Pulled Elbow in Children — What Every Parent Needs to Know
Category: Children's Health & Chiropractic | Reading time: 5 min | Audience: Parents and caregivers of young children
It happens in an instant. You're helping your toddler up a kerb, swinging them playfully by the arms, or pulling them back from a hazard — and suddenly they're crying, holding their arm limply at their side, refusing to move it. No obvious swelling. No bruising. But something is clearly wrong.
What you're most likely dealing with is a pulled elbow — also known as nursemaid's elbow, or in clinical terms, radial head subluxation. It's one of the most common elbow injuries in young children, it looks alarming, and most parents have never heard of it until it happens to them.
Here's everything you need to know.
What Is a Pulled Elbow?
A pulled elbow occurs when the radial head — the top of the radius bone in the forearm — slips partially out of the ligament that holds it in place at the elbow joint. In children under five, this ligament (the annular ligament) is still developing and relatively loose, which makes it easy for the radial head to slip through when the arm is pulled or jerked.
The result is a partially dislocated elbow that is uncomfortable, restricts movement, and causes the child to guard the arm protectively.
It is not a fracture. It is not a full dislocation. But it does need to be corrected — and the sooner, the better.
How Does It Happen?
Pulled elbow is almost always caused by a sudden longitudinal traction on the arm — meaning the arm is pulled along its length. Common scenarios include:
Lifting a child by the hands or wrists — especially swinging them up steps or over puddles
Pulling a child away from danger — grabbing the wrist quickly to stop them running onto a road
Swinging a child by the arms — a classic playground activity that carries real risk in under-fives
A child falling while their hand is being held
Rolling over in an unusual way during sleep (less common, but it happens)
It's worth noting that pulled elbow is almost never the result of rough or negligent parenting. It happens to careful, attentive parents all the time, often during completely ordinary moments. There is no need for guilt — just knowledge.
How to Recognise It
The signs of a pulled elbow are usually quite distinctive:
The child holds the arm limply at their side, often slightly bent at the elbow with the palm facing downward or inward
They refuse to use the arm — won't reach for toys, won't lift it, won't let you straighten it
There is crying at the time of injury, which may settle to a low-level complaint or simply a reluctance to move the arm
There is no visible swelling, bruising, or deformity (if there is, a fracture needs to be ruled out)
The child is otherwise well — they may be upset or clingy, but not systemically unwell
Children rarely complain of severe ongoing pain once the initial cry has settled. The dominant sign is simply that the arm isn't being used normally.
What Age Group Is Affected?
Pulled elbow is most common in children between 1 and 4 years of age, though it can occur from around 6 months up to about 6 or 7 years. After this age, the annular ligament becomes strong enough that the same force that would cause a subluxation in a toddler is more likely to cause a fracture instead.
Once a child has had a pulled elbow, they are more prone to it happening again — sometimes repeatedly — until the ligament matures. This is completely normal and not a sign of an underlying problem.
What Should You Do?
Stay calm. Your child will take their cues from you, and a pulled elbow — while distressing to witness — is very treatable.
Don't try to "fix" it yourself by manipulating or twisting the arm. Without knowing exactly what you're dealing with, you risk causing further injury.
See your GP or head to urgent care as soon as possible. A pulled elbow needs to be assessed and reduced by a medical professional — your GP is a great first call during business hours. If it's after hours or on a weekend, head to an urgent care centre. In the Hills District and Western Sydney area, Wise Emergency (wisemergency.com.au) is a dedicated emergency and urgent care facility well equipped to manage this type of injury quickly and with minimal wait times compared to a public hospital ED.
The reduction itself is a simple, quick procedure performed by the treating doctor. Most children are using their arm normally within minutes of it being done.
How to Prevent It Happening Again
Once the elbow is back in place and your child is using the arm normally, a few simple habit changes can significantly reduce the risk of recurrence:
Lift children from under the armpits, not by the wrists or hands
Avoid swinging children by the arms — hold them around the torso instead
When holding hands, let the child bear their own weight rather than pulling upward or sideways on their arm
Educate other caregivers — grandparents, older siblings, childcare workers — so everyone is across the same approach
These adjustments become second nature quickly and make a real difference.
When to Go Straight to Emergency
For any pulled elbow, your first step should be your GP or an urgent care centre. However, go directly to your nearest emergency department if:
There is visible swelling, bruising, or deformity at the elbow
The child is in severe, unremitting pain
The injury was caused by significant force (a fall from height, a car accident)
The child is systemically unwell, has a fever, or the arm is warm and red
There is any numbness or colour change in the hand or fingers
These signs may indicate a fracture or more complex injury that requires imaging and emergency management. Wise Emergency is a great local option for families in Western Sydney — they offer emergency-level care with shorter wait times than a public hospital ED.
A Note on Children's Health at Epoch
While we don't perform pulled elbow reductions at Epoch Health, we're always happy to help point you in the right direction — and once your child has been cleared by their GP or urgent care, our team is here to support their ongoing musculoskeletal health.
Children's physical health — from growing pains and posture concerns to sports injuries and developmental movement patterns — is something we care deeply about at Epoch. Our approach to treating children is always gentle, age-appropriate, and parent-inclusive.
Have questions about your child's health? Call Epoch Health on 1300 887 513 or visit epochhealth.net.au. We have two locations in Dundas Valley and Telopea serving families across West Sydney.