Disclosure :: after one of our own team members experienced Nursemaid’s Elbow, we realized as a team that this is a topic that would be of great benefit to our readers. We are thrilled to bring you Marie’s story, as well as useful medical information from our sponsors Children’s Hospital New Orleans. You may never play with your kids the same way again!

The Playful Thing I Did That Sent My Son to The Emergency Room

“One, Two, Three – Weeee!”

“One, Two, Three – Weeee!”

“One, Two, Three – Weeee…need to go to the emergency room.”

Last month, my family and I visited my in-laws in Cape Cod. One day, after a lovely lunch on the harbor, we took my son Ben down to the docks to look at the sailboats. When it was time to leave, Ben wanted to run freely along the docks; however, I knew that my 16-month-old water bug might very well jump off of the dock. Ben fussed when I tried to hold his hand to walk back to the car, so I suggested that my Mother-in-Law and I do what my family and I have done many times before with kids: each hold one of Ben’s hands, count to three, and then swing him in the air. Ben loves this. Well, Ben loved this.

On this day, after the third swing, Ben crumpled into tears. At first, I wasn’t sure whether it was just a tantrum because he wanted to run on his own or if he was just tired (it was past his naptime), but by the time we got home he wasn’t moving his arm and wouldn’t lift it. That’s when I knew that something was definitely wrong.

Worry. Fear. GUILT. These emotions hit me like a Mack truck. On the drive to the hospital, Ben calmly drank milk. His sweet, tear-stained face looked up as me as I cried so hard that I became light-headed. I spend EVERY day trying to protect him from being hurt. I cut his food small so he won’t choke. I guide him on the stairs so he won’t fall. I make sure dangerous objects are out of his reach. But on this day, I was the reason he was in pain. Me. His mama. The person who would catch a grenade for him. Throw my hand on a blade for him. {Please excuse me getting super cheesy by throwing in those Bruno Mars lyrics! I had to make myself groan in order to stop myself from crying thinking about how I felt on that car ride.}

The Diagnosis: Nursemaid’s Elbow

I couldn’t be more satisfied with our emergency room experience. From the start, the staff allayed my fears and guilt. Apparently, they see this type of injury about twice a week. The Physician Assistant asked me a few questions and examined Ben’s arm and wrist. He diagnosed Ben with a radial head dislocation, a.k.a. Nursemaid’s Elbow, a partial dislocation of the elbow joint caused when a ligament slips out of place near the elbow. Then he started gently maneuvering Ben’s arm in different directions to pop the ligament back into place. Ben was given Motrin, and we stayed thirty minutes for observation.

By the time we got home, Ben was feeling much better. He took a two-hour nap. When he woke up, he was moving his arm normally again. The following day, it was like nothing happened. I was still shaken up and couldn’t believe that I hadn’t even heard of such a common injury, so of course I did what many moms do this day and age and dug myself into an internet search wormhole researching Nursemaid’s Elbow.

So What Is Nursemaid’s Elbow?

Nursemaid’s elbow is a common injury in young children. Typically, it occurs when a child is pulled up too hard by the hand or the wrist — for example, when an adult lifts a child by taking hold of one arm. It is especially likely to occur if twisting is part of the movement, such as when lifting the child over a curb or high step. The injury may also result when:

The child tries to break a fall with the arm

The child rolls over the arm in an unusual way

An adult swings a young child from the arms while playing

Once the elbow dislocates, there is a 10% chance that it will happen again, especially within a month after the original injury. Some children have weaker elbow ligaments than others, making them more prone to the injury.

Nursemaid’s elbow (known clinically as radial head dislocation) is less common after age 5. By this age, a child’s joints and the surrounding ligaments are stronger, and the child is less likely to be in the kind of situation that typically leads to this injury. However, it can occur at any age; in older children in adults, it often accompanies a fracture of the forearm.

Symptoms of Nursemaid’s Elbow

The child usually cries right away and refuses to use the arm because of elbow pain. Some children stop crying as the first pain subsides, but they continue to refuse to move the elbow.

The child may move the shoulder but will not move the elbow.

The child will hold the arm slightly bent at the elbow and pressed up against the abdominal area.

Children sometimes report pain in the shoulder or wrist once they stop moving the elbow. So, no matter where the child says the pain is, pay attention if he or she refuses to move the elbow.

There is usually no swelling, deformity, or bruising at the affected elbow. The presence of deformity, bruising, or a lot of swelling may mean that another kind of injury has occurred (bone fracture, for example).

Nursemaid’s Elbow Exams, Tests and Treatment

A child who experiences any of these symptoms needs to be examined by a health care provider. Place ice on the elbow, and take the child to your pediatrician’s office or the Children’s After Hours Clinic or an emergency room. Typically, the provider can make the diagnosis based on how the injury occurred and the manner in which the child holds his or her arm. Only rarely might an x-ray be necessary to make sure there are no broken bones.

Sometimes the radius bone will slip back into place by itself. Even so, it is still a good idea to have the child examined.

The provider will fix the dislocation by gently pressing against the elbow end of the radius while turning the hand to face the palm forward. Then the provider will bend the elbow. A faint pop or click may be heard when the joint goes back into place. Do NOT try this yourself—you may harm the child.

Prognosis for Nursemaid’s Elbow

If nursemaid’s elbow is not treated, the child may be permanently unable to move the elbow. But with prompt treatment, there is usually no lasting damage.

Many children resume using the elbow within minutes of the procedure, although it may take up to 24 hours for the pain to resolve completely and for the child to regain normal use of the elbow.

A few children experience nursemaid’s elbow again and again. In these cases, the doctor may teach the reduction maneuver to a parent or family member. Do not attempt this yourself without such instruction. YouTube is NOT the place to learn this maneuver!

Preventing Nursemaid’s Elbow

To prevent nursemaid’s elbow, parents, caregivers—and rambunctious uncles—should follow these guidelines:

Do NOT lift children by grasping their hands or arms. To safely lift a child, grasp him or her gently under the arms (by the armpits).

Do NOT swing children by the hands or forearms. To swing a child in circles, provide support under the arms, and hold the upper body next to yours.

Do NOT tug or pull on a child’s hands or arms.

“But I’ve done these things a dozen times, and nothing ever happened,” you may be thinking. If so, you’ve been lucky. But don’t press your luck.

Helpful Resources on Nursemaid’s Elbow and Playground Safety

Dr. John Firestone, Jr.

Dr. John Firestone, Jr., is a Board-certified pediatrician and allergist who has been in practice for 28 years in the metro New Orleans area. He now works with Children’s Hospital After Hours, an after-hours pediatrician-staffed facility in Metairie.