Pulling toddler up by arms: Is this safe?

I am trying to explain to my teenage daughter why she should not lift her 11-month-old brother by his arms. I fear this could cause a shoulder dislocation. Are my fears warranted?

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

One of the most common arm injuries that occur in young children is officially called radial head subluxation but more commonly called nursemaid's elbow.

The bones of the upper arm and forearm meet at the elbow. When one of the bones in the forearm (the radius) separates slightly from the bone in the upper arm called the humerus, a ligament called the annular ligament may slip into this joint. Then when the bones come back together, they pinch this ligament between them causing the pain of the nursemaid's elbow. It occurs in children from a few months of age to about five years. At five years, the annular ligament is usually strong enough to keep from slipping, so this injury usually doesn't occur after this age.

The most common cause of nursemaid's elbow is when the arm is pulled while it is extended. One typical story in which this happens is when Dad and child are playing and Dad swings the child around holding one ankle and one wrist. Another common scenario is when an adult is holding a child's hand while crossing the street, the child trips, and the adult instinctively pulls the child up. When this injury occurs, the child typically holds the arm in front of him with the elbow slightly flexed. He may complain of wrist or shoulder pain even though the injury is in the elbow.

Fixing this injury is rather straight forward for the doctor, and x-rays are usually not needed. It is done by manipulating the arm to allow for the bones to separate again and the ligament to go back into place. It only takes a few seconds to do, and the child usually begins using the arm normally after about five to ten minutes.

Your concerns for how your infant is picked up are not unwarranted. While it would be rather unusual to cause injury to the shoulder when being picked up by the arms, picking up a child under five by the forearms, wrists, or hands could cause nursemaid's elbow. This is particularly true if picked up by just one arm.

Picking your little one up by placing the hands under her armpits is the safest way to avoid this.

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