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How do you treat smashed fingers?
Q: My 19-month-old recently got his finger smashed in the car door by his older brother (an accident). I put ice on it right away, but now the nail looks as if it might fall off. Should I take him to see a doctor or can I do something from home?
A: Mandy, unfortunately, many young children get their fingers smashed by a door or a hammer at some time. But it usually causes only bruising and swelling of the soft tissues, which can be cared for at home and doesn't require a visit to the doctor. Here are basic steps to take:
  • If there is a wound, wash it thoroughly with soap and water. Apply pressure to the wound with sterile gauze or a clean cloth to stop any bleeding. Use a fine scissors cleaned with rubbing alcohol to trim any dangling bits of skin or nail to prevent catching on things and further tearing. Apply antibiotic ointment and a bandage.
  • To help reduce swelling, apply ice or soak the finger in cold water for 10 to 20 minutes.
  • If your child is experiencing pain, you can give him a dose of acetaminophen or ibuprofen.
  • Keep the finger bandaged and change it every day until it's no longer sensitive.
If the nail bed was badly bruised, there can be some bleeding underneath the nail and darkening of the nail bed. A damaged nail may or may not fall off within days or weeks after the injury—you just have to wait and see. But a new nail almost always grows back, often looking good as new,but sometimes a little different from the original nail. As the new nail grows in from the nail bed, it lifts off the old nail, which falls off or can be trimmed off. Complete regrowth of a new nail usually takes a month or two for an infant or toddler, and up to four months for an older child.

If you see any of the following signs of a more serious injury, consult your doctor:
  • A serious wound in the finger or nail bed: If your child has a deep wound, a wound through the nail bed at the bottom of the nail, debris that cannot be easily cleaned from the wound or a wound that does not stop bleeding after 10 minutes of pressure, the wound may need to be evaluated and treated by the doctor. Wounds need to be cleaned thoroughly, and deep ones may need stitches and antibiotics to heal properly.
  • Lack of normal movement in the joints: If the finger cannot be straightened or bent easily, or your child won't use it after several days, it may be fractured and should be seen by a doctor. It may require X-ray and splinting.
  • Severe pain: If there is bleeding underneath the nail bed, pressure can build up, causing throbbing and significant pain. The doctor should evaluate this and may use an instrument to make a small hole in the nail to relieve the pressure.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician