Circulation Checks

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Your child has received a treatment that can affect blood flow (circulation) in the injured arm or leg. You will need to check the circulation in your child’s fingers or toes. This is to prevent injury to the nerves and other tissues that could be caused by swelling.

Some pain is normal after an injury or broken bone. The pain should not be worsening, severe or difficult to control. Pain should be manageable with over-the-counter pain relievers, such as ibuprofen or acetaminophen, or prescription pain medicines. Pain that is worsening, severe and not controlled could be a sign of poor circulation. Please call your child’s provider or the bone doctor (orthopedist) if you are concerned.

Do circulation checks 3 or 4 times a day while your child is awake for 7 to 10 days. If your child has new complaints in the injured area, start circulation checks again until checks are normal. Do the checks before breakfast, lunch, dinner and at bedtime. Compare the injured side to the uninjured side.

These are the signs of normal circulation:

  • Color: Pink
  • Swelling: None
  • Sensation: Yes
  • Temperature: Warm
  • Numbness or Tingling: No
  • Motion: Yes
  • Capillary Refill: Rapid (3 seconds or less)

How to check circulation

Symptom What to Look For

Normal: The fingernails or toenails should be pink.

Not normal: A pale or bluish color

How to check: Compare the color of both sides. If the fingers or toes are pale or bluish, encourage your child to wiggle them.


Normal: The fingers or toes should be warm to touch.

Not normal: Cool or cold fingers or toes are not normal.

How to check: Compare the temperature of both sides. If fingers or toes are cold, put a blanket on to cover the fingers or toes and check again in one hour.

Capillary Refill

Normal: Pink within 3 seconds or less. Less than 3 seconds is rapid.

Not normal: If it takes longer than 3 seconds (the time it takes to say capillary refill), the refill is slow.

How to check: With your fingers, squeeze the tip of the finger or toe on the injured side. Or push down on the nail. Where pressure is applied, the area will look white or lighter. Release the pressure and time how long it takes for the color to return.


Normal: There may be some swelling of the injured side, especially in the first 3 to 5 days. Some swelling is all right if it is not associated with severe pain.

Not normal: A large amount of swelling or swelling associated with significant pain.

How to check: Compare the injured side to the uninjured hand or foot. In addition to fullness, look for the absence of wrinkles to indicate swelling.


or Tingling

Normal: Fingers and toes on the uninjured side should feel normal to the child.

Not normal: Numbness or tingling. Numbness or tingling associated with severe pain is very concerning.

How to check: Ask your child if there is any unusual or “funny” feeling in fingers or toes. Ask if fingers or toes feel “asleep” or like “pins and needles.”


Normal: Your child should be able to move all the fingers or toes on the injured side.

Not normal: Being unable to move the fingers and toes on the injured side.

How to check: Ask your child to move the fingers and toes. You may also look at your child’s fingers or toes for movement.


Normal: Some pain is normal. Mild to moderate pain may be normal.

Not normal: Pain that is severe or hurts too much for the child to move fingers or toes. Severe pain when you move your child’s fingers or toes.

How to check: Ask your child to wiggle his or her fingers. Straighten and extend all of the fingers toward the back of your child’s hand or toes toward the top of the foot.

If your child has any results that are not normal, raise the injured arm or leg above the level of the heart. You can prop it up with blankets, firm pillows, cushions or folded blankets. Your child should lie down flat. Then place the injured arm or leg with the cast or splint on the pillows or blankets (fingers higher than the elbow; elbow higher than the heart or toes should be higher than the level of the nose with blankets or cushions behind the calf). Check the circulation again in one hour.

If swelling is present, apply an ice pack to the injured arm or leg. Be sure the ice pack will not leak.

Depending upon your child’s age, it may be hard to detect some symptoms, such as numbness and sensation. In these cases, rely upon results from the other areas you checked.

When to call the provider

Call your child’s provider or the bone doctor (orthopedist) if:

  • The circulation check is not normal and does not improve after 1 to 2 hours with the arm or leg raised.
  • Your child’s pain is getting worse, he or she is unable to move fingers or toes or has no feeling in the injured fingers or toes.
  • Any other concerns that worry you.

Follow up appointment

Call the Orthopedic Clinic or provider listed on your child’s discharge instructions to arrange his or her follow-up appointment. If your child has a follow-up appointment listed already, please keep your scheduled appointment.

If you have any questions, please contact your child’s provider or the bone (orthopedic) doctor, Nationwide Children’s Hospital Orthopedic Center at (614) 722-5175 or Nationwide Children’s Sports Medicine at (614) 355-6000.


 Circulation Checks (PDF)

HH-II-60 10/81, Revised 8/18 | Copyright 1981, Nationwide Children’s Hospital