Nursemaid’s Elbow

Nursemaid's elbow (radial head subluxation) is an injury in which a bone of the elbow joint is pulled out of place and gets stuck in that position. This injury is common in young children. It often happens when you lift or pull the child by one or both arms. The injury commonly occurs when a parent or caregiver is trying to keep the child out of harm’s way. This might be grabbing a child who is about to step out into the street. Sometimes a playmate will tug hard enough on the arm to cause this injury.

This injury happens because the ligaments in the elbow can be weak in some young children. Your child’s healthcare provider can usually fix this fairly easily by gently moving the bone back into place. But the injury can happen again if the arm is pulled again. Ligaments strengthen by 5 or 6 years of age. Nursemaid’s elbow will usually not occur after that.

After the bone is put back into position, it usually takes about 30 to 60 minutes before the child will start using that arm normally again. In some cases, it may take up to 24 hours before the child starts using the arm again. If your child is not using the arm normally by 24 hours, he or she may have other injuries. Your child may need X-rays or other tests to find out what they are.

Home care

Follow these guidelines when caring for your child at home:

  • If all symptoms get better before you leave the facility, your child doesn’t need any more treatment.

  • If your child is still having arm pain, a splint and sling may be put on. Leave this in place until the next scheduled exam, or as advised by your child’s healthcare provider.

  • Use acetaminophen for fussiness or discomfort. In babies older than 6 months of age, you may use ibuprofen instead of acetaminophen.

Prevention

Until your child is at least 5 years old, this injury may occur again with any type of lifting or pulling on the arm. To prevent it from happening again:

  • Don’t lift or pull your child by the arm. Hold your child under the arms to lift.

  • Don’t swing your child by holding his or her hands or arms.

  • Teach siblings and playmates not to tug or pull on your child’s arms.

Follow-up care

Follow up with your child’s healthcare provider, or as advised. If a splint was put on, follow up for a repeat exam within the next 24 hours, or as directed.

When to seek medical advice

Call your child’s healthcare provider right away if any of these occur:

  • Pain gets worse or you child continues to cry

  • Swelling or bruising occurs around the elbow

  • Your child isn’t using the arm normally by the next day

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