Your kid hits the ground and cannot get up. The athletic trainer is at the other field. You are a parent on the sideline, not a doctor. The framework below is what you are looking at while you decide.
This is not medical advice. It is the triage shape that doctors and trainers use, in plain language, so you can make the next call.
The signs that mean ER, now.
Visible deformity. The bone is not where it should be. The ankle, the wrist, the collarbone, the finger has an angle that is wrong. Visible deformity is bone, almost always.
Cannot bear any weight. The kid cannot put any weight on the leg, even with help. Sprains usually allow some weight-bearing, even painful weight-bearing. A complete inability is a flag.
Open wound near a suspected fracture. Bone ends up exposed or skin is broken over the suspected break. Open fracture is a true ER situation because of infection risk.
Numbness, tingling, or color change distal to the injury. The fingers below a wrist injury are numb, gray, or cold. The toes below an ankle injury are not pink. Vascular or nerve compromise. ER, do not wait.
Significant deformity of the joint with no movement. The knee, elbow, or shoulder is locked at a non-natural angle. Possible dislocation. ER.
Head, neck, or back injury where the kid did not move on their own. Spinal precaution. Do not move the kid; call 911.
The signs that lean urgent care or same-day pediatrician.
Swelling and bruising over a specific bone, with point tenderness when you press on it, but the kid can move the joint and bear some weight.
Pain on motion that escalates over an hour, rather than calming down with ice and elevation.
A “pop” felt or heard at the moment of injury, especially in the knee, even if the kid is now walking with a limp.
Persistent pain that interferes with sleep or normal activity 24 hours later.
X-ray decisions for these are made at urgent care or the pediatrician.
The signs that say RICE and re-evaluate.
Swelling and bruising that develops gradually. Pain that improves with ice, rest, elevation, and compression over the first few hours. Range of motion that is limited but present. Ability to bear partial weight.
RICE: Rest, Ice, Compression (elastic wrap, not too tight), Elevation. 20 minutes ice, 20 minutes off, repeat for the first 48 hours. The standard.
If the kid is not noticeably better at 48 hours, escalate to the pediatrician.
Two specific kid-injury patterns worth knowing.
Growth-plate injuries. Pediatric bones have growth plates (physes) that are weaker than the surrounding bone in growing kids. A “sprain” in an adult can be a growth-plate fracture in a 12-year-old. Point tenderness over a bone end (wrist, ankle, knee) in a kid is worth an X-ray even if other signs look mild. AAOS has good lay-language resources on this at orthoinfo.aaos.org.
Buckle (torus) fractures. Common pediatric forearm injury after a fall on outstretched hand. The bone bends rather than breaks all the way through. May not be visibly deformed. Point tenderness on the forearm bones in a kid who fell warrants an X-ray.
What to actually do.
If any of the ER criteria are present, call 911 if movement is risky, or transport directly. Do not splint a possible spinal injury yourself.
If urgent-care criteria are present, splint the joint in the position you find it (do not try to “set” anything), and head to urgent care or the ER. The team’s first-aid kit should have a finger splint and a wrist splint.
If RICE-zone, RICE for 48 hours, watch for escalation, see the pediatrician if not better.
The thing parents miss most: a kid who is hurt but trying to walk it off does not always tell you the truth about pain. Ask specifically. Watch the gait the next morning. A kid still limping the next day is a kid who needs an X-ray.