“I’ve never heard my daughter Elsa scream like that. That’s why I knew she was in real pain.”

Pain The Koskela family living in Oulu, Finland, were spending a Saturday evening with friends in nearby Haukipudas. The adults were chatting indoors, while the children were outside bouncing on a trampoline. Suddenly, the mothers heard a piercing scream through an open window. Katja Koskela rushed out and met her 6 years old daughter Elsa, sobbing at the doorstep.

Elsa’s left knee instantly swelled up, but there were no cuts or wounds on the leg. A cold compress was used as first aid. The emergency department of the private clinic was closed for the day, so they headed to the Oulu region emergency room. They picked up father Keijo Koskela from home on the way to the hospital.

“One parent is usually enough when the children need to see a doctor, but this time it felt like both of us should be there,” Katja explains.

After the accident Elsa could not bend the knee nor put weight on the leg. Luckily, she has since recovered and her knee is better now.

Positive emergency room
experience

The emergency room was just as busy as one would expect on a Saturday night, but a nurse quickly gave Elsa pain medication and a new cold compress. After about half an hour, a doctor examined Elsa’s leg and said that the knee should be x-rayed. Elsa could not bend the knee nor put weight on the leg.

After seeing Elsa’s leg, the x-ray nurse immediately guessed where the accident had taken place. Based on the x-rays, the doctor said that Elsa had sprained her knee.

“Similar strain on an adult bone would have broken it, but a child sustained a lesser injury. It was a fright nonetheless, because it seemed that Elsa simply would not calm down,” Katja says.

Demanding
patients

Professor Matti Uhari from the Department of Paediatrics and Adolescence, University of Oulu, says that Katja Koskela’s story sounds familiar. Treating a child who is in pain is demanding even for an experienced professional.

“It is difficult to assess the seriousness of a child’s injury based on pain, because children have a different threshold of pain than adults. However, we must ask the child directly, because pain is a symptom whose intensity can only be assessed by the patient. ”

The parents’ assessment of their child’s pain is an important aid during the medical examination. According to professor Uhari, it is also important to keep a close eye on the child’s reactions during the examination because they may be caused by fear as well as pain.

“Abating children’s fear is something we paediatricians do every day.”
But he points out that medication must not be forgotten:

“Medication may have an important effect on the final result of the treatment, as well as on the child’s attitude towards visiting a doctor in the future. The quality of treatment is not good if the injury-related pain is not alleviated at least partially. But it is important to keep in mind that even with the methods of modern medical science, we cannot make the patient 100% pain free.”

“I’ll never jump on
the trampoline again!”

Elsa was prescribed painkillers, and she was advised to rest and move as much as was comfortable. A little over a week after the accident, Elsa visited an orthopaedist because walking was difficult.

After four weeks of knee exercises, Elsa, the youngest Koskela family member, was getting restless. The summer holiday of the family was approaching, and walking up or down the stairs was still difficult for her, and cycling was completely out of the question.

The accident was a scare to Elsa. Playing with her favourite doll has helped her process it.

“I’ll never jump on the trampoline again!” Elsa declared immediately after the accident. Later in the summer she did, however, jump on her cousins’ trampoline, albeit only alone and at her own pace. She also insisted that her father was to be watching by the trampoline at all times. Gradually, she also became more confident and jumped a bit more.
 
Looking back at the accident, Katja Koskela regrets that there were so many children on the trampoline at the same time, and of different ages and weights.

“We have tightened the rules regarding the use of trampoline since.”
Elsa started preschool this autumn. She is still a bit hesitant to jump on a trampoline and does not wish to have one on her own yard.

Text Titta Vilppa | Photos Kai Tirkkonen