Nursemaid's elbow

Template

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Counseling

Nursemaid's elbow can happen again until about age 5. Recommended supportive care with tylenol or motrin as needed, with an emphasis on lifting the child under the arms and avoiding pulling or swinging by the hands or wrists. Return precautions given including not using the arm again, swelling, bruising, pain that keeps getting worse, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

CounselingNot in the note with these choices

The elbow did not go back into place today, so an x-ray and a recheck will guide the next step. Recommended supportive care with tylenol or motrin as needed, with an emphasis on keeping the arm comfortable and supported. Return precautions given including swelling, bruising, numbness, a cold or pale hand, pain that keeps getting worse, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Nursemaid's elbow
• Holding the arm pronated at the side, without swelling, deformity, or bony tenderness
• Reduced with hyperpronation after discussing benefits, risks, and alternatives
• Using the arm normally with full range of motion after reduction
• Follow up as needed

Nursemaid's elbow can happen again until about age 5. Recommended supportive care with tylenol or motrin as needed, with an emphasis on lifting the child under the arms and avoiding pulling or swinging by the hands or wrists. Return precautions given including not using the arm again, swelling, bruising, pain that keeps getting worse, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Typical exam (no swelling, deformity, bony tenderness)
X-ray, orthopedics
Recurrence and prevention

Return precautions in the template

not using the arm againswellingbruisingpain that keeps getting worse

Sources

Sport-Related Concussion in Children and Adolescents. Clinical Report. Pediatrics 2018;142(6):e20183074. (newest AAP concussion CR found; also Early Childhood…
Overuse Injuries, Overtraining, and Burnout in Young Athletes. Clinical Report. Pediatrics 2024;153(2):e2023065129. (replaces earlier report)
Early Childhood Concussion. State-of-the-art review. Pediatrics 2024;154(5):e2023065484 (not an AAP policy)

Few formal guidelines cover this topic, so the template also leans on expert opinion.