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Nursemaid's Elbow

Here's how you can avoid this common toddler pulling injury.

Laughter turned to tears in an instant. I had been trying to wrestle my vigorous 19-month old son into getting dressed. Trying to make it fun, I dragged him by the hand into his room. Big mistake!

Ian’s crying subsided after a few minutes, but his left arm hung conspicuously at his side. When I offered a potato chip, he took it with his injured arm, setting off another round of crying. We knew something must be wrong, so we spent Mother’s Day even­ing in the emergency room learning about nursemaid’s elbow, a common toddler injury.

How It Occurs

Nursemaid’s elbow is a pulling injury. “A lot of time it is a combination of what the child is doing and what the parent is doing,” says Adam Richards, MD, director of pediatric services at Kennedy University Hospital in Washington Township, NJ. It can happen any time there are
opposing forces on a child’s arm, which causes the radius bone of the forearm to slip out of a ligament at the elbow. `

At ages 1-4, the radius bone can easily come loose from the elbow ligament. As kids age, the radius forms a ridge at the end “like the handle of the baseball bat,” says Dr. Richards. This ridge prevents the ligament from coming off the bone.

Symptoms

The tricky thing about nursemaid’s elbow is that “you will see almost nothing,” says Kate Cronan, MD,  an emergency room attending physician at Nemours/A.I. duPont Hospital for Children in Wilmington, DE.

Most of the time, the child will hold the arm at his side, with the back of the hand facing forward, says Dr. Cronan. The condition usually isn’t very painful unless the child tries to move his elbow, but he probably will favor the uninjured arm.

Treatment

Going to the emergency room is appropriate, says Dr. Richards, because the longer the bone is out of its ligament, the harder it is to get it back in. Doctors usually do a procedure called reduction, which slides the bone back in place. Once reduced, kids often can use their arm again within 10 minutes.

Mya, age 21 months, was injured when her father grabbed her arm to prevent her from falling, says her mom, Jackie Pinkney of Clayton, NJ. An ER doctor performed reduction on Mya. She stayed in the ER for a few minutes afterwards and was “quickly back to normal again,” reports Pinkney.

How To Avoid Nursemaid’s Elbow

Lift children under the armpit, or gently grab the upper arm if you must pull the child. If your toddler’s a good listener, simply instruct her to “come,” rather than pulling her along. While it can be fun, swinging your child by the wrist, is a definite no-no, says Dr. Cronan.

Suzanne Koup-Larsen is a contributing writer to MetroKids.

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