In general, if the child has taken a fall or twisted ankle and there is substantial deformity noted that I recommend an x-ray urgently. If the swelling occurs rapidly, the child feels something snap or pop, or deformity is seen it may be a fracture. On the other hand, if the child is noting some pain in the joint but they are able to continue walking and/or using the upper extremity without significant limitations then I recommend removing them from sports, elevating the extremity, placing gentle compression and ice to reduce swelling. Typically, low-grade sprains/strains will resolve over course of 7-10 days. The pain is continuing and the child is limping or not using the extremity as you would expect – I then recommend an orthopedic evaluation.