Toddler's broken leg leads mother to learn the very young quickly forget mishaps

Jacob Kolko was walking again soon after his leg was put in a cast
Jacob Kolko was walking again soon after his leg was put in a cast (Dayna Smith for The Post)
By Lauren Markoe
Special to The Washington Post
Tuesday, May 18, 2010

My baby broke his leg while he was sitting in my lap. When people ask about the powder-blue cast running from Jacob's diaper to his toes, I always mention the lap part right upfront. At first I did this to show that I am not a neglectful parent: My 16-month-old was snuggled in my arms when it happened, not alone on a high ledge.

Jacob and I were swooshing down a playground slide three weeks ago. His foot dropped from my lap and caught on the surface of the slide. As the two of us slid forward, Jacob's foot stayed back. Then he screamed. His tibia had fractured.

Friends, family and random people on the street who want to know what happened to the "poor baby" have kindly assured me that this was a freak accident.

But I blamed me. I had bought him those sneakers with the gripping soles. Shouldn't I have known they could mean disaster on a fast slide? Why hadn't I used one arm to keep his little legs safely on top of mine? My guilt deepened as I watched Jacob, who walked at 10 months, begin to crawl again, dragging his cast behind him.

It was Jacob who snapped me out of my funk.

He did this by quickly reverting to his mobile, mischievous self. The clunky blue cast that drew sighs of "oh, no" from complete strangers didn't seem to register with Jacob at all. Within days of the break, he had resumed his favorite forbidden habit of climbing into the dishwasher. In a few more days, he relearned to walk. Last week, at baby music class, Jacob hobbled across the room to swipe another baby's rattle.

As it got harder and harder to feel sorry for the kid, it began to dawn on me: The very young comprehend misfortunes differently than adults.

What was going on in his happy little head?

I asked Kathleen Ross-Kidder, a developmental psychologist at George Washington University.

My son, it turns out, is ignorantly blissful.

"He doesn't have any cognitive awareness of what's going on," said Ross-Kidder. "You can explore the implications of what's happened to him. He can't. His brain isn't that developed yet."

So I look at his leg and think: No baths, no swimming, and that cast might get itchy if the weather turns hot. Jacob thinks: There's my blankie, and I'm going to go get it.

With my grown-up cognitive powers, I count the days until the cast comes off, and I wish I could make Jacob understand that it's not something he will have to contend with for the rest of his life. But again, Jacob's brain doesn't work that way. "He's a toddler functioning without any sense of the future," said Ross-Kidder. "He lives in the here and now."

I wondered when we grow out of this wonderful ability to live only in the present.

It doesn't last long, said Ross-Kidder.

Somewhere between 2 and 3, children begin to grasp the idea of consequence, and they begin to do some real thinking about serious misfortunes. But they often misperceive. A child who throws a tantrum in the morning and breaks her arm in the afternoon may assume that the former caused the latter. This idea of "imminent justice" lasts until about age 6. Older children, from about 7 to adolescence, react differently, often associating their injuries with death. They are beginning to worry about their own mortality, but their understanding of the concept is not sophisticated, Ross-Kidder said. Any injury can seem life-threatening.

Talking to the psychologist, I almost started to feel lucky about Jacob's breaking his leg so young. It would be far worse if an older, more cognitively developed Jacob felt he was in some way to blame, or feared for his survival.

I sought additional insight into Jacob's easy adjustment from Liz Hollis, the orthopedic technician who put the cast on his leg. Hollis, who works for Kaiser Permanente of the Mid-Atlantic States, started casting in the Army more than 30 years ago. She has treated thousands of adults and children, and all parts of the body. I asked her if she ever saw a young child who didn't adapt well to a cast.

"Never," she said. "Not even in a hip spica."

A spica is a cast that starts below the chest and immobilizes broken hip or thigh bones. Often a small child will be put under general anesthesia for the application of the cast, which can extend to the toes. Children in spicas often manage to walk, though pictures of them will make you wonder how.

As I write this, Jacob will get out of his cast in a week.

Between now and then, and in the years to come, I expect to tell the story of his broken leg many more times, and how he surprised us all by dancing in his cast. But I'll still begin with how it happened -- because, really, who would think a baby could break his leg in his mother's lap?

Markoe is a freelance writer and editor who lives in Washington.

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