Is your recovery window still open? Free one-page chart ↓
One Tug, One Cry, and Now Your Toddler Won’t Use the Arm. Breathe. This One Is Usually Fixed in Seconds.
A pulled elbow (nursemaid’s elbow) happens when a toddler’s arm is tugged or lifted by the hand, and a small ring of ligament slips partly off the top of a forearm bone at the elbow. Your child holds the arm still at their side and won’t use it. A doctor can usually slide it back in seconds, and most children are reaching and playing again within 10 to 30 minutes. No cast, no sling.
You lifted them up a curb by the hand. Or they flopped to the floor mid-tantrum while you were holding on. Now there’s a toddler holding one arm like it belongs to someone else… and a parent googling with the other hand.
First, the guilt. Drop it. This happens to careful, loving parents every single day, cos the anatomy of a 2-year-old’s elbow makes it easy.
The real risk is a different one. Assuming it’s “just” a pulled elbow when the story actually involved a fall, and missing a fracture. Or trying to pop it back yourself after watching a video, on an elbow that turns out to be broken.
So here’s how to tell, what the doctor will do, and how to stop it happening again.
What is a pulled elbow?
The forearm has two bones. The radius is the one on the thumb side, and its top end, the radial head, sits at the elbow wrapped in a ring of ligament called the annular ligament.
In young children that ring is loose and the radial head is still small and rounded. A sharp pull on the hand lets the ring slide partly up and off the head, and it gets pinched in the joint. Nothing is broken. Nothing is torn in any lasting way. It’s slipped. See elbow anatomy for how the joint is built.
Doctors call it a radial head subluxation. It’s most common between about 1 and 4 years old.
How does nursemaid’s elbow happen?
- Lifting a child up by the hands or wrists, including up a step or curb.
- Swinging a child by the arms. The “one, two, three, WHEEE” game.
- Holding on while they pull away, or drop to the ground in protest.
- Sometimes a simple fall, or a baby rolling over onto the arm.
It looks dramatic, a child suddenly refusing to use an arm, and it’s usually one of the quickest fixes in children’s emergency care.
What does a pulled elbow look like?
- One cry at the moment it happened, then settling, often quickly.
- The arm held still at the side, elbow slightly bent, palm facing down or toward the body.
- The arm is ignored. Your child won’t reach, play or lift with it, and may point to the wrist or shoulder rather than the elbow.
- Usually no swelling, bruising or obvious deformity.
- Pain when someone tries to turn the palm up.
A simple thing you can watch: hold out a favorite snack or toy just above shoulder height. A child with a pulled elbow reaches with the good arm every time. Don’t pull or turn the sore arm to test it.
Does my child need an X-ray?
Often not. When the story is a classic pull, the child is the right age and there’s no swelling, the history is usually enough for the diagnosis.
An X-ray comes in when the story or the arm doesn’t fit:
- A fall from a height, off a bed, couch, climbing frame or trampoline, rather than a pull.
- Swelling or bruising around the elbow, forearm or wrist.
- Pain when the bone itself is pressed.
- Your child still won’t use the arm after the doctor’s maneuver.
- Fever, or your child seems unwell.
Those point toward a fracture or something else entirely. See supracondylar elbow fracture, buckle fracture of the wrist and growth plate fractures.
How does a doctor fix a pulled elbow?
- One quick movement of the forearm and elbow. The two common ones are turning the palm up while bending the elbow, or turning the palm further down. Both slide the ligament back into place.
- There may be a click under the doctor’s thumb, and a brief, loud cry. That cry is usually the last one.
- Your child starts reaching and playing within about 10 to 30 minutes. The waiting room is the test. A sticker or a snack held up high tells everyone it worked.
- No sling or cast is usually needed afterward.
If the elbow has been out for many hours, some children take longer to trust the arm again, occasionally until the next day. Your doctor will tell you what to watch for. If your child still isn’t using the arm after the maneuver, the doctor will usually try again or get an X-ray.
Should I try to put it back myself?
No. Not unless a doctor has shown you how after a previous episode, and the story is a clear pull with no fall and no swelling.
The maneuver is simple on a pulled elbow. On a broken elbow it hurts, and it can move the break. From the outside, in a crying toddler, you can’t always tell the difference. That’s the doctor’s job.
What happens after it’s put back?
- Normal use, straight away. No rest, no sling, no special exercises. Let your child play.
- Mild soreness for the rest of the day is common. Children’s pain relief, dosed for their weight as the pack or pharmacist says, is fine if needed.
- Daycare or preschool: usually the same or next day, once they’re using the arm normally.
- Watch for the next 24 hours. If the arm goes back to being held still, get it seen again.
Honestly? This is one of the few conditions on this site where a hand therapist usually isn’t needed at all. Once it’s back, it’s back.
Is there a window to worry about?
This site runs on the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open. Plenty of hand and arm problems run on a clock.
A pulled elbow, as far as we know, doesn’t. Waiting a few hours to be seen doesn’t damage the elbow. The only clock is your child’s discomfort, which is reason enough to get it done today.
That’s exactly why the pull-or-fall question matters so much. A fracture near the elbow DOES run on a clock, sometimes measured in hours. If there was a fall, treat it as a fracture until an X-ray says otherwise.
Can a pulled elbow happen again?
Yes. Plenty of children do it more than once, especially in the toddler years. Most grow out of it by around 5 or 6, as the ligament tightens and the radial head grows.
To cut the chances:
- Lift under the armpits, not by the hands. Think Rafiki holding up Simba: hands around the chest. (Minus the cliff and the choir.)
- Skip the swinging games by the arms or wrists, at least until they’re older.
- Hold the upper arm or the body, not just the hand, when a toddler is likely to pull away or drop.
- Tell the grandparents and babysitters. They do the swing too.
And while you’re lifting a toddler 50 times a day, your own wrists are taking a beating. See wrist pain from carrying a baby.
Go to the emergency department now if
- The fingers or hand are pale, cold, blue or numb.
- The elbow, forearm or wrist looks bent or out of shape.
- There was a fall from a height and the arm is swelling.
- Your child has a fever with a hot, red, swollen joint, or seems unwell or unusually drowsy.
Get your child seen today if
- They suddenly won’t use an arm after a pull or a fall.
- There is any swelling or bruising.
- They still aren’t using the arm normally after it was put back.
- It keeps happening. Repeat episodes are worth a conversation with your doctor.
Lift under the arms, never by the hands, and you cut the chance of it happening again.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. A toddler who still won’t use the arm after it’s been put back deserves an X-ray today. For other causes of a sore elbow at any age, see elbow pain by location.