Have you ever swung your little ones by the arms, dragged them across the playground by the arm while running with them, or watched as they played happily on the monkey bars in the park? As innocent as these fun things we do with our kids are, they may result in a very painful condition known as nursemaid elbow in toddlers.
Exactly What is Nursemaid’s Elbow?
Nursemaid elbow is a bone injury caused by the dislocation of the toddler’s bone in the arm/s. The medical term for the injury is “radial head subluxation.”
Not much force is needed to pull young children’s elbows out of place because they have not fully developed yet. Nursemaid elbow happens very frequently in children between one to four years of age. However, it can still occur any time from birth until the child is six or seven years old.
Although the injury may be painful at first, a healthcare professional or paedatrician can easily “fix” the dislocation. Resetting the elbow to its default position quickly relieves any discomfort and restores arm movement. However, if left neglected, persistent nursemaid’s elbow can cause permanent functional disability of the elbow.
How Does Nursemaid Elbow in Toddlers Happen?
Suddenly pulling a child’s outstretched arm causes nursemaid’s elbow. You may hear or feel a “pop” from the joint. The child may cry or feel pain, but the discomfort fades away quickly.
Most of the time, the injury happens when parents swing their toddlers around using their arms. Pulling children using one arm, and even pulling on a toddler’s arms to prevent them from falling can cause nursemaid elbow in toddler.
It is commonly also known as “pulled elbow” because it occurs when a child’s elbow is pulled and partially dislocates.
Parents should avoid spinning their children as they could risk causing nursemaid elbow injury to their kids.
Other situations which can cause this injury include falling onto the elbow, falling to an outstretched arm or twisting the forearm. A child younger than six months old can also suffer nursemaid elbow when they roll over in bed onto their arm.
Caregivers may describe that before there were symptoms, the child’s wrist was pulled upwards, or that he or she was swung around by the arms. However, caregivers might be unaware that the incident could have caused the injury and may report no known trauma.
Signs and Symptoms of Nursemaid Elbow in Toddlers
There may be some observable symptoms due to the fact that the dislocated muscles causes discomfort and pain.
These include the child:
- holding the fully extended arm very closely to his or her side, or on their lap, without moving it
- refusing to bend the elbow or move the arm
- becoming upset if parents try to touch the arm
- being unable to move their elbow
- protecting the affected arm with the other hand
Other physical symptoms that may lead to a diagnosis of nursemaid elbow are:
- having no pain unless the arm is moved
- tenderness at the radial head, an area near the elbow
Note that nursemaid’s elbow does not cause any of the following symptoms:
- skin redness
- discolouration of the skin (e.g. blue skin from bruising) from physical trauma
- swelling
Even though nursemaid’s elbow is painful, it does NOT cause bruising!
Nursemaid elbow in toddlers can spontaneously reduce or disappear before visiting a doctor.
Parents, perhaps you might be worried that your child’s symptoms miraculously disappearing is too good to be true. But your doctor will be able to provide a better explanation and assure you about your child’s condition after doing a proper physical exam (which is all that is required).
How to Manage Nursemaid’s Elbow in Toddlers
A cool, moist towel or a small bag of ice wrapped in a towel may help to relieve the pain. Where necessary, you can also give an approved painkiller like Panadol.
The most important thing to do though, is to bring your child to the doctor immediately if an injury does occur. Bring your children to the nearest emergency department if he or she seems to be in excruciating pain or if you suspect a fracture.
Note that you should not try to fix the injury by putting the displaced bone back in its place without the advice of a medical professional. Even if the bone recovers to its default position without any external physical force by you or the child, do visit the doctor anyway.
The first point of action is to consult a medical professional for advice.
How Do Doctors Diagnose Nursemaid Elbow in Toddlers?
When you enter the doctor’s office, expect him or her to perform a physical examination of your child’s arm. The doctor will search for places where the arm feels tender. X-rays are not needed unless your doctor suspects another injury.
What Are the Red Flags?
Nursemaid elbow usually does not come with a great deal of pain. Children may feel sharp pain when the injury happens, but the pain or discomfort does not persist when they visit the doctor.
However, symptoms such as excruciating pain, swelling, bone deformity, or any cut in the skin could signal a fracture (a broken bone). An X-ray is needed to assess a fracture as it is more serious. If the doctor is unable to “fix” the joint and the X-ray results show no abnormalities, then children might need an elbow splint and further follow-up with an orthopedic specialist.
Treatment Options for Nursemaid’s Elbow in Singapore
Doctors treat nursemaid’s elbow in toddlers by a special technique called a “reduction.” This is done by rotating and flexing the arm with the elbow held by the examiner.
Reducing the arm is often performed in a few seconds and without requiring anaesthesia. Although short, the process can cause pain as the ligaments reduce to its proper position. The pain should resolve after the elbow has been reduced, even though the child will likely be upset.
Parents are to hold the child in their arms while the doctor faces the child to minimize trauma and increase comfort for the patient.
Toddlers should feel the pain disappear immediately and feel or hear a distinctive “click” sound if the doctor is successful. Even though it may be cause some discomfort, most children will start using their arm within five to 10 minutes. By 30 minutes 90% of children will have no symptoms. It may take a few minutes for the children to realise that it is no longer painful to move the arm.
Note that a successful reduction does not require splinting or an arm sling.
What If My Toddler Still Can’t Use His Arm?
If toddlers are still unable to move their arm, or if issues still persist after the reduction, parents should consider imaging studies to check if a fracture has happened. A consultation with an orthopedic specialist is also a good option.
In the case that the toddler still refuses to use the arm post-reduction despite normal findings from imaging studies, the doctor may recommend putting a sling around the arm. In addition, the doctor might also consider a follow-up consultation with an orthopedic surgeon.
How Can Parents Prevent Nursemaid Elbow in Toddlers?
There are many ways to avoid physical injuries that cause nursemaid’s elbow. Here are some tips that parents and caregivers should note when caring for children below seven years of age:
- To safely lift a child, grasp gently under their armpits and pull them upwards. Do not lift children by pulling or holding their hands or arms.
The right way to hold a toddler!
- Although children like being swung around, their muscles and bones are still developing and you could risk injuring them. To prevent nursemaid elbow in toddlers, don’t swing a child by their hands or arms.
- Avoid tugging, lifting, jerking or pulling on a child’s hands, wrists, arms or forearms.
- Do not pull them back to yourself if a child pulls you in one direction
- Monitor children in the playground. Sometimes children can play with the monkey bars. In this case, parents should advise them to not overexert themselves, or not allow them to play until they are older.
References: JAMA, Nursemaid’s Elbow Journal, NCBI, OrthoInfo, Hamilton First Aid, Boston’s Children Hospital, emedicinehealth, Kelsey-Seybold Clinic, Singapore Sports and Orthopaedic Clinic
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