Health condition · Clinically reviewed
Paediatric fractures, why children’s bones break differently - and heal so well.
Growth plates, bendy bone and remarkable remodelling mean children’s fractures need a different lens to adult breaks - and, where needed, careful safeguarding thought.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Checked against NICE, RCPCH and peer-reviewed sources you can see at the end.
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Current for 2026
Reflects modern UK guidance on growth plate injury, casting and safeguarding assessment.
Key facts
Paediatric fractures at a glance.
The essentials, in plain English - why children’s bones break the way they do, and how they’re managed in the UK today.
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What it is
A break in a child’s bone - distinct from adult fractures because of open growth plates and more flexible, porous bone.
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Growth plates
The physis is the weakest point in a growing bone - Salter-Harris classification grades the risk to future growth.
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Unique patterns
Greenstick, buckle (torus) and plastic bowing fractures occur only in children because their bone bends rather than snaps.
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X-ray
Essential for every suspected fracture - including dedicated views of the growth plate when a physeal injury is suspected.
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Healing potential
Children remodel bone remarkably well - most simple fractures need only a cast or splint, not surgery.
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Safeguarding
Every injury is checked against the child’s developmental stage and the explanation given - inconsistency must always be explored.
Why this guide matters
A growing skeleton needs its own rulebook.
Children aren’t small adults - their bones break, heal and are assessed differently. The three points below shape everything else on this page.
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Growth plates change everything
The physis is softer than surrounding bone and often the first thing to give way - and the part that most needs protecting.
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Most fractures don’t need surgery
Children’s excellent remodelling potential means a cast or splint is often all that’s required for a full recovery.
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Safeguarding is always considered
Every fracture is checked against the story and the child’s developmental stage - a routine step that protects every child.
How the diagnosis is made
From injury to a clear plan.
The steps a UK emergency department or paediatric team will normally follow, in order - so you know what to expect and why.
Phase 1 · Assessing
History, examination and infant presentation
Phase 2 · Confirming
Imaging, classification and safeguarding
Phase 3 · Next steps
Specialist referral where needed
- 01
Assessing
History and mechanism
How, when and where the injury happened - checked carefully against what the child can physically do at their age.
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Assessing
Look, feel, move examination
Swelling, deformity, tenderness and reluctance to use or bear weight on the limb are the key clinical signs.
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Assessing
Infant presentation
Babies and toddlers can’t describe pain - unexplained crying, refusal to move a limb or non-weight-bearing may be the only clues.
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Confirming
X-ray, including the growth plate
Plain film is essential - views are chosen to show the physis clearly whenever a growth plate injury is possible.
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Confirming
Salter-Harris classification
Growth plate fractures are graded I to V - higher grades carry a greater risk of future growth disturbance.
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Confirming
Safeguarding assessment
Mechanism versus developmental stage is always considered - non-accidental injury must never be missed.
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Next steps
Specialist orthopaedic referral
Growth plate involvement, displacement or a complex fracture pattern warrants a paediatric orthopaedic opinion.
Typical timeline: assessment and X-ray on the day, with a cast fitted or a specialist referral arranged straight away.
Symptoms
What a fracture looks like in a child.
The classic signs across all ages - and the features in infants and toddlers that can be easy to miss.
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Pain at the injury site
Often sudden and worse with movement or pressure - the most consistent symptom across all ages.
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Swelling and bruising
Soft tissue swelling develops quickly around the fracture and can obscure the underlying deformity.
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Visible deformity
An obvious bend, angulation or shortening of the limb suggests a displaced fracture needing urgent assessment.
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Reluctance to bear weight
A limp or refusal to stand on a leg is a classic sign in toddlers, even without an obvious injury history.
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Reluctance to use the limb
A child may hold an arm still, refuse to grip, or stop using a hand they were using normally minutes before.
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Unexplained crying in infants
Pre-verbal children may present only with inconsolable crying, especially when the limb is handled or moved.
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Reduced range of movement
Pain-limited movement at the joint above or below the fracture is common and easy to miss on a brief look.
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Red flag - open wound or numbness
An open fracture, pale or numb fingers/toes, or an absent pulse need emergency care straight away.
Treatment
How paediatric fractures are treated in the UK.
Casting first for most simple breaks, with reduction and surgical fixation reserved for displaced, unstable or growth-plate-threatening injuries.
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Cast immobilisation
The mainstay for most simple, undisplaced fractures - children heal and remodel bone remarkably well without surgery.
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Splint or backslab
Used short-term for swelling control before a full cast, or for stable, minor injuries such as buckle fractures.
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Closed reduction under sedation
Manipulation to realign a displaced fracture, performed under sedation or anaesthesia before casting.
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Surgical fixation
Wires, plates or screws for unstable, open, or growth-plate-threatening fractures that won’t hold in a cast alone.
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Growth plate monitoring
Follow-up X-rays over months to years to check for growth arrest or angular deformity after a physeal fracture.
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Age-appropriate pain relief
Paracetamol and ibuprofen first-line, with stronger analgesia used carefully and briefly where needed.
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Safeguarding assessment
A formal review where the mechanism doesn’t fit the injury or the child’s developmental stage, involving the wider safeguarding team.
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Physiotherapy
Guided return to movement and activity once the cast is off, particularly after joint-adjacent or growth plate fractures.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP, emergency department or paediatric orthopaedic team knows your child’s history and can tell you which parts apply to them. If in doubt, get seen.
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NICE. Fractures (non-complex): assessment and management (NG38) - relevant paediatric principles.
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Royal College of Paediatrics and Child Health (RCPCH). Child protection guidance on fractures.
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British Society for Children’s Orthopaedic Surgery (BSCOS). Guidelines on paediatric fracture management.
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The Royal College of Radiologists. Standards for imaging suspected non-accidental injury.
Red flags
When a fracture needs urgent attention.
Most paediatric fractures are managed calmly and effectively. These are the situations that need immediate or specialist care.
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Open fracture
Bone visible through broken skin is an emergency needing immediate hospital care and antibiotics to prevent infection.
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Absent pulse or pale, cold limb
Signs of compromised blood supply beyond the fracture need urgent orthopaedic and vascular assessment.
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Numbness or loss of sensation
Nerve involvement below the fracture site is a red flag for urgent specialist review.
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Compartment syndrome features
Severe pain out of proportion to the injury, tightness and pain on passive stretch of the limb need emergency assessment.
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Growth plate fracture (high Salter-Harris grade)
Salter-Harris III to V injuries carry a higher risk of growth arrest and need close specialist follow-up.
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Inconsistent mechanism
An explanation that doesn’t match the fracture pattern or the child’s developmental stage must always prompt a safeguarding review.
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Multiple fractures at different stages
Fractures of varying ages on imaging are a recognised marker for non-accidental injury and need a full skeletal survey.
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Non-mobile infant with a fracture
Any fracture in a baby who cannot yet walk or climb is inherently concerning and needs safeguarding assessment.
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Repeated fractures with minimal trauma
Recurrent fractures from low-energy injury may suggest an underlying bone fragility condition and need paediatric review.
Living with it
A treatable injury, with an excellent outlook.
Four things that make the biggest difference while a fracture heals - careful cast care, sensible rest, growth plate follow-up and confidence in a child’s own healing power.
A quiet reminder
Children’s bones are built to heal.
Remodelling means minor angulation often corrects itself over time - patience and the right follow-up matter more than perfection on day one.
- 01 Cast care
Keep the cast clean and dry
Cover it for baths and showers, and check fingers or toes regularly for colour, warmth and movement.
- 02 Activity
Rest the limb as advised
Follow the specific guidance on weight-bearing and activity - too much too soon can disturb healing.
- 03 Follow-up
Attend growth plate reviews
Physeal fractures need follow-up X-rays over time, sometimes for a year or more, to check bone growth stays even.
- 04 Confidence
Most children heal completely
The vast majority of paediatric fractures heal fully with excellent function - remodelling is one of the great strengths of a growing skeleton.
Frequently asked
Everything we get asked about paediatric fractures.
Quick answers on growth plates, casting, safeguarding checks and recovery.
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Why are children’s fractures different from adult fractures?
Children have open growth plates (physes) that are the weakest point in the bone, and their bone is more flexible and porous than an adult’s. This produces unique patterns - greenstick, buckle (torus) and plastic bowing fractures - that don’t occur once the skeleton is mature.
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What is a Salter-Harris fracture?
It’s a classification (grades I to V) for fractures involving the growth plate. Higher grades carry more risk of the growth plate being damaged, which can affect how the bone grows afterwards, so these need specialist paediatric orthopaedic follow-up.
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How can I tell if my child has broken a bone?
Look for pain, swelling, visible deformity, or reluctance to use or bear weight on the limb. In babies and very young children who can’t explain what’s wrong, unexplained crying or refusal to move a limb can be the only signs.
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Will my child need a cast or an operation?
Most simple, undisplaced fractures in children heal very well with just a cast or splint because of their excellent remodelling potential. Surgery is reserved for unstable, open, or growth-plate-threatening fractures, or displaced breaks that need manipulation first.
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Why do doctors ask so many questions about how the injury happened?
Clinicians routinely check that the mechanism of injury is consistent with a child’s developmental stage. This isn’t an accusation - it’s a standard safeguarding step that protects every child, and any inconsistency is always explored further.
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Will the fracture affect my child’s growth?
Most fractures, including many growth plate injuries, heal without any lasting effect on growth. Higher-grade Salter-Harris fractures carry more risk of growth disturbance, which is why these are monitored with follow-up X-rays over time.
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