Spleen Injuries

The spleen is an easily injured abdominal organ in children. Most spleen injuries happen by motor vehicle crashes, falls, bicycle crashes, contact sports and violence. A spleen injury may also happen from a gunshot wound or knife wound which tears and cuts the organ.

The spleen is located in the upper left area of your abdomen and sits behind and below the stomach.

The spleen's job is to filter and remove old blood cells and bacteria. The spleen also makes red blood cells and is important in helping the body fight infection. 

Most children with spleen injuries have abdominal or belly pain. He / she may also complain left shoulder pain. Your child will be given a physical examination. X-rays, CAT scan (a picture that shows more detail than an X-ray), or blood tests may be done to determine how badly your child's spleen is hurt.

Spleen injuries are rated based on how they look on the CAT scan and are given a grade of injury. Grade 1 injuries are the least severe injuries while Grade 5 injuries are the most severe.

Most spleen injuries do not need surgery. Children with the Grade 1-3 spleen injuries are usually admitted to a general floor unit and children with a Grade 4-5 spleen injury are usually admitted to the ICU (Intensive Care Unit).

Usually, treatment is strict bed rest for about one to five days, but it may be shorter or longer depending on how badly your child is hurt or if they have other injuries. Sometimes the spleen is seriously injured and won't stop bleeding on its own. If surgery is needed, all efforts are made to save the spleen.

Surgery may be a repair to the spleen (splenorrhaphy), removal of part of the spleen (hemisplenectomy), or removal of the whole spleen (splenectomy). The child will have staples or stitches after surgery. He/she may need to be given some extra blood before or after surgery. The child will not be allowed to eat right away and will have an IV (a small tube placed in the vein) to give fluids.

Your child will be closely monitored in the ICU after surgery for a few days to watch for any bleeding, pain, or infection. Your child will then be transferred to the general floor unit as healing continues.

If your child's spleen was so badly damaged that it needed to be taken out, then the protective workings of the spleen were also removed. There are several ways that these can be partially replaced. To help replace the antibody function or job, your child will need new vaccinations about 10-14 days after surgery or before leaving the hospital.
The vaccines include:

  • Pneumovax for pneumococcal infections
  • Vaccine for meningococcal infections
  • Vaccine for haemophilus influenza type B infections 

The pneumovax is repeated every three to five years while the meningococcal vaccine should be given every five years. The haemophilus B vaccine does not need to be given again. Your child may also need to take antibiotics all the time to help the body fight infections. It is important that you tell your doctor or dentist before any procedures that your child's spleen has been removed.

After you leave the hospital, your child will need to be watched for signs of re-bleeding from the spleen. A bleeding spleen causes sudden abdominal or belly pain. Your child may also have:

  • Shortness of breath
  • Dizziness
  • Fast pulse
  • Pale colored skin

You will need to seek medical attention right away if your child has any of these things happen after you leave the hospital. 

Speak to your healthcare provider about medications your child has previously taken. Your child may have some pain or soreness at home. Give acetaminophen (also known as Tylenol) for pain. Your child's doctor may give you a prescription for stronger pain medication. Give the prescription if the pain does not go away one hour after giving acetaminophen. Follow the directions on the bottle.

Do not give your child ibuprofen (also known as Motrin, Advil, Aleve, etc.) until the doctor says that it is OK. Do not give your child aspirin.

Your child may shower or take a tub bath, but may need help for several days after going home. Check with your doctor about taking baths if your child has had surgery. If your child has cuts or scrapes on the skin from other injuries, wash the areas with warm, soapy water and pat dry. If your child has stitches, follow the specific instructions on caring for them. 

After the injury, your child may be tired and irritable. It takes time to heal. Use this time for rest and quiet activities. Tell your child that he or she will feel better soon. Have your child play board games, read, or do small craft projects for short periods of time. It is harder to get infants and toddlers to rest or do quiet activities. Try putting your infant or toddler in a large crib or playpen. Ask family and friends to visit, but only for a short time because your child needs to rest. 

Parents, teachers and other caregivers need to learn the signs and symptoms of infection that include:

  • Fever
  • Shaking chills
  • Cough
  • Aching muscles
  • Headache
  • Vomiting
  • Diarrhea
  • Abdominal pain

You should protect your child from an environment that could easily expose him / her to infection. It is also important to tell the doctor right away if your child develops signs and symptoms of infection. 

It is very important to teach your child about all types of safety. Your child watches you and will do what you do, so you should always use proper safety precautions. Your child should learn to wear a helmet when riding a bike, rollerblading or skate boarding. You should also teach your child to always wear their seatbelt when they are riding in a car. Remember that children 12 years old and younger should always be in age-appropriate restraints in the backseat of the car.

All children with Grade 1-4 spleen injuries will be seen in the trauma clinic two weeks after discharge. Grade 5 injuries are seen in surgery clinic. We will make an appointment for you before leaving the hospital or we will give you a number to call to make an appointment. Usually, no follow-up testing is needed. Once it is OK for your child to return to normal activity, no further follow-up will be needed. After healing has happened, children who have had a spleen injury are not at risk to hurt their spleen again.

Your child may not feel like eating regular foods right away, but it is important that your child eats nutritious foods and drinks as much fluid as he or she did before they were hurt. 

Plan quiet activities for the first several days at home. Your child does not need to stay in bed, but should walk and play quietly. Your child should not play rough with family, friends, or pets. 
Your child will be on strict activity restrictions for several weeks depending on the grade of your child’s injury. He or she should not participate in any activities that involve jumping, climbing, running, bike riding, skating, dance, or gym class during this time. In addition, your child will not be able to participate in any sports such as gymnastics, football, basketball, soccer or track for an additional several weeks.

Your child can go back to day care or school usually one to two weeks after your child is injured. Your nurse / doctor will help you decide when it is time to send your child back to school. If surgery was needed or your child has other injuries, they may be out of school longer. The trauma team will help you with your child returning to school. At school, your child should not take gym class until the doctor says it's OK. Your child should leave class five minutes before the other students, to avoid bumping into other children in the halls. Your child should not carry or lift more than one to two textbooks at a time, even if they are in a book bag or backpack. 

Last Updated 07/2014