Safety is one of the first things parents are concerned about when a baby is on its way. Ensuring you have completed a CPR course, have a good car seat, have secured the pool, locked up the medicines, gated the stairs and so on are all really important. But there is one thing you probably aren’t aware of when dealing with young children.
The way you pick up a child is vitally important, as incorrect handling can lead to physical damage. There are a few areas parents may be familiar with which I will not spend much time on:
- Head support. In the newborn phase, head support is essential when lifting or holding a baby. This is primarily due to the fact that their neck muscles are not strong and a baby doesn’t have the capacity to control the head.
- Holding the head and spine in alignment. There are times that a baby is held in such a way that the head is turned in an awkward direction to allow the baby to breathe. If the head and body are not in alignment, the baby may hurt its neck trying to turn the head in such a way that breathing is easier.
- Injuries to the wrist, elbow and shoulders. It is extremely important that adults take into account that a child’s bones and ligaments are fragile. Injuries to these joints are common, may occur more frequently in children younger than five years and are often the direct result of being picked up incorrectly or swung around by the hands.
I would like to spend some time discussing the third point, with a particular focus on the elbow injury. The injury in question is commonly known as Nursemaid’s elbow or pulled elbow. The medical term is radial head subluxation.
Causes of Nursemaid’s elbow
The most common cause of Nursemaid’s elbow is pulling or jerking on a child’s hands, particularly twisting the arm. This kind of injury may occur if you:
- swing a child around, holding their hands;
- lift a child off the floor by one hand so that the body weight is on that arm;
- swing a child onto your back;
- pull a child’s hand to get the arm through a sleeve;
- pull a baby by the hands to a sitting position from a lying down position;
- grab a child by one arm to prevent a fall or them running into the street;
- pull a child by the hand to get them to keep up with you;
- swing a child between two adults, each holding a hand.
There are some examples of how this injury occurs doing the rounds on Facebook – search for ‘holding your child can be dangerous’. They show clearly the kinds of movements which may result in Nursemaid’s elbow. This injury can also occur if a child uses both hands to brace themselves during a fall, or if an infant rolls onto an arm.
“When the child is swung around or jerked, the radius slips out from under the ligament but doesn’t fully dislocate. This results in a lot of pain and the child will be unable to use his or her arm.”
6 signs and symptoms of Nursemaid’s elbow
- The child refuses to use their arm.
- The child has a lot of pain.
- There is no swelling or bruising.
- The arm hangs limply and doesn’t have an odd position (sometimes a broken bone will cause the arm to be in a peculiar position).
- The X-ray or MRI doesn’t show anything.
- You have been playing with your child and pulled on the hands or wrists.
How does the elbow sublux?
The elbow joint itself has three little bones, one of which is called the radius. The bones are attached by ligaments. When the child is swung around or jerked, the radius slips out from under the ligament but doesn’t fully dislocate. This results in a lot of pain and the child will be unable to use his or her arm.
What happens now?
If you suspect that your child has a subluxation you will need to get medical assistance. The attending doctor may well order an X-ray to make sure that there aren’t any broken bones. Once a fracture has been ruled out, the doctor will have to perform a simple procedure to put the radius back into its place. The procedure may cause pain initially but the wonderful thing is that the whole ordeal is over really quickly. Your child will be good to go within minutes.
The procedure is simple:
- The doctor will stretch out the arm and rotate it.
- Next, the hand will be bent towards the shoulder.
- As the radius moves back under the ligament and into position, a pop may be heard and the child might experience some pain.
If you are interested, there are a couple of YouTube videos which demonstrate how a doctor would attend to a subluxation. I am adding a link to one of the videos. In this video, you can see how the child refuses to use the injured arm and the procedure necessary to relocate the radius.
Next time a little child begs to be swung around say no! Remember, the ligaments and bones of children under the age of five are tender. After this age, the ligaments and bones are harder, thicker and tougher. Kiddies’ activities like swinging from bars, doing handstands and just growing up makes children older than five years much less susceptible to this injury. Take care of those little joints.
The experience of a subluxation is just as traumatic for you as it is for your child and it is an injury that can be avoided. The bad news is that once a child has had a subluxation (Nursemaid’s elbow) the chances are much higher that it can happen again. The good news is that there is no evidence that your child will develop arthritis or any other long-term condition as a result of a subluxation. The moral of the story is to avoid tugging on those little arms or playing the sorts of games that involve holding a child by their hands and swinging them around.
This article was written for BabyYumYum by our partner paediatrician, Dr Maraschin.