Nursemaid’s Elbow

Have you heard of a nursemaid’s elbow? This is a fancy coined term for elbow subluxation or elbow dislocation. The name comes from caregivers (nursemaids) pulling on children’s arms and dislocating the elbow! EEK!

The elbow has two bones in it, the radius and the ulna. In a nursemaid’s elbow, the head of the radius is dislocated out of place and can cause pain and suddenly not wanting to use the arm. Children ages 0-4 are more likely to get a nursemaid’s elbow because of the laxity of their joints.

So HOW does Nursemaid’s Elbow happen?

This happens when a quick force is applied to the elbow joint, causing the radius to dislocate! It can happen from your child falling and trying to catch himself OR a quick pulling force on the arm. Often it happens when a child is picked up by the arms (below the elbow), swung around by the arms or if the child is holding an adult’s hand and falls down (your natural instinct is to pull up to catch their fall).

WHY is nursemaid’s elbow so common?

There are a few reasons. Nursemaids Elbow is most likely to occur between ages 1 and 4: 

  1. Between these ages, a child’s ligaments are very lax because they are still developing. Kids grow at a super fast rate during this period, so they need their joints to be able to grow and expand quickly. Lax ligaments are great for growing, not so great for fragile joints like the elbow!
  2. During this age, think about how much kids depend on an adult: getting dressed, getting picked up, holding hands in the parking lot or crossing the street. The elbow just tends to be in a more compromised position a lot of the time during the age range AND just happens to be in its most fragile state then, too!

It does not take much force at all to cause a nursemaid’s elbow. This is why I suggest never holding babies hands overhead to practice walking and to never pick up by the hands/arms. The joint is just loose and fragile and it can be the smallest amount of pressure that causes it. 

How can you PREVENT nursemaid’s elbow?

  • NEVER pick your child up by the arms/hands. Always pick them up under the arms/around the trunk
  • AVOID swinging or lifting your child by the arms for fun. I know it’s cute, but it is SO not worth it.
  • AVOID pulling or jerking the arms/hands when getting dressed or doing other daily living tasks
  • PAY ATTENTION to your child’s arm position when holding their hands in a parking lot, playground, crossing the street, etc. If they fall while holding your hand, please don’t PULL up on the arm to break their fall. A skinned knee is better than a dislocated elbow!

How will you know if your child has this?

When the dislocation happens there will be almost immediate pain. Depending on your child’s age, they may not be able to verbalize or localize the pain. But, typically, you will see a sudden avoidance of using the arm. Your baby won’t want to crawl on the arm, won’t use it to pull to stand, won’t reach with it. They may even hold it close to their body to guard it and not want it to be touched. There usually is no redness or swelling unless there is also a fracture (less common) with it. So, the most noticeable symptom will be suddenly protecting the arm and not wanting to use it like normal!

What to do if you suspect nursemaid’s elbow?

If you think your child has a dislocated elbow, they need to be seen by a medical professional ASAP! It is actually a pretty quick and easy fix, but the sooner the dislocation can be reduced (or put back in place), the better! Don’t try to straighten the arm or force it in any position yourself. If you have a repeat dislocater (since it can be more frequent once it happens) your medical team might show you how to reduce it on your own, but only do that if you have been given specific instruction, training, and been cleared to do so!

The GOOD NEWS is that once the dislocation is reduced, most of the time the pain subsides pretty quickly and your child will most likely return to full function of the arm soon. Depending on how long it was dislocated there would be some inflammation (swelling) in the joint and that can cause some irritation and pain. You can use ice on the elbow if your babe will tolerate it. Ask your doctor about any pain management that might be appropriate. If your child is older they might be afraid to jump right back into using the arm for fear that it will hurt again. Don’t force anything– just follow your child’s lead and let them go at their own pace!

This is a common question:

Can my child give herself a nursemaid’s elbow by pulling up, climbing on the playground, etc? The answer is VERY unlikely! When your child is ACTIVELY pulling up, doing monkey bars, climbing, etc. the muscles around the elbow are firing and holding the joint stable. Nursemaid’s elbow happens when your child is being held PASSIVELY and then a quick force is applied. There is no muscle activation to support the joint. So, don’t worry about your child doing this to themselves, it is very unlikely.

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