is not without risk too. My nephew is asthmatic and did in fact breat a bone last weekend. The nurse's line said there are a lot of sick kids at the ER and not to expose him unnecessarily. She ended up taking him to a place that just does X-rays on Monday morning. They then referred her to an orthopaedic since it was broken.

Call the pediatrician. They may want her to go do an X-ray just to be sure. They may not even want to see her but just have the radiologist look at the pictures. If it's broken they'll go from there. If it's not there isn't anything else they can do except stay off it and use ice and/or heat.

I broke my arm in elementary school, it hurt immediately, but I still went to school for 2 more days before the school nurse called my mom and said she thought I had a broken arm. I can remember not using it and catching a kick ball with my other arm. The X-ray taken days later showed the break quite clearly.

Please update us since this was posted yesterday-- did you take her for an X-ray? I hope you did. Better to get one, and be told she's OK, than to not get one and find out later than there was damage that could have been found and treated earlier.

By the way, pain is not always about fractures. She could have pulled a muscle or tendon or have tissue damage. Those don't show on an X-ray but the pain is real if they're injured. It doesn't sound very likely, from what you described last night. But it's helpful as parents to remember that there are other things that can be issues, not just broken bones.

Unless it is so much worse in am, I would wait a few days.

Last year my daughter came out of dance one Tuesday complaining her foot hurt. We iced it and gave her Motrin (my husband is NOT a doctor, but worked in the medical field in the Navy for 20 years and knows enough). She was walking fine and would only complain sometimes. The next night she was running and playing at the park, but complained occassionally.

Thursday we took her to the doctor and guess what, she had an avulsion fracture. She ended up in a boot for 3 months, painful for her as a dancer and 10 year old at the time.

Please take your kid to the doctor...I hope you did go.

I would do it now. It may be a bad sprain or a hairline fracture. If there is any Urgent Care in your area, that might be more timely than the ER.

Kids will absolutely run around on fractures. If it still hurts in the morning, take her to the doctor? Worst case - they say it is bruised and send you home. So what have you lost?