Toddler in lots of pain /won't bear weight on leg

[gomez]

Okay, DS (almost 15 month) injured this afternoon, I didn't see what happened but lots of wailing and when I reached him he was on hands and knees attempting to stand-up. Couldn't - cue hysterical crying etc. Calmed him down, gave some Nurofen and got him to sleep for about 15 mins, lots of whimpering etc. whenever he moved. Woke up, more wailing called GP then took to A & E for x-ray. Hip was x-rayed, inconclusive bring back in a week.

He is fairly okay (but doped on Ibuprofen, was given a bumper dose at A&E) when not moving but can't bear any weight on his leg at all - like he moves and screams.

I am not confident in the Doctor who saw us at A&E - she couldn't explain what could be causing such pain if x-ray clear.

Can anyone here tell me what could be causing him such problems. Also I am not prepared to wait a week if he continues in the same way, so how long would you leave it if he was still in significant pain? Honest it is heartbreaking and he is my third so no PFB here honest? Can I go back to A& E do you think?

Any advise/experience welcome - even to tell me to stop being a silly mare!

I know, I know and hindsight is such a wonderful thing 'cause of course now I knew IYSWIM.
Anyhoo I will kick up a fuss, to make myself feel better if nothing else.

Thanks again.

That is terrible, poor wee thing.

TBH usually my A&E asks for the whole leg hip to foot for such cases and then we ask parents where they think the problem is and start at that end and then work along until we see something (or not), so to have only the hip asked for is rare for a child who cannot verbalise. Often we get a request that says 'cannot examine, please x-ray' as if we have magical powers to make a scared child in pain stay still long enough to get multiple good images. I know they want to keep the radiation dose as low as possible, but you get a gut feeling that things aren't right.

That's interesting Vole3 thanks. Are you a radiographer?

DS has/had no obvious signs of injury and wasn't particularly distressed during physical prod and poke until the Doc started manipulating his hip and which point he hit the roof so I can kinda understand why she focussed on that area initially but when the film came back clear surely it would have made sense to then request further x-rays? Given he still couldn't stand stand on it and was clearly in pain when trying to move....grrrrr.

With that wonderful hindsight thing he was obviously going nuts because she had a firm grip of his lower leg to manipulate the hip so was probably placing pressure on the fracture when doing it.

Excuse my ranting DH is away so I have no one around to bounce things off...

poor boy and poor you too - oh the guilt.
My DD walked around for a week with a fractured arm before i stopped listening to other people and demanded an x-ray.

Just shows an experienced mother knows best! It was clear from your posts yesterday, you knew your ds's leg wasn't right; can't see you going to A&E on a whim.

Glad he's been treated. Hope they apologised for their earlier mistake. Happens a fair bit, I now know, following my mother's undiagnosed hip break.

So glad he got properly dx'd in the end
Meant to say that when dd got a sudden painful limp, she was taken to A+E despite no injury occuring and no issues except for weight bearing being painful
she was xrayed, tested, and was in all day for checks and referrals etc.
Very poor in the first instance I feel for your ds.
Hope the wee fella is ok, sounds very painful bless him, takes a lot to fell an active toddler

Wow gomez - I am but not surprised. Honestly, I know soooooo many people who have similar experiences, including myself for both ds1 and me!

Yep am I a radiographer and have the pleasure of going back to it after maternity leave next week. I'm quite interested to see how my practice has changed since becoming a mum.

Previously if we had an 'xray whole child' type request (unless there was something obviously wrong that needed immediate attention) we would leave them in the play area for a few minutes and observe what they were / weren't able to do to try and gauge where a problem might be. My only worry for the future is that ds will end up waiting a bit longer before going to A&E because I will underestimate what he's done to himself and wait and see if it gets better first.

pals is the patient liaison service. They are there to start the ball rolling in investigating these things, and yes they should have a protocol. Out of interest what level of doctor did you see ? Important to find this out as if a senior doctor then not excusable, if junior then maybe misguided.

Am meeting with the Educational Supervisor (i.e. the Consultant) of the Doc we initially saw on Monday tomorrow. Arranged through Patient Relations and Consultant's Secretary. I am bizarrely quite looking forward to it!

Orthopedic Consultant we saw this AM was super and DS is now sporting a full-length bright green cast and loved the constant attention in M&S earlier today .

I will keep you updated.

Ok, thats good. Just remember don't loose your cool and remember all you really want is:-

1 an appology
2 an explanation
3 a soloution to stop it happeneing to somebody else's lo

Most high profile cases of sueing the nhs would not have gone as far as they did if the complainants had recieved an appology at the start. Not that I am saying you are going to sue them or anything.

Will attempt to retain professional persona a all times. Have discussed in terms of clinical decision making and protocols so far and refrained from offering opinion on the shitty comunication and manners of Doc.
I will however touch on these matters tomorrow.....

Thanks for your advice and I'll let you know outcome.

No intention of suing of course but would like to see at least a degree of humble pie being eaten.

Rather unsatisfying conversation with A&E Consultant which unsurprisingly didn't clarify much. He had apparently not discussed the issues with his junior doctor prior to meeting with me so could only comment in a general sense.

I suggested we reschedule for next week, giving him time in the intervening period to review the case notes and discuss with the relevant people.

He was somewhat taken aback by this suggestion but agreed. His secretary was to call today to schedule meeting for next week - she has not as yet .

I am not going away.....

I haven't read the full thread but a very similar thing happened to us in July - only details different was DS was 13 months, and original x-ray was of hand. Was treated originally for brroken fingers. Turned out he had "broken" (ie greenstick bulge) of his forearm. I had to fight for him to be x-rayed at all. I found out by a senior radiologist calling several days after the original A&E trip. I was pretty disgusted too but in the end just relieved DS was healed. Good on you for fighting it.

I think they got the message today that you are not going away. i have to admit to being an A&E nurse and if that had been a nurse who failed in her duty a full investigation would have happened by now. I think you have to make them realise that mistakes do happen with junior doctors and that re education would be necessary for that dr in order for it not to happen again.

Pretty disgusting that it hasn't been discussed with the jr doctor yet ! I might have got a bit angry at that point. There are protocols for examination and xray of limbs bearing in mind the mechanism of injury etc. Radiographers try not to xray too much, but with little people it is so hard to pinpoint an area of pain. We can do it as adults, but my 21mth old dd has only just started to point to where it hurts.

Stay resoloute and you set the agenda not them.

Spoke with the Senior A&E Consultant today and received a full apology for DS - for the missed diagnosis and delay in responding adequately. Jr Dr has been spoken with and was aplogetic and full of chargin at failing such a young patient. She has been given learning points on the correct application of the protocol, return periods and patient management (i.e. bedside manner).

All in all a good result .

Consultant fully agreed [yeah, right emotion] that always worthwhile raising such concerns!!

Thanks for your input and interest.