Understanding and Preventing Nursemaid’s Elbow

Have you heard of a nursemaid’s elbow? It’s just a fancy way of saying 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. Nursemaids Elbow happens when the radius dislocates and causes pain to the child. This typically prevents them from using their arm.

When the head of the radius dislocates out of place, it causes pain, and the child refuses to use their arm. Children ages 0-4 are more likely to get a nursemaid’s elbow because of the laxity of their joints.

What Causes Nursemaid’s Elbow

Your child can dislocate their radius by trying to catch themselves when falling or a quick pulling force on their arm. Most frequently, a child dislocates their radius when they are being picked up by the arms (below the elbow), swung around by their arms, or if the child is holding an adult’s hand and falls (your natural instinct is to pull up to catch their fall).

Is Nursemaid’s Elbow Common?

Unfortunately, Nursemaid’s Elbow is very common in children ages 1-4. There are a few different reasons. First, between these ages, a child’s ligaments are very lax because they are still developing. Kids grow at a fast rate during this period, and their joints need to be able to grow and expand quickly. Lax ligaments are great for growing but not so great for fragile joints like the elbow!

The second reason is that during this age, kids depend on their parents a lot! They need help with getting dressed, being picked up, and holding hands while in a 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 a baby’s hands overhead to practice walking and never picking them up by the hands/arms. The joint is loose and fragile, and it only takes the smallest amount of pressure to cause Nursemaid’s Elbow.

Preventing Nursemaid’s Elbow

Thankfully, there are some ways you can prevent Nursemaid’s Elbow from happening to your little one. This includes:

• NEVER pick your child up by the arms/hands. Always pick them up under the arms/around the trunk of their body.
• 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 their arms/hands when they’re 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!

Symptoms of Nursemaid’s Elbow

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 their arm, won’t use it to pull to stand, and won’t reach with it. They may even hold it close to their body to guard it and avoid it being 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!

Treating Nursemaid’s Elbow

If you think your child has a dislocated elbow, they need to be seen by a medical professional ASAP! It is 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!

What Happens Next

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, which can cause irritation and pain. You can use ice on the elbow if your babe tolerates 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, fearing 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.