Nursemaid elbow is one of the most common elbow injuries in young children. Beyond being painful and scary, these injuries can bring up big feelings for both the child and the adult because they often happen during normal, well-intentioned caregiving moments. Let’s walk through what nursemaid elbow is, why it happens, how to recognize it, and what parents should (and should not) do.
What Is Nursemaid Elbow?
Nursemaid elbow – also called radial head subluxation – occurs when a small bone in the forearm (the radius) partially slips out of place at the elbow joint.
Young children are more prone to this injury due to several factors:
- Their ligaments are looser and thinner
- The radial head is smaller and not fully shaped yet
- The elbow joint is still developing stability
A quick pull on an extended arm can allow the radial head to slip out from under the ligament that normally holds it in position.
As kids grow, the ligament tightens and the bone shape changes, making this injury far less likely with age. By age 5 or 6, radial head subluxation is an uncommon injury (1).
To learn more about managing other common childhood injuries, read these articles: What To Do When Your Child Has A Strain Or Sprain and A Guide To Cleaning Minor Cuts & Scrapes
Common Ways Nursemaid Elbow Happens
Radial head subluxation is rarely caused by a fall. It almost always involves a pulling force on the arm (1), such as:
- Lifting a child up by one or both hands
- Swinging a child by the arms
- Pulling a child quickly to prevent a fall
How to Recognize Nursemaid Elbow
The signs of nursemaid elbow in children are usually very specific. A child with nursemaid elbow will typically (1):
- Suddenly stop using one arm
- Hold the arm slightly bent or straight, close to the body
- Avoid rotating the forearm (turning palm up or down)
- Cry briefly when it happens, then appear calm but guarded
Signs of nursemaid elbow in children typically don’t include the following, which may be signs of a different elbow injury and likewise require medical evaluation:
- Significant swelling
- Bruising
- Deformity
Sprains and strains are also common during childhood. To learn more, read this article: What To Do When Your Child Has A Strain Or Sprain
What Should Parents Do If They Suspect Nursemaid Elbow?
If you suspect your child has nursemaid elbow, it’s important to have them evaluated promptly by a medical professional. A trained clinician can usually correct nursemaid elbow in seconds using a gentle maneuver, and most children regain normal use of the arm within minutes.
Large pediatric emergency department studies show that true fractures are rare in children diagnosed with nursemaid elbow. In a review of more than 88,000 pediatric emergency visits, missed fractures occurred in only 0.3% of cases. Imaging was often unnecessary, and outcomes were generally excellent when the clinical presentation was typical (2).
That said, X-rays may still be considered in certain situations, particularly in older children, when the story or exam is atypical, or if pain, swelling, or refusal to use the arm persists after reduction. If your child does not begin using the arm shortly after the elbow is put back in place, or if new symptoms such as swelling or bruising develop, further evaluation is important to rule out another injury.
To learn more about X-rays, read this article: Radiation Detox for Kids: How to Support Your Child After X-Rays, CT Scans, or PET Scans
Recurrent Subluxation & Tips To Prevent Nursemaid Elbow in Children
Some children seem to be especially prone to nursemaid elbow injuries. This is usually due to naturally looser ligaments and the shape of the developing elbow joint in early childhood
In these children, the same elbow may sublux more than once during the toddler and preschool years. The good news is that this tendency almost always resolves on its own as the joint matures and the surrounding tissues strengthen.
Prevention of nursemaid elbow is mostly about changing how we lift, guide, and play with young children, especially during moments of urgency or resistance.
Helpful habits include:
- Lifting under the arms instead of by the hands
- Avoiding swinging games that involve arm pulling
- Encouraging siblings to avoid tugging on arms
- Holding hands gently, especially during resistance or tantrums
Supporting Your Child After A Nursemaid Elbow Injury
Once nursemaid elbow is put back into place, most children feel immediate relief and begin using the arm again within minutes. For many kids, no additional treatment is needed beyond reassurance and a return to normal activity at their own pace.
That said, it’s also normal for some children to experience mild soreness, stiffness, or hesitation for the rest of the day, especially if the experience was frightening or if the arm was held immobile for a period of time.
Support after reduction is typically simple and comfort-focused:
- Rest, reassurance, and gentle comfort measures, such as cuddling, warmth, and a calm environment
- Topical arnica, a favorite for comfort after minor musculoskeletal injuries
- Herbal support for comfort or big feelings tends to work well
- Over-the-counter pain relief if needed and age-appropriate
In most cases, children feel significantly better within hours once the elbow is reset. If your child continues to refuse use of the arm beyond the same day, or if pain, swelling, or bruising worsens rather than improves, follow-up medical evaluation is important to rule out another injury.
Summary
Nursemaid elbow is a common and generally minor elbow injury in young children caused by a pulling force on the arm. Young children (under age five) tend to be more prone to this injury because the elbow joint and ligaments are still developing. Children usually stop using the arm suddenly, but don’t usually experience much swelling or bruising.
A simple, gentle maneuver by a clinician typically resolves the issue within minutes, and children typically feel better immediately or within the day. Some children may experience repeat episodes, but most outgrow this tendency as their joints mature. Prevention focuses on avoiding pulling or lifting children by the hands or arms.
References:
- Nardi NM, Schaefer TJ. Nursemaid Elbow. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430777/
- Genadry KC, Monuteaux MC, Neuman MI, Lipsett SC. Management and Outcomes of Children With Nursemaid’s Elbow. Ann Emerg Med. 2021 Feb;77(2):154-162. doi: 10.1016/j.annemergmed.2020.09.002. Epub 2020 Oct 27. PMID: 33127100.
