In the great flurry of childhood activity (don't you wish you had some of their energy?), smashed fingers and toes are common and memorable events. Whether trapped in doors, banged by hammers, or hit by bricks, some nails re-grow beautifully while others are permanently misshapen.

With most of these accidents, swelling and bruising of the soft tissues and underlying bones are the only injuries. Soaking the finger or toe in cold water immediately after the trauma can reduce both pain and swelling. Acetaminophen or ibuprofen administered right away can also help prevent some of the pain. While taking care of these things (and administering a few hugs and kisses for good measure), you can decide whether or not your child needs to see a doctor.

When to see a doctor:

• Blood collects under the nail, causing increasing pain.
• The finger or toe can't be straightened and bent easily.
• The injury causes immediate damage to the nail, such as a visible tear below the "quick".
• The skin is open and may need stitches.
• There is dirt in the wound you can't wash out.

Sometimes blood collects under the nail -- what we call a subungual hematoma. When handled properly, this does not increase or decrease the odds of the nail healing well. If enough blood is trapped to cause painful throbbing, the nail should be evaluated.