Nursemaid’s Elbow—A Risk to Toddlers

Amalia feeling much better the day after her visit to the ER

Despite rearing three children, I had never heard the term “Nursemaid’s Elbow” until the day after Christmas last week, when I accompanied 3-year-old granddaughter Amalia to the Emergency Room.  It had been a special day for Amalia, who was visiting us in Massachusetts with her parents for the holidays—a day that included a ride on the “Polar Express” train from Hopedale, MA to the “North Pole” where Santa got on board and gave each child a silver bell.  Then we met for a family dinner at a restaurant, where Amalia ate pizza.  When we all got home, she was shrieking with joy as she danced in the family room with her grandfather—it was the “Amalia Dance” which involved “Papou” holding both her hands and twirling her.

Suddenly Amalia burst into tears, clutching her left arm to her chest, slightly bent at the elbow.  Despite our pleas, she insisted she couldn’t move the arm or straighten it.  I was certain that it was broken—because that’s what happened to me when I was six years old and I pulled on my mother’s apron strings so hard that she sat down on me.  I wore a cast on that arm for a long time.

We called a niece who is a doctor and she said that she thought the arm was dislocated rather than broken, but that we should take Amalia to the Emergency Room at the UMass Memorial Medical Center nearby.

As soon as we walked in the door with Amalia and described her symptoms, the receptionist nodded and said “Nursemaid’s Elbow—we’ll fix her right up.”  She directed us to the pediatric waiting room which, despite being crowded with ailing children and their parents, was much more pleasant than the waiting room for adults.  Amalia and her daddy passed the time playing video games on one of the screens in the room.  A nurse called the name of a family who had been waiting a long time and then gestured to us, saying “You come along too.”

All of the examining rooms were occupied, so we sat on a gurney in the hall until a white-haired gentleman came up and introduced himself as Dr. Murphy.  He felt up and down Amalia’s forearm and asked her where it hurt—near the elbow and near the wrist, she said.  He rotated her hand slightly and then said, “There, it’s fixed. I popped it back into place.”

I was startled, because Amalia hadn’t so much as said “Ouch!”  I was expecting something like those dramatic movie scenes where the doctor gives the patient a cloth to bite on, to muffle his screams, and then yanks the broken bones back into place.

“Here’s the test,” said Dr. Murphy, “to see if she can hold a popsicle in her left hand.”  He went over to a nearby freezer case. She dropped the first (orange) one, but held on to the second (green) one and demonstrated that she had perfect mobility in her fingers, hand and arm.  The whole procedure had taken only a few minutes.

“Nursemaid’s elbow, we see this all the time in toddlers four years and under,” the doctor said, and described a typical scenario.  “The babysitter takes the kid to Toys R Us and then, when she says it’s time to leave, the toddler drops to the floor and refuses to budge. So the babysitter tries to pull her up by her arm and the elbow gets dislocated.  In young children the ligaments are looser and more flexible and easily dislocated.  That’s why you should never pick up a small child by the hands or arms, but only by holding her under the arms.”

He said that this could happen again to Amalia, especially in the next 24 hours, so we should be very careful. Then he took Amalia’s daddy aside and showed him how to manipulate the ligament back into place if it happens again—by twisting the left hand until the elbow’s ligament pops back.  (Later I learned that for some reason, Nursemaid’s Elbow happens more often to girls than boys and usually to the left arm—just as in Amalia’s case.)

Amalia herself was delighted with the whole ER experience—especially the fact that Dr. Murphy had fixed her just as swiftly and efficiently as her favorite TV character—Doc McStuffins—a six-year-old girl who plays doctor to broken toys.

We all left the Emergency Room saying that it had been a Christmas miracle.  We also agreed that we would avoid the “Amalia Dance” and any other games that involve pulling on arms, until she was much older.