Children are surprisingly tough, but early educators know all too well that a child’s body can be just as fragile as it is strong. In this issue of “Be on the Safe Side,” from the NC Division of Child Development and Early Education, the topic is a relatively common injury experienced by young children–nursemaid’s elbow.
What is nursemaid’s elbow?
Nursemaid’s elbow (also known as radial head subluxation, dislocated elbow, or pulled elbow) is an injury where a child’s elbow becomes partially dislocated. Dislocation means the bones have been pulled out of place. While this sounds quite painful–and it certainly can be for many little ones–it can fortunately be remedied relatively quickly by a health care professional. After successful treatment, the child should feel immediate relief but will be more likely to have another dislocation of the elbow in the future.
What are the causes?
Cases of nursemaid’s elbow are most often seen in children under the age of five. This is because the ligaments–the strong tissues that hold bones together–are still developing and the elbow joints are weaker. Typically, the injury occurs when a child’s lower arm or hand is pulled, especially when the child’s arm is twisted at the time of the tugging. Examples of the most common causes include when a person:
- catches a child by the hand to stop a fall or pull them away from a dangerous situation;
- is holding a child’s hand when the child suddenly steps off a curb or stair step;
- lifts a child up by the hands or wrists;
- pulls a child’s arm too roughly through a jacket sleeve;
- swings a child by the arms or hands; or
- yanks on a child’s arm to make them walk faster.
While this is not a complete list, it provides an idea of how the injury can occur.
How to know if a child is experiencing nursemaid’s elbow
It can be difficult to know if a child is experiencing nursemaid’s elbow. Usually there is no swelling, redness, or bruising to indicate this specific injury; however, there may be swelling or bruising from other injuries sustained in the same incident. Observe the child to see if there are changes in his or her behavior. If a child is experiencing nursemaid’s elbow, the following may be seen:
- the child may verbally indicate the arm/elbow hurts when moving it;
- the child may simply hold the arm close by his or her side; and/or
- the child may refuse to bend or rotate the elbow or use the arm.
If a child is showing any of these behaviors, first find out whether one of the common causes of nursemaid’s elbow occurred. Was there a struggle with putting a jacket or coat on the child? Did the child get picked up or pulled by the arm, wrist, or hand?
If a potential cause for nursemaid’s elbow occurred and any of the above symptoms are present, take the following steps:
- Consult your facility’s Emergency Medical Care plan (10A NCAC 09 .0802 for centers, 10A NCAC 09 .1713 for homes).
- Call the child’s parent or guardian and explain the behavior witnessed (.0802 (a)(2)(C); .1713 (3)) and recommend the child be seen by a health care professional
- Complete an incident report (.0802 (e); .1713 (3)).
- Send a copy to the NC Division of Child Development and Early Education within seven days if medical treatment is required (.0802 (f); .1721 (e)(3)).
- Update your incident log (.0802 (g)(1-6); .1713 (e)(4)).
Links to a sample Incident Report and the mandatory Incident Log are included in the “Reference” section below.
How is nursemaid’s elbow treated?
Do not try to treat or correct nursemaid’s elbow yourself.
Sometimes a child’s elbow will pop back into place on its own, which may relieve the symptoms. In this case, it is still important to inform the child’s parents or guardians by completing an incident report and update the incident log.
If the elbow does not correct itself, a health care professional can correct nursemaid’s elbow by gently moving the child’s arm and “popping” the elbow back in place. This simple fix may be performed as a quick outpatient procedure. Often this will immediately reduce pain and increase movement in the child’s arm. Some children may be hesitant to use the injured arm afterwards. Once a child has experienced nursemaid’s elbow, they are statistically more likely to experience it again. Review a child’s medical history or ask the parent or guardian whether a child has experienced nursemaid’s elbow in the past.
Preventing Nursemaid’s Elbow
Awareness of the most common causes of nursemaid’s elbow (listed above) will help you to handle young children more safely. Be patient with children when putting on their coats this winter; make sure to gently place your hands on either side of their torso near the rib cage when lifting them; and use verbal cues to get a child’s attention instead of pulling them by their arm. Children are tough but often that toughness causes injuries to go unnoticed. Be mindful!
- The North Carolina Child Care Health and Safety Resource Center
- Incident Report Form Sample
- Incident Log
- American Academy of Orthopaedic Surgeons
- National Institutes of Health
- US National Library of Medicine
For more information and assistance: