Nursemaid's Elbow (Pulled Elbow)

Content reviewed against published AAP, ACEP, NIH guidelines

Last reviewed: July 2026

Nursemaid's elbow (radial head subluxation) occurs when a ligament in the elbow slips out of place, usually from pulling or swinging a toddler by the arm. It is the most common elbow injury in children under 5. The child will suddenly stop using the arm and hold it still against their body. It is painful but easily fixed by a medical professional — usually without X-rays.

Immediate actions

May not require 911 — see guidance below
Do NOT try to straighten or move the arm — let child hold it in whatever position is comfortable
DO NOT: Do NOT try to pop the elbow back into place yourself (unless previously trained by your doctor for recurrent cases)

Step-by-Step Response

Recognize the signs

Child suddenly stops using one arm after it was pulled or tugged. Arm hangs limp at the side, often slightly bent with the palm facing down or inward. Child cries with any attempt to move the arm or if arm is touched.

Note what happened

Common mechanisms: pulling child up by the hand/wrist, swinging child by the arms, yanking child away from danger, child rolling over their arm in sleep (less common), pulling arm through a sleeve.

Keep the arm still

Do not attempt to move or examine the arm. Let child hold it in whatever position they have chosen. A makeshift sling (scarf or pillowcase) can provide comfort but is not required.

Manage pain

Give age-appropriate acetaminophen or ibuprofen. Apply a cloth-wrapped cold pack to the elbow if there is swelling. Distract and comfort the child.

Seek medical care

Go to your pediatrician (if open), urgent care, or ER. The reduction maneuver takes seconds and usually provides immediate relief. Most children use the arm within 10-30 minutes after reduction.

The reduction procedure

The doctor will hold the child's arm at the elbow and either supinate (turn palm up) while flexing the elbow, or hyperpronation (turn palm down firmly). A "click" may be felt. The child typically stops crying within minutes and begins using the arm.

Post-reduction observation

After reduction, the doctor will watch the child for 10-30 minutes to confirm they begin using the arm normally (reaching for objects, lifting arms up). If the child does not use the arm, further evaluation may be needed.

Follow-up

No follow-up is usually needed if child recovers fully. If it recurs (common in some children), your doctor may teach you the reduction technique for at-home use. Children outgrow susceptibility by age 5-6.

What NOT to Do

✕Do NOT try to pop the elbow back into place yourself (unless previously trained by your doctor for recurrent cases)
✕Do NOT pull, twist, or straighten the affected arm
✕Do NOT assume it is "just a sprain" if child is not using the arm at all
✕Do NOT force child to move the arm or pick up objects
✕Do NOT panic — this is common, easily treated, and causes no lasting damage
✕Do NOT swing children by their arms or hands (the most common cause)

When to Seek Help

Call 911 if:

Child has a visibly deformed arm or elbow (may indicate fracture, not nursemaid's elbow)
There is significant swelling with bruising (may indicate fracture)
Child has numbness or tingling in the hand (nerve compromise)
Fingers are blue, cold, or white (circulation compromise)
Injury resulted from a significant fall or impact (not just a pull)

Go to ER if:

Child is not using the arm and you cannot reach your pediatrician
This is the first time it has happened and you need a confirmed diagnosis
The mechanism involved a fall (X-rays may be needed to rule out fracture)
There is significant swelling or bruising of the elbow or arm
Child is not improving after the reduction procedure
You are unable to get to urgent care or pediatrician within a reasonable time

Call your doctor if:

Child is not using one arm after it was pulled — classic presentation
You suspect nursemaid's elbow and want advice on whether to go to urgent care or ER
This has happened before and you want to learn the reduction technique
Child was reduced at ER but is not using the arm the next day
Child seems to get nursemaid's elbow frequently — discuss prevention

Age-Specific Guidance

6-12 months

Can occur even in infants when arm gets caught in crib bars or when being pulled up by the arm. Less common than in toddlers but does occur. Always consider nursemaid's elbow if a baby suddenly stops moving one arm.

1-3 years

Peak age for nursemaid's elbow. Toddlers are pulled by arms frequently (crossing streets, keeping from running away, being swung playfully). The ligament is loose at this age, making subluxation easy. Girls are affected slightly more often than boys.

3-5 years

Still common in preschoolers but becoming less frequent. Children who have had it before are at higher risk of recurrence. By age 5-6, the annular ligament tightens and outgrowth occurs. Parents of repeat cases may learn to do reductions at home.

Prevention

NEVER swing a child by the hands or wrists
NEVER pull a child up by one arm — lift under both armpits instead
NEVER yank a child by the arm to prevent them from running into danger — grab clothing or body instead
When holding hands while walking, do not jerk or pull if child stumbles — let them fall instead of dislocating the elbow
Teach all caregivers, older siblings, and grandparents about this risk
When dressing a toddler, guide the arm gently through sleeves rather than pulling
If your child has had nursemaid's elbow before, they are more susceptible — extra caution is needed
Children typically outgrow this vulnerability by age 5-6 as ligaments strengthen

Frequently asked questions

Should I call 911 for nursemaid's elbow (pulled elbow)?

Not always. Call 911 if: Child has a visibly deformed arm or elbow (may indicate fracture, not nursemaid's elbow)

What should I do first?

Do NOT try to straighten or move the arm — let child hold it in whatever position is comfortable. Do NOT pull on the arm again. Comfort the child — this is painful but not dangerous. Go to your pediatrician, urgent care, or ER for reduction (putting it back in place). Apply a cold pack wrapped in cloth if there is swelling. Offer age-appropriate pain relief (acetaminophen or ibuprofen) while waiting

What should I NOT do?

Do NOT try to pop the elbow back into place yourself (unless previously trained by your doctor for recurrent cases). Do NOT pull, twist, or straighten the affected arm. Do NOT assume it is "just a sprain" if child is not using the arm at all. Do NOT force child to move the arm or pick up objects. Do NOT panic — this is common, easily treated, and causes no lasting damage. Do NOT swing children by their arms or hands (the most common cause)

How can I prevent this?

NEVER swing a child by the hands or wrists. NEVER pull a child up by one arm — lift under both armpits instead. NEVER yank a child by the arm to prevent them from running into danger — grab clothing or body instead

Sources

AAP ACEP NIH

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources

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Bottom line

Stay calm and follow the steps above. When in doubt, call your pediatrician or go to the nearest emergency room.

You are doing the right thing by learning what to do in an emergency. Being prepared is one of the best things you can do for your child.