When a Tug Turns Painful: Understanding Nursemaid’s Elbow in Kids  

It can happen in a second; your toddler is playing, swinging, or you’re pulling them from the ground, and suddenly they cry out and refuse to move their arm. If you’ve been in this situation, you may have encountered something called “nursemaid’s elbow”, also known by medical providers as “radial head subluxation”. 

This common childhood injury can be scary, but the good news is that it’s usually easy to treat and doesn’t cause lasting harm. Here’s what every parent should know. 

What Is Nursemaid’s Elbow? 

Nursemaid’s elbow happens when one of the bones in the forearm (the radius) slips slightly out of place at the elbow joint, and a ligament (the annular ligament) gets stuck in the joint. 

This injury is most common in children under the age of 5 (with an average age of 2 years), because their joints and ligaments are still developing and more flexible than an adult’s.  Parents will be relieved to know that this injury does not happen in older children (≥6 years old). 

How It Happens 

Nursemaid’s elbow often occurs from a quick pulling or tugging motion on a child’s arm, such as: 

• Lifting or swinging a child by their hands or wrists 

• Catching them suddenly when they’re about to fall 

• When a child pulls away while holding hands 

• Occasionally, even from rolling over awkwardly or occasional falling from standing. 

• It’s not caused by rough play or neglect; it can happen to any active, well-loved toddler in the blink of an eye! 

Signs and Symptoms 

• Suddenly stops using one arm in the absence of trauma 

• Holding the arm straight at their side or slightly bent 

• Refusing to bend the elbow 

• Pain when the arm is moved 

• NO swelling of the elbow, wrist, or hand – this is a key way to tell the difference between nursemaid’s elbow and fractures or other more serious injuries 

What To Do if You Suspect Nursemaid’s Elbow 

If your child stops using one arm after a pulling incident: 

• Stay calm – This injury is common and treatable. 

• Don’t try to force the arm to move. It may make things worse or cause more pain. 

• Visit PM Pediatric Urgent Care, as our providers can diagnose and quickly move the bone back into place. 

• The procedure takes only a few seconds, and most children feel relief almost immediately and begin using their arm again within minutes! 

• Most patients do not need an Xray if the medical provider can get an accurate exam.  Our providers are trained to do thorough exam, and if there is no tenderness or swelling detected, then the reduction can take place without a preceding Xray.  We always want to minimize unnecessary radiation exposure, but occasional an Xray is indicated if the provider cannot eliminate the possibility of a fracture. 

Can It Happen Again? 

Yes, once a child has had nursemaid’s elbow, they have a 30-40% chance of it happening again, until around age 5 or 6, when the ligaments grow stronger and they are no longer at risk 

To help prevent it: 

• Avoid lifting or swinging your child by the hands or wrists until age 5-6 

• Instead, lift under their arms or around their chest 

• Teach older siblings to do the same 

When To Seek Care Right Away 

Always seek medical care if: 

• Your child won’t move their arm 

• The elbow looks swollen, bruised, or deformed 

• They are in significant pain 

• Joint pain plus fever 

• You’re unsure what caused the problem 

At PM Pediatric Urgent Care, our teams are specially trained to identify and treat nursemaid’s elbow quickly and gently, helping your child get back to playtime as soon as possible.