Colin Snow
A broken humerus is a serious injury that can impact a child's sleep. The humerus is the upper arm bone, which forms the shoulder joint with the shoulder blade. This type of fracture is common in children and can be caused by falling onto the arm or shoulder. Treatment typically involves placing the injured arm in a sling to support the weight of the arm and prevent further injury. But does a child need to sleep with a sling for a broken humerus?
| Characteristics | Values |
|---|---|
| Recovery time | 4-8 weeks for the bone to start healing; up to 2 years for a full recovery |
| Sleeping position | Sleeping upright in a chair or with extra pillows is recommended |
| Sling | Should be worn 24 hours a day for the first 4 weeks, except when washing or exercising the arm |
| Dressing | Front button shirts and pull-up trousers with elastic waistbands are recommended; injured arm should be dressed first |
| Exercises | Gentle exercises of the wrist, hand, neck, elbow, and fingers are recommended to prevent stiffness |
| Physiotherapy | May be needed after the fracture has started to heal |
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What You'll Learn
Sleeping upright in a chair or with pillows
A broken humerus can make it difficult for a child to sleep. The pain and swelling that accompany the injury can be challenging to manage, and finding a comfortable sleeping position can be tricky. However, there are some things that can be done to help your child sleep more comfortably. Here are some tips for sleeping upright in a chair or with pillows:
Sleeping in a Chair
If your child is sleeping in a chair, it is recommended to use an armchair or recliner that allows them to sit in an upright position. This can help to reduce swelling and limit the amount of blood pooling at the break. It may be more comfortable for your child to sleep in a chair for the first few nights after the injury. Ensure their feet are supported by a footstool or ottoman.
Sleeping with Pillows
Using pillows is another way to keep your child's injured arm elevated and supported throughout the night. Prop them up in bed using several pillows to create a comfortable and stable position. It is recommended to use pillows on both sides of your child to limit their movement during sleep. Additionally, a memory foam pillow can be placed under the fractured humerus to provide extra support and cushioning. This can help to reduce pressure on the injury and improve comfort.
It is important to create a peaceful and comfortable sleeping environment for your child. This includes maintaining a consistent bedtime routine, keeping the bedroom at a comfortable temperature, and minimising screen time before bed.
Remember, it is crucial to follow your doctor's advice and prescribed medication schedule to manage pain and promote healing.
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Using a sling during sleep
The use of a sling at night for a child with a broken humerus will depend on the type of sling and the specific instructions from the Virtual Fracture Clinic team or doctor. It is important to follow their recommendations for optimal healing.
For some injuries, the sling should be kept on while sleeping. In these cases, it is recommended to sleep on the back with a pillow under the injured arm for support. A semi-sitting position may also be more comfortable. Using plenty of cushions or pillows to prop up the child in bed or sleeping in a reclining armchair can also help.
If the child is allowed to sleep without the sling, it is important to still ensure that the injured arm is supported. This can be done by using a large V-shaped pillow or a "pregnancy pillow" to lie on the side with the injured arm resting on the pillow.
Additionally, sleeping upright in a chair or with extra pillows may be more comfortable for the child during the first few weeks. Front-opening pyjamas or button-up shirts are also recommended for easier dressing.
It is important to keep the injured arm elevated to reduce swelling. Performing gentle exercises with the wrist, hand, and elbow can also help prevent stiffness.
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Managing pain
Medication
Simple over-the-counter painkillers can help reduce swelling and pain. If your child has allergies or conditions that prevent the use of pain-relieving or anti-inflammatory medication, consult a doctor or pharmacist. In more severe cases, opiate-based medication such as codeine can be prescribed, but these may cause drowsiness or dizziness during the day.
Ice Packs
Using ice packs on the injured area can help with pain management and reducing swelling. It is recommended to apply the ice pack for 10-15 minutes every 2-3 hours during the first 72 hours after the injury. Crushed ice, such as frozen peas, is the most effective form of ice pack. Remember to wrap the ice in a damp towel to prevent skin damage.
Sleep Position
Sleeping upright in a chair or with extra pillows can be more comfortable for the first few weeks. Using plenty of cushions to support the weight of the arm and prevent it from pulling down on the shoulder joint is advised. Alternatively, sleeping in a reclining armchair with the feet up on a footstool can also be more comfortable.
Exercises
Gentle exercises can help reduce swelling and pain. This includes bending and straightening the elbow, opening and closing the hand into a fist, and gentle neck stretches, as the sling can put a lot of pressure on the neck. Keeping the elbow, wrist, and fingers moving is important to prevent stiffness.
Sleep Preparation
Preparing for sleep is important for improving sleep quality. This includes turning off screens at least one hour before bed, avoiding exciting or distressing activities or media, and avoiding excessive fluids before bed. Simple stretches, deep breathing exercises, and short meditations can also help unwind the body and clear the mind.
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Exercises to prevent stiffness
- Bending your hand up towards the ceiling and down towards the floor, turning your palm towards the ceiling and then down towards the floor.
- Bending and straightening the elbow.
- Holding a soft ball or rolled-up socks and squeezing as hard as you can, holding for 5 seconds, and repeating 5 times.
Other exercises to prevent stiffness in the neck include:
- Bending your neck, bringing your ear to your shoulder.
- Turning your head to look over your shoulder.
Once the pain is under control, you can start regular pendular exercises. For example, rest your unaffected arm on a table and let the affected arm hang down freely. Try to write each letter of the alphabet using your affected arm.
After 2 weeks, you can start Phase 2 exercises. These include:
- Lying down and using your good arm to help lift the affected arm back as far as you can tolerate within comfort, taking the hand back towards the pillow behind you.
- Doing the same movement but keeping the elbow straight and stretching the arm back behind you.
- Standing with a stick and doing the same movement, this time with the affected arm holding the stick and the good arm helping to stretch.
- Moving the affected arm across the body, using a stick to help move the arm so that the forearm is in line with the body.
After 6 weeks, you can start Phase 3 exercises. These include:
- Lifting the affected arm up and down, forwards, and out to the side.
- Doing a hand-behind-back movement, taking the hand higher up the back.
- Strengthening exercises, such as using one hand to push against the other and vice versa.
In the late stages of recovery, you can start doing more challenging exercises such as wall push-ups and using a theraband to stretch the arm.
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Avoiding certain activities
A broken humerus is a serious injury that requires a lot of rest and recovery time. It is important to avoid certain activities that may hinder the healing process and cause further injury. Here are some guidelines for activities to avoid when a child has a broken humerus:
Avoid high-impact and contact sports
It is recommended that children refrain from participating in high-impact or contact sports for at least four to six weeks after the sling is removed. This includes activities such as football, rugby, or martial arts, where there is a risk of falling or colliding with others. These activities can place additional stress on the injured arm and delay healing.
Refrain from repetitive shoulder movements and heavy lifting
Children should avoid repetitive shoulder movements and lifting objects heavier than a cup of water during the initial recovery phase. While their movement improves and pain reduces, they can gradually increase the weight they lift, but it is important to progress slowly. Returning to an active hobby too soon or lifting something too heavy can overload the soft tissue and delay recovery.
Avoid activities that require full range of motion
Until the child has regained full strength and a full range of motion in their arm, they should refrain from activities that require a full range of motion, such as swimming or throwing a ball. These activities can be reintroduced gradually as the child heals and regains strength and flexibility in their shoulder.
Avoid activities that increase the risk of falling
To prevent further injury, it is important to avoid activities that increase the risk of falling, such as skating, skateboarding, or climbing. A fall could cause additional trauma to the injured arm and delay healing. It is crucial to prioritise the child's safety and allow their humerus to heal properly.
Avoid activities that cause pain or discomfort
It is important to listen to the child's body and avoid any activities that cause pain or discomfort in the injured arm. This may include activities such as carrying heavy objects, playing sports, or doing certain exercises. If an activity causes pain, it is a sign that the child's body is not ready for it, and continuing could hinder their recovery.
It is important to follow the advice of medical professionals and gradually reintroduce activities as the child's healing progresses. Each child's recovery is unique, and a healthcare provider can provide personalised guidance based on the type of fracture and the child's overall health.
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Frequently asked questions
A proximal humerus fracture is a fracture of the upper arm bone, which forms the shoulder joint with the shoulder blade.
Proximal humerus fractures usually take between 4 to 12 weeks to heal. However, a full recovery may take up to two years, and some degree of stiffness is inevitable.
The best way to treat the initial pain and discomfort is to place the injured arm in a 'collar and cuff' foam sling. Simple over-the-counter painkillers will help to reduce swelling and pain.
Your child may find sleeping upright in a chair or with extra pillows more comfortable for the first few weeks.
Your child should wear the sling during the day for three to four weeks. The sling must be worn 24 hours a day, except for when taking the arm out to wash and exercise.
