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To Ice or Not To Ice

To ice or not to ice? This is an issue I face daily as the school nurse. The little ones get bumped and boo-boo’ed and the first thing everyone thinks is “oh dear, you need ice for that pain!”. But when is it appropriate to give ice for an injury and when is it not appropriate?

First of all, why is ice even used? When you get an acute (new) injury, your body is programmed to start an inflammatory response – your blood vessels dilate (get wider) drawing more blood to the site of the injury to try and heal it. This creates redness, heat, swelling, and often pain. Your body may also create a bruise – some of the tiny blood vessels break from the injury and a little blood leaks out under the surface of the skin and creates that bluish/greenish/purplish bruise (ouch!). The purpose of the ice is to help reduce this inflammatory response. Ice will help reduce swelling, reduce the appearance and pain of bruising. Ice can also slow bleeding a bit by helping the blood vessels shrink down again.

Ice is best used when there is an injury such as a twisted ankle (or other areas) that is swelling, a head injury that includes swelling, or any injury that produces swelling, bruising and pain. Pain alone does not mean ice is needed. Ice is also used for overuse injuries (think baseball pitcher, athletes), also for injuries like back and neck strain or tendonitis type issues (issues that most kids don’t have to deal with).

Ice should be used within the first 48 hours of the injury occurring. It should be applied for 15 to 30 minutes, three times a day. Always wrap ice packs in a towel or cloth of some sort to prevent skin injury from the ice.

All of this being said, brings me back to my original question: should we ice or not? In an elementary school setting the short answer is “probably not”. In general, the minor injuries that happen in elementary do not require ice. Bumped elbows on desks, slaps, thrown pencils, thrown food,  trips, and bumps (why does everyone hit their heads on the bathroom door?) do not require an ice pack and a 15-minute time-out. Yes, sometimes an ice pack makes the “big boo-boo” feel better along with the caring and attention from a grown-up and that’s ok and expected with these little ones who are away from their caregivers during the day.

Big injuries that occur less often such as fights involving closed fist punches, fell while running or playing, heads with visible bumps, twisted ankles or knees, or any kind of injury that produces swelling and/or a bruise all warrant an ice pack and a time-out. Injuries that happened at home or last week that “still hurt” do not require ice. The ice will not serve a purpose in that situation.

 More often though, what I encounter is students who are erroneously instructed that “ice will heal the injury no matter what it is”. The students have a pain for whatever reason and they think that ice will solve it. Sometimes the school nurse (or teacher) can see that the student is upset by the pain and perhaps will be able to get on with their day a little better with the application of some ice, but for a lot of these “injuries” children (and adults too, honestly) need to understand that sometimes we have a pain or a discomfort but it does not need to be addressed because it will go away. Many times I have said to the kids after hearing a complaint that they have a bumped body part “yes it hurts, but it will stop hurting” because that’s what our bodies do. They hurt for a short time but then it goes away.

It’s a difficult balance to decide which is more important for the kids: do they need the attention of seeing the nurse and receiving an ice pack or do they need to learn to tolerate discomforts and move on? The majority of the time, the students need to remain in their class and participate in learning. There is nothing wrong with the expectation that they will move on from minor bumps and boo-boos without intervention.

When all else fails, a little “boo-boo cream” (aloe or body lotion or plain water in the fridge labeled “boo-boo away”) might just do the trick!

Published by Emme Mauer M.Ed., BSN, RN, CSN

Mom to two preemies, anxiety sufferer, postpartum depression survivor, and school nurse extraordinaire.

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