How To First Aid Nursemaid’s Elbow Occurring In Children

Nursemaid's Elbow

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What Is Nursemaid’s Elbow In Children

What is Nursemaid’s Elbow? Every child has squealed with delight and begged for more when you swing them around by the arms. But did you know that this ancestral rite of passage can result in causing one of the most common injuries in young children called Nursemaid’s elbow?

As anyone who has suffered any elbow pain will know, it is quite painful for your little one to endure and can impact their range of motion. It also may have broader impacts on their willingness to undertake activities they normally love in a bid to prevent suffering unwanted pain by using the affected limb.

What Does It Mean To Have Nursemaid’s Elbow

Nursemaid’s elbow means the elbow has slipped out of its normal position and alignment at the elbow joint.

The elbow bone (radius) is connected to the elbow joint (humerus) by elastic-like bands of stretchy fibre called ligaments. These ligaments grow stronger and tighter as a child grows older. In children and babies, the ligaments are still loose. This makes it easy for the elbow to slip out of alignment within the joint and go unnoticed by the parent without an X-ray to see what has taken place.

It is a common condition in children younger than four years of age. It is also called pulled elbow, slipped elbow, or toddler’s elbow. The medical term for Nursemaid’s elbow is radial head subluxation.

Why Do Young Children Get Nursemaid’s Elbow

Nursemaid’s elbow is a common injury among toddlers and pre-schoolers’. The injury is not often seen in kids older than six years. As children grow, their bones harden, and the ligaments get tighter and thicker. This helps keep the elbow firmly in place.

Statistically, girls are slightly more likely than boys to suffer from Nursemaid’s elbow.

What Causes Elbow Injuries

Nursemaid’s elbow often happens when you tug or pull on a child’s lower arm or hand, especially if the arm is twisted. It doesn’t take much force for the injury to occur. The most common cause of Nursemaid’s elbow is a pulling-type injury that results from swinging the child between two adults. Something every parent has done more than once over a puddle or just because it is fun and the child loves the sensation of being weightless and flying.

Nursemaid’s elbow may occur if you:

  • Catch a child by the hand to stop a fall
  • Lift a child by the hands or wrists
  • Pull a child’s arm through a jacket sleeve
  • Swing a child by the arms or hands
  • Yank on a child’s arm to make them walk faster or stop suddenly.
  • An infant rolls over onto the arm
  • A child uses their hands to brace themselves during a fall

What Are the Symptoms of Nursemaid’s Elbow

The main symptom of a pulled elbow is pain when the child moves the arm. Nursemaid’s elbow can be quite painful, no different to ‘tennis elbow’ in adults. There is, though, no swelling, bruising, or other sign of a serious injury, and that means the condition can go unnoticed for some time in some cases.

The child may show signs of the condition in the following manner:

  • Cry when the arm is moved or touched
  • Complain that the elbow hurts
  • Hold the arm close to their side or support it with the other arm
  • Avoid using the arm where possible

You should not try to straighten the arm or move the elbow back into place. If you do, the child will resist, and you could cause more serious damage and will cause them pain.

Severe pain, even without swelling, can signify a broken bone. Call your doctor if your child injures their elbow and have an X-ray taken to see what is happening under the skin.

Is Nursemaid’s Elbow An Emergency

No. Nursemaid’s elbow is not an emergency. Treatment depends on your child’s age, the cause of the injury, and overall health. The doctor will examine the child and ensure the bone is not broken. X-rays are necessary to diagnose the extent of a fracture or dislocation correctly.

To control pain, over-the-counter pain medicine, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), may be given. Make sure you read the instructions and give the correct dose for your child’s age and weight. Never give aspirin to a child under age 12.

The doctor will use a “reduction manoeuvre” method to put the elbow back into the correct position. This method is also called a “reduction.” Any dislocated joint receives a reduction to realign the position correctly. Reductions are usually down under a mild and temporary sedative to knock out or relax the patient but are not always necessary or wanted.

In this method, the doctor holds the child’s wrist and elbow. The doctor then carefully moves the arm in a specific way until the elbow pops back into place. You may hear a “click” when this happens. A reduction manoeuvre only takes a few seconds. It may be done in the doctor’s office. The procedure can be briefly painful. The child will probably cry for a few seconds.

Most patients can use the arm without pain within 10 to 15 minutes of undergoing the reduction procedure. Some children may initially avoid using the arm because they remember the pain. If this happens, your doctor may recommend pain medication and observation for the next hour to ensure the child moves the arm freely and without further pain.

X-rays are usually not needed for dislocations. X-ray results are normal in someone with Nursemaid’s elbow. But X-rays may be taken if the child does not move the arm after a reduction or if there is any suspicion the elbow has suffered a fracture.

Sometimes, the first attempt at a reduction does not work. It may take two or more times to put the elbow back into the correct position. Surgery is rarely needed. If your doctor can’t put the elbow bone back into place, they’ll call an orthopaedic specialist.

Nursemaid’s elbow may sometimes be the result of, and an indicator for, child abuse. A child abuse investigation may be conducted if there are other signs that the child is being abused or if it occurs in a child older than six years. Repeat cases will require further investigation to identify and exclude child abuse or other medical conditions that might predispose the child to having weak ligaments and joints.

Can You Prevent Nursemaid’s Elbow In Children

Yes. As your child grows, their ligaments will strengthen. It becomes less likely that pulling a child’s arms will cause a nursemaid’s elbow. Until then, you may be able to prevent Nursemaid’s elbow if you:

  • Do not lift a child up by the arms or hands. Lift the child under the arms instead.
  • Do not tug or jerk a child’s hand or arm.
  • Never swing a child by the hands or arms.
  • Kids who have had Nursemaid’s elbow once are statistically more likely to get it again in the future. 
  • Children with hyper-mobile joints also frequently suffer from dislocating joints with no injury or cause other than movement in the wrong direction suddenly.

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