January 8, 2019
Nursemaid’s elbow, also known as pulled elbow or radial head subluxation, is a common musculoskeletal disorder among children younger than five years old. This condition happens when the end of one of the bones in the forearm (head of the radius) slips out of position and gets caught in that position. It typically happens to young children who are being pulled, lifted, or swung by their hands or wrists or who fall on their arm. After this occurs, the child will refuse to use the arm because of pain with movement and will hold the palm of the hand rotated inward towards the lap.
Researchers at the Center for Injury Research and Policy of the Research Institute at Nationwide Children’s Hospital analyzed data for children five years and younger treated in US emergency departments for nursemaid’s elbow associated with consumer products and recreational activities from 1990 through 2011. They found nearly 431,000 children treated for this problem during the 22-year study period, averaging about two children every hour. Most of these children were one and two years of age.
The most common way a nursemaid’s elbow occurred was a fall (43%) or arm pull (39%). Beds or bed frames (16%), floors (13%), sofas and couches (11%), and stairs (9%) were the top four products or structures associated with this condition. The “beds or bed frames” category was most frequently associated with nursemaid’s elbow related to falls, and the “stairs” category was most frequently associated with an arm pull. This makes sense because adults often hold a child by the hand or wrist as they walk on stairs. If the young child slips or the adult pulls up on the hand suddenly, the condition can occur.
The number and rate of injuries per year almost tripled (190% increase) over the 22-year study period, which may be related to an increase during recent decades in the number of young children in the United States who are obese or overweight.
Girls accounted for more of the injuries than boys (about 57%). The reason that nursemaid’s elbow is more commonly seen among girls is unclear, but possible reasons may include that young girls more frequently have their hands held or are more frequently picked up when they fall due to societal traditions.
Here are some tips to prevent nursemaid’s elbow:
• Pick Up by the Armpit
The American Academy of Pediatrics (AAP) recommends that children be picked up by holding the body and lifting from under the arms, instead of lifting by the hands or wrists.
• Prevent Falls
Preventing falls in this age group is difficult as they challenge their newfound mobility; however, many types of falls, for example from furniture and nursery products, can be reduced.
• Remove Shirts Carefully
Use caution when removing clothing, especially tight-fitting shirts or pullovers. Avoid tugging on a child’s arm as clothes are removed.
• Avoid Swinging Children
The AAP also recommends that parents not swing children by the hands, wrists, or arms.
• Maintain a Healthy Weight
To the extent that obesity may predispose children to nursemaid’s elbow, this offers another reason for maintenance of a healthy weight among young children.
Laura (Friedenberg) Dattner, MA is a research writer/editor in the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital in Columbus, Ohio. With both a health communications and public health background, she works to translate pediatric injury research into meaningful, accurate messages that motivate the public to make positive behavior changes. Gary A. Smith, MD, DrPH is a Professor of Pediatrics, Emergency Medicine, and Epidemiology at The Ohio State University and is founder and director of the Center for Injury Research and Policy (www.injurycenter.org) of The Research Institute at Nationwide Children’s Hospital. He holds the Dimon R. McFerson Endowed Chair in Injury Research. He is also president of the Child Injury Prevention Alliance, a nonprofit organization working to prevent child and adolescent injury nationally and globally. He has been an active researcher and advocate in the field of injury prevention for more than thirty years.