Red flags & when to go in person for Nursemaid’s Elbow (Radial Head Subluxation) - Triage

Audience: adult

Nursemaid’s elbow, also called radial head subluxation, is a common injury in young children where the elbow joint partially slips out of place. It often happens when a child’s arm is pulled suddenly or twisted. The child may hold their arm still and refuse to use it because of pain. This condition usually can be treated quickly and safely by a healthcare provider who gently moves the elbow back into place. Telemedicine can help assess the situation and guide caregivers on initial steps. However, certain warning signs mean the child needs to be seen in person promptly. These include severe pain, swelling, deformity, or if the child cannot move the arm at all. This guide helps adults understand when to seek in-person care versus when telemedicine may be appropriate for nursemaid’s elbow. It is educational and not a substitute for professional medical diagnosis or treatment.

Red flags — go in person / ER

• Child cannot move the arm at all or shows severe pain despite gentle handling — seek emergency care immediately.
• Visible deformity, swelling, or bruising around the elbow — get prompt in-person evaluation.
• Signs of numbness, tingling, or weakness in the arm or hand — urgent medical attention needed.

What telemedicine can do

• Initial assessment of symptoms and injury history.
• Guidance on observing the child’s arm and behavior.
• Advice on when to seek urgent in-person care.
• Education on injury prevention and aftercare.

What telemedicine cannot do

• Performing the physical reduction procedure to reposition the elbow.
• Diagnosing fractures or other serious injuries requiring imaging.
• Managing severe pain, swelling, or neurological symptoms.
• Providing emergency care for complications.

What is Nursemaid’s Elbow?

Nursemaid’s elbow occurs when the radius bone in the forearm slips out of its normal position at the elbow joint. This injury is common in children under 5 years old because their ligaments are still flexible. It often happens when a child’s arm is pulled or swung by the hand or wrist.

Signs and Symptoms

Children with nursemaid’s elbow usually hold their arm slightly bent and close to the body. They may refuse to use the arm or show pain when it is moved. Swelling and bruising are usually minimal or absent. The child may cry or seem upset but typically does not have other symptoms like fever.

When to Use Telemedicine

Telemedicine can help caregivers by assessing the child’s symptoms and guiding them on what to do next. A healthcare provider may watch the child’s arm movement via video and ask questions about how the injury happened. Telemedicine is useful for initial advice and deciding if in-person care is needed.

When to Go In Person

Seek in-person medical care immediately if the child has:

These signs may indicate a more serious injury requiring urgent evaluation.

Treatment Overview

A healthcare provider typically treats nursemaid’s elbow by gently moving the bone back into place, a quick and usually painless procedure. After treatment, the child often uses the arm normally within minutes. Follow-up care may include rest and avoiding pulling on the arm.

Preventing Nursemaid’s Elbow

To help prevent this injury, avoid pulling or swinging young children by their arms or hands. Support their wrists and elbows when lifting or carrying them. Teaching older children safe play habits can also reduce risk.

How to prepare for your tele-visit

• Have the child sit comfortably in a well-lit area for the video call.
• Be ready to describe how the injury happened and the child’s symptoms.
• Prepare to show the child’s arm on camera from different angles if possible.
• Have a list of any other health conditions or medications the child is taking.
• Ensure a quiet environment to hear and communicate clearly with the healthcare provider.

After your tele-visit

• Follow any instructions given by the healthcare provider, including rest and activity limits.
• Watch for changes in the child’s arm use, pain, or swelling.
• Avoid pulling or swinging the child by the arms for several days.
• Seek in-person care if symptoms worsen or new symptoms develop.
• Schedule follow-up care if recommended by the provider.

FAQs

Can nursemaid’s elbow happen more than once?

Yes, some children may experience nursemaid’s elbow multiple times because their ligaments remain flexible. Preventing pulling on the arm can reduce the risk.

Is nursemaid’s elbow serious?

While painful, nursemaid’s elbow is generally not serious and can be treated quickly. However, it should be evaluated by a healthcare provider to confirm the diagnosis and rule out other injuries.

Can I try to fix nursemaid’s elbow at home?

It is not recommended to attempt to reposition the elbow yourself. Improper handling can cause more injury. Seek advice from a healthcare provider, who may guide you via telemedicine or recommend in-person care.

How soon will my child feel better after treatment?

Most children start using their arm normally within minutes after the elbow is gently moved back into place by a healthcare provider.

When should I seek emergency care?

Go to emergency care if your child cannot move the arm, has severe pain, swelling, deformity, or numbness and weakness in the arm or hand.

Sources

1. Radial Head Subluxation (Nursemaid’s Elbow) — MedlinePlus, U.S. National Library of Medicine.
2. Nursemaid’s Elbow — Mayo Clinic.
3. Radial Head Subluxation — American Academy of Pediatrics.
4. Elbow Injuries in Children — Merck Manuals Consumer Version.

This telemedicine guidance is for educational purposes only and is not a substitute for professional in-person medical evaluation, diagnosis, or treatment. If you have concerns about your child's health or if red flags are present, seek prompt in-person medical care.