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Nursemaid Elbow: My Toddler’s First Trip to the ER

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Fifteen minutes before dinner, my daughter locks eyes with me and reenacts a silent-film starlet’s series of intense emotions. Her eyes are screaming, “Mommy, Mommy, the train is coming! Rescue me at once!” The lines on her forehead begin to form a map of distress. Her chin starts to quiver like Grandma’s fruit Jell-O; then suddenly the sound barrier is broken and a tsunami of anguish has me impulsively joining her in a chorus of “AhhhhOwieAhhhh!”

I call out to my husband, “Come quick. Bailey’s hurt. She was climbing on the couch and then held her arm and began to scream, ‘Owie! Owie! Owie!’ I don’t know what happened.” “Did you see her fall?” “No.” “She must have twisted her arm or fractured it.” “It doesn’t look broken.”

I try to gently move each digit, each joint. She cries. I get the Tylenol. We turn on Our Neighbor Totoro for distraction, or was it Caillou? My husband, George, starts calling hospitals in the area to confirm which have urgent care and will also take our insurance. My mind snaps quips at myself: we should have already done this, I thought we had. I grab the diaper bag and some snack bars and we’re off.

Now comes the question of do we risk hurting her arm further by putting her in her car seat or do I hold her and risk injuring her more if there’s a car accident? We chose to put her in the car seat and thankfully, it did not seem to cause additional pain to her arm.

In the emergency waiting room, her walk is a modest version of Quasimodo. She lets her left arm just hang by her side, limp. She leans into it as she does her plush Elmo, knowing this is a part of her she cares for and wants restored. A beam replaces her ache when she realizes she has an audience and at twenty-one months begins her touring performance set of “The ABC Song,” “Row, Row, Row Your Boat,” and her show stopper finale of “Frère Jacques.”

As the spectators revolve from adoring, seven-year-old girl with rash to leave-me-alone projectile vomiting, burly biker man, Bailey’s howling lament resumes. Four hours later, George reports to the triage nurse that Bailey’s condition is worsening. Twenty minutes later we go in. The doctor offers the diagnosis in less than two minutes: Nursemaid Elbow. I, who like to glamorize everything, hear: Mermaid’s Elmo and think, how cute!

The doctor said that the most common way this happens is from lifting the child by their wrist, arm, or hand. Last week, Bailey was holding her Godfather’s hand and my hand; and as we were walking over sand dunes on the beach we lifted her up by her hands, like countless generations have done before. Yet, at the time, my mother’s intuition said, “The baby books said this could be dangerous.” But I was too afraid of hearing Godfather allude that I was once again being overprotective, so I said nothing. Now I have mommy guilt, which is much worse than Godfather fear. Of course, I don’t know conclusively that this had an impact on Bailey’s condition, but it’s eating away at me nonetheless.

Nursemaid elbow is, in essence, a dislocated elbow. Published case series report a slight predominance in females.1 and a slight left arm predominance in both males and females.1 It was my daughter’s left arm. It most commonly occurs in children aged one to four years. However, it has been reported in patients as young as four months and as old as fifteen years. Nursemaid elbow tends to reoccur. Avoidance of future axial traction should minimize risk of reoccurrence.

Therefore, I have an excuse why Bailey cannot be lifted by her hands again. Not that I need one, but then again, maybe I do. I have fewer critics as a performer than I do as a mother. Since most people either have parents, become parents or both, they tend to think they are an expert on parenting. If only people could remember that their words are like songs we often sing along to subconsciously, perhaps they’d choose their words more thoughtfully. In addition to that, I have to embrace the fear of criticism if I am to put my daughter’s safety first. My instincts for and knowledge of my child must take precedence over others’ parental experience with their children.

The doctor said that he could either manipulate her elbow now or take x-rays to confirm that it needed manipulation. Being a firm believer in communicating with my child I explained to her what was going to happen. She went into hysterics and began a tantrum disproportionate to any other before. In the process, she manipulated or snapped, her elbow back into place herself.

Her requiem of grief escalated to a crescendo inspiring even gun shot wounded patients to part their curtains and observe the unearthly commotion. This and her new flailing arm, which she was using as a target to slap mommy’s face repeatedly, persuaded us to just admit defeat to the paroxysm and leave.

As the doctor was hurriedly getting the paperwork to accommodate us in a swift departure, the x-ray technician magically appeared. Deciding that it was fate interceding to cover all our bases, we went forth with the x-rays. It’s unfathomable that it can take two large adults to hold down one tiny toddler, but fear can have the strength of unforeseen forces. It was at this point I began praying like an in debt, alcoholic gambler at the Roulette table. But instead of asking for the ball to land on twenty-nine, I asked for my daughter’s discomfort to cease.

My prayers were answered when her uncontainable wet tears became dry, gaspy sobs that slowly surrendered to an exhausted, melancholy gaze. I held her tight and swayed with song to soothe us both. Her x-rays were clear, no broken bones or fractures. A friendly nurse appeared with an orange elixir by the name of, Ibuprphen. I don’t like for Bailey to ingest anything I don’t ingest first, so we downed our first shots of pain relief together. I gently settled her on the hospital bed and within moments, her arms, legs, and head formed the shape of a slumbering starfish, sans her Mermaid’s Elmo.

While we were waiting for the doctor to bring us our discharge papers, I realized the room was lit, she was asleep, and this was a perfect time to cut her fingernails. I had been trying to trim them for days, she had already started making slight slashes across her forehead when brushing her curls aside, and I was afraid her arm might be too sore for me to hold to cut her nails tomorrow and I didn’t want her to cut her face up anymore tonight. I just happened to have a spare pair of clippers in her diaper bag and as I reached for them my husband laughed at me saying, “Only you would think of trimming her nails at a time like this. You’re so you!”

The cleaning lady arrived before the paperwork so we decided to hurry the process along so that someone who really needed a hospital bed could have the one I was using as a manicure station. As George gathered our scattered belongings, it was time for the consummate groomer to enfold her tiny toddler into her mama bear arms and release her family from the chaos of the E.R. and back into the quietude of home.

Dinner was only six hours late and consisted of dashboard dining from Del Taco. Bailey’s dinner was the sustenance of sleep. We drove home grateful for six working elbows and we all slept through the night. Night being five hours escape from wakefulness. But with working elbows, who needs sleep?

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