Growth Plate Injury in Toddlers
Content reviewed against published AAP, NIH guidelines
Last reviewed:
Your baby's physical development is unique, and concerns about growth plate injury in toddlers, here is what you need to know.
The short answer
Growth plates (physes) are areas of developing cartilage near the ends of long bones where bone growth occurs. They are weaker than surrounding bone and ligaments, making them vulnerable to injury in growing children. Growth plate injuries account for 15-30% of all childhood fractures. In toddlers, these injuries typically occur from falls or twisting injuries. Most growth plate fractures heal well with proper treatment and do not affect future growth. However, certain types of growth plate injuries need careful management to prevent growth disturbance.
Key takeaways
- Growth plates (physes) are areas of developing cartilage near the ends of long bones where bone growth occurs. They are weaker than surrounding bone and ligaments, making them vulnerable to injury in growing children. Growth plate injuries account for 15-30% of all childhood fractures. In toddlers, these injuries typically occur from falls or twisting injuries. Most growth plate fractures heal well with proper treatment and do not affect future growth. However, certain types of growth plate injuries need careful management to prevent growth disturbance.
- Usually normal when: Your toddler had a fall and has mild swelling and pain that resolves within 24-48 hours without treatment - minor bumps and bruises are part of active toddlerhood.
- Call your doctor if: Your toddler has obvious deformity of a limb after a fall, cannot move the limb, or has severe swelling near a joint - seek emergency evaluation for possible fracture.
- Varies by age — see the age-by-age breakdown below
“Supervised tummy time is recommended daily from the time the baby comes home from the hospital to help prevent flat head syndrome and to strengthen neck and shoulder muscles.”
Thousands of parents search for this exact thing. You are not alone.
By Age
What to expect by age
0-3 months
Growth plate injuries in very young babies are rare and would typically only occur from significant trauma. If a newborn has swelling, tenderness, or refuses to move a limb, medical evaluation is important. Birth-related fractures (such as clavicle fractures) are more common at this age but typically do not involve growth plates. Any suspected bone injury in a very young baby should be evaluated promptly.
3-6 months
As babies become more active (rolling, reaching), the risk of falls increases slightly. Growth plate injuries remain uncommon at this age. If your baby has unexplained swelling at a joint, refuses to move a limb, or cries when a limb is moved, seek medical evaluation. X-rays can help identify fractures, though growth plate injuries can sometimes be subtle on imaging in young babies.
6-12 months
Babies who are pulling to stand and cruising are at increased risk of falls. A fall from standing height can occasionally result in a growth plate injury, most commonly at the wrist or ankle. Signs include swelling near a joint (not in the middle of a bone), tenderness, inability or refusal to use the limb, and bruising. If the injury is near a joint, request that the doctor specifically assess the growth plate. X-rays may look normal initially in mild growth plate injuries.
12 months+
Toddlers are active, adventurous, and prone to falls from climbing, running, and playground equipment. The most common growth plate injuries in toddlers involve the distal radius (wrist), distal tibia (ankle), and distal fibula. Treatment depends on the Salter-Harris classification of the fracture. Types I and II (the most common) usually heal well with casting. Types III, IV, and V may require surgical treatment and closer follow-up. After healing, your doctor may monitor the affected limb for growth disturbance.
What Should You Do?
When to take action
- Your toddler had a fall and has mild swelling and pain that resolves within 24-48 hours without treatment - minor bumps and bruises are part of active toddlerhood.
- Your toddler had a growth plate fracture that was treated with a cast and has healed with normal follow-up X-rays showing no growth disturbance.
- Your child limps briefly after a minor fall but returns to normal walking within a day - transient limping can be from a bruise or minor strain.
- X-rays after treatment show the growth plate returning to its normal appearance.
- Your toddler has persistent swelling near a joint (wrist, ankle, knee) after a fall, even if they are still using the limb.
- Your toddler is limping or refusing to bear weight for more than a day after an injury.
- A previously treated growth plate injury - ask about growth monitoring at follow-up appointments.
- Your toddler has obvious deformity of a limb after a fall, cannot move the limb, or has severe swelling near a joint - seek emergency evaluation for possible fracture.
- Your child has an open wound near a fracture site, or bone is visible - this is an orthopedic emergency.
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss Growth Plate Injury in Toddlers.
Things to mention
- Your toddler has persistent swelling near a joint (wrist, ankle, knee) after a fall, even if they are still using the limb.
- Your toddler is limping or refusing to bear weight for more than a day after an injury.
- A previously treated growth plate injury - ask about growth monitoring at follow-up appointments.
Observations to share
- Your toddler has persistent swelling near a joint (wrist, ankle, knee) after a fall, even if they are still using the limb.
- Your toddler is limping or refusing to bear weight for more than a day after an injury.
- A previously treated growth plate injury - ask about growth monitoring at follow-up appointments.
Urgent signs to report immediately
- Your toddler has obvious deformity of a limb after a fall, cannot move the limb, or has severe swelling near a joint - seek emergency evaluation for possible fracture.
- Your child has an open wound near a fracture site, or bone is visible - this is an orthopedic emergency.
My notes
From ismybabyalright.com — free, evidence-based baby health guides
Related Resources
Growth Percentile Calculator
Plot your baby's weight, length, and head circumference on WHO/CDC growth charts.
Month-by-Month Development
Detailed monthly development guides from birth through 24 months.
When to Call the Doctor
General guide on when to call the pediatrician, visit urgent care, or go to the ER.
Frequently asked questions
Is growth plate injury in toddlers normal?
When should I call the doctor about growth plate injury in toddlers?
When is growth plate injury in toddlers normal?
What causes growth plate injury in toddlers?
What should I mention to my pediatrician about growth plate injury in toddlers?
Is growth plate injury in toddlers normal at 0-3 months?
Is growth plate injury in toddlers normal at 3-6 months?
Should I go to the ER for growth plate injury in toddlers?
Does growth plate injury in toddlers go away on its own?
References
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Related Resources
Bottom line
Most cases of growth plate injury in toddlers are normal. Talk to your pediatrician if your toddler has obvious deformity of a limb after a fall, cannot move the limb, or has severe swelling near a joint - seek emergency evaluation for possible fracture.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
Was this page helpful?
Related Physical Concerns
Should I Use Adjusted Age for My Preemie's Milestones?
Yes — for premature babies, developmental milestones should be assessed using adjusted (corrected) age, not chronological age, until at least 2 years of age. Adjusted age is calculated by subtracting the number of weeks your baby was born early from their actual age. For example, a 6-month-old born 2 months early would have an adjusted age of 4 months, and should be assessed against 4-month milestones. Most pediatricians use adjusted age for developmental assessment through age 2-3, and for growth charts through age 2.
Baby-Proofing a Small Apartment
Baby-proofing a small apartment is absolutely possible and focuses on the same key safety principles as any home: securing furniture to walls, covering outlets, locking cabinets with hazardous materials, and ensuring safe sleep spaces. Small spaces actually have an advantage - there is less area to monitor. Focus on eliminating the most dangerous hazards first: falls, poisoning, choking, and burns.
My Baby Seems to Use One Side More Than the Other
Babies should use both sides of their body fairly equally during the first 18 months of life. While slight preferences can be normal, a consistent pattern of favoring one side - using one arm much more than the other, crawling with one leg dragging, or turning the head predominantly one way - should always be discussed with your pediatrician. Early identification of asymmetry leads to the best outcomes.
My Baby Only Army Crawls
Army crawling (also called commando crawling) is a completely valid and normal way for babies to move. Many babies army crawl for weeks or even months before transitioning to hands-and-knees crawling, and some skip hands-and-knees crawling entirely. What matters is that your baby is independently mobile and exploring their environment.
One Side of My Baby's Body Moves Differently
Babies should generally use both sides of their body equally. If one side consistently moves differently, is weaker, stiffer, or less coordinated, this warrants evaluation. Asymmetric movement can indicate hemiplegia (cerebral palsy affecting one side), brachial plexus injury, or other neurological conditions that benefit from early therapy.
My Baby Crawls Unevenly
While some variation in crawling patterns is normal, consistently favoring one side or dragging one limb while crawling warrants attention. Babies should use both arms and both legs relatively equally when crawling. Persistent asymmetry could indicate muscle tone differences, hip issues, or neurological concerns that benefit from early evaluation.