Nursemaid’s Elbow in Kids Caused by Common Activities

Nursemaid’s elbow is one of the most common injuries in small children, and it can happen during the most innocent activities, like swinging a child by the arms or playing tug-of-war.

“There is a natural looseness in the ligaments of little kids’ elbows,” according to CHOC Children’s pediatric orthopaedic surgeon Dr. Jessica McMichael. “Nursemaid’s elbow happens when the arm gets tugged or pulled, which can partially dislocate the radial head portion of the elbow.”

The injury can happen when a baby or small child is lifted by the hands, or when a child tugs their arm while holding someone’s hand. It can also happen when an object is pulled from their hand, when a baby rolls over or because of a fall.

What are Symptoms of Nursemaid’s Elbow?

Parents can look for these characteristic signs of nursemaid’s elbow in their child:

  • The child stops using their arm normally or treats their arm gingerly
  • The elbow appears straight and the child doesn’t want to bend it
  • The child holds their arm limply and away from the body, “like a paralyzed arm”
  • The palm is rotated inward, rather than facing out toward the front of the body
  • The child complains of pain in the elbow, forearm or wrist
  • Someone holding the child’s hand may feel a pop in the child’s wrist when the injury happens

Nursemaid’s elbow is a very common orthopaedic condition treated at CHOC, according to Dr. McMichael. It is likely to happen multiple times after a child has it once.

“Nursemaid’s elbow is not threatening to the limb, but it does need to be treated,” Dr. McMichael says. “It’s okay to wait until the next morning if your child is acting okay. If your child is not acting like themselves, get it checked out.”

How to Fix Nursemaid’s Elbow

To fix nursemaid’s elbow, a medical professional will gently and quickly pop the elbow back in place. A child might feel pain for a brief moment during the procedure but should start using their arm normally within a few minutes.

If a child’s elbow pops out of place three or more times in a month, a cast may be put on to immobilize the arm and promote stiffness.

Nursemaid’s elbow can be treated by a pediatrician, a pediatric orthopaedic specialist or at a pediatric emergency department. Parents should not correct the elbow themselves unless instructed by a doctor.

Dr. McMichael encourages parents to educate people who are around their child, like grandparents, daycare staff and preschool teachers, about the safest ways to lift a child, hold their hands and play with them.

Nursemaid’s elbow is less likely to occur after age four, when the elbow ligament starts to tighten up and improves with age and growth.

To make an appointment with a CHOC orthopaedic specialist, call 888-770-2462.

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Is Your Teen a Safe Driver?

By Kambria Nguyen, pediatric resident at CHOC Children’s

Motor vehicle accidents are the number one cause of unintentional injuries in adolescents age 15-19. These accidents account for 36 percent of all deaths in this age group ― Six teens die every day due to motor vehicle accidents. Summer months have the highest rates of teen fatalities throughout the year, but it’s not just teen drivers who are at risk; teen passengers are also at increased risk.

There are many factors unique to teens that put them at increased risk of having an accident:

  • Teens are inexperienced drivers and may not be able to recognize dangerous situations.
  • Teens are also more likely to engage in risky behaviors such as speeding and leaving little room between themselves and the car in front of them (known as headway).
  • Teens have the lowest rates of seat belt use.
  • 40 percent of teens report texting while driving.
  • The risk of being in an accident increases with the number of teen passengers.

According to the Centers for Disease Control (CDC), nearly one-third of traffic-related deaths occurred due to an alcohol-impaired driving crash. However, drugged driving is on the rise. A recent study found that the number of people killed in crashes where drugs were present surpassed the number killed in crashes where only alcohol was detected.

In 2014, the most recent data available, 209 child passengers ages 14 and younger died in alcohol-impaired driving crashes. More than half were riding in the vehicle with the alcohol-impaired driver.

Safe Driving Tips for Teens

  • Always wear your seatbelts.
  • Follow the rules of the road.
  • Never drink and drive. Never get into a car with someone who had a drink. Make sure you have a designated driver or someone you can call if you are stuck.
  • Whether it be alcohol, marijuana or recreational drugs, impaired driving of any kind can be deadly.
  • Remember that your texts can wait. Distracted driving is dangerous.

How can you help your teen be a safe driver? Keep in mind the following tips to support your teen and their safe driving habits:

  • Before teens drive alone, supervise them driving during different times of the day and in different weather conditions.
  • Lead by example. Wear your seatbelt and do not text and drive.
  • Stress the importance of a good night’s rest as drowsy driving leads to accidents.
  • Prohibit teen passengers for the first year your teen is licensed. In California, you cannot drive between 11 p.m. and 5 a.m. or transport passengers under 20 years old, unless accompanied by a California-licensed, parent or guardian, driver 25 years or older, or a driving instructor.
  • Talk to your teen about drugs and alcohol. Discuss the dangers of impaired driving and distracted driving.
  • Sign a parent-teen driving agreement. The CDC has a template, or you can make your own.

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Prevent Nursery Product-Related Injuries by Babyproofing the Nursery

When preparing for a new baby, most parents consider baby proofing their home, but the nursery is often overlooked. Children’s products are recalled more than any other type, says Amy Frias, community educator at CHOC Children’s and Safe Kids Orange County coordinator.

“Accidents are going to happen. Parents just need to do what they can to prevent serious injuries,” says Frias. “Nobody thinks a major accident in the home is going to happen to them.”

Frias offers the following tips for baby proofing the nursery. These “babyproofing” rules apply not only to your home, but anywhere else your baby may spend time, such as a grandparent or babysitter’s house or daycare.

Falls

Since children up to age 5 spend most of their time at home, they are more likely to be injured in the home than anywhere else. Most injuries children experience in the home are due to falls.

“If a product for your child comes with a strap, use it. Don’t assume the baby is safe without a strap,” says Frias. “Babies don’t tell you when they’ve learned a new trick like how to roll over and in this case off the changing table. You don’t know what they can do until they do it.”

Lower your crib mattress once your baby is able to sit up. Lower it again once the baby begins to pull themselves up.

Before a baby learns to crawl, secure furniture to the wall, especially heavy items such as tall dresses and changing tables to prevent them from tipping over.

Parents are not immune to falls, so when using a baby carrier, be aware of your surroundings when wearing your baby,” says Frias.

Safe sleep for babies

Although it’s safe for babies to room share with their parents, they need their own sleep surface. Remember the ABC’s of safe sleep: babies should sleep ALONE, on their BACK, in their own CRIB (or other sleep surface).

Remember that a baby’s sleep surface should be naked. Remove any blankets, stuffed animals or other items from their crib.

The biggest risk factors in nurseries are tied to suffocation, strangulation and entrapment, says Frias:

  • Suffocation: don’t keep bumpers, blankets, stuffed animals, or anything else besides a mattress and fitted sheet in the baby’s crib.
  • Strangulation: avoid using mobiles. Furniture should be kept away from windows that have cords, since baby can pull themselves up and become entangled in the cords.
  • Entrapment: there should be no gaps larger than two fingers between the crib side and mattress. The crib mattress should be firm and fit well in the crib. It is important that parents only use a Consumer Product Safety Commission approved crib. Cribs with drop sides do not meet the current standards, are not safe, and should not be used. If your child will be in a used crib make sure it does not have a drop side. Do not use infant positioners such as wedges or pillows due to risk of suffocation and entrapment. Avoid using crib bumpers.

The dangers of baby walkers

Walkers are safer now than they used to be, but the risks outweigh any perceived benefits, says Frias. “Research shows that baby walkers are not developmentally helpful for children as they learn to walk.”

Using baby walkers can calm and entertain a baby while a parent needs their hands free, but it allows babies to move faster than they can on their own— often faster than a parent’s reaction time, she says.

They also give babies a boost to reach hot, heavy or poisonous objects.

“Even though some walkers come with locking wheels that prevent a spill down the stairs, they can fit through a lot of doorways you wouldn’t expect them to,” Frias says. “It’s best not to have them in the house, especially if you have stairs.”

The American Academy of Pediatrics has recommended a ban on the manufacture and sale of baby walkers in the United States. Canada banned the sale, advertising and import of baby walkers in 2004.

Research baby products carefully

Before making a purchase, research the product via the United States Consumer Product Safety Commission, which offers specific product-related information on recalls, research and safety standards.

Used products should be researched the same way, if not more stringently than new products.

Remember to register your products with the manufacturer to ensure that you will be notified in the event of a recall.

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Importance of Stretching for the Young Athlete

By Victor Araiza, physical therapy assistant at CHOC Children’s

Stretching can often take a back seat to your general exercise routine and sport-related activities, but these are an essential part of any conditioning or physical therapy program. Stretching decreases the risk of injury or re-injury and promotes wellness.

Why is stretching so important?

Stretching the right way will help improve flexibility and make it easier for you to move. Stretching properly can increase and improve motion in your joints, increase blood flow, and decrease feelings of stiffness. Other potential benefits of stretching can include reducing delayed onset muscle soreness, increasing athletic performance and reducing the risk of tendon or muscle tears.

It is important to stretch correctly and know which muscle groups you want to stretch. Often, the muscles that tend to be tight are the hamstrings, hip flexors, quadriceps, calves and chest muscles. If proper technique is used when stretching, it will help improve flexibility and increase range of motion. This will increase blood flow and decrease stiffness, in turn decreasing the risk of injury or reinjury.

When to stretch

It is recommended that you perform static stretches after exercising, engaging in strenuous physical activity or participating in an athletic event. Static stretches target specific muscles based on the position you are in with the intent to elongate just past the point of a moderate pulling sensation. The static stretch should be held in the same position for 30-60 seconds and repeated two to three times. For an athlete, it is common to perform a dynamic warm-up prior to sport related activities and static stretches after activities. The American College of Sports Medicine guidelines recommends stretching activities be done at least two days per week. It is also important to know and understand which stretches would benefit you based on your limitations and desired activity participation.

Stretching is encouraged:

  •  When range of motion is limited.
  • Prior to or after vigorous exercises.
  • As a component of your sport-specific conditioning program, team warm-up/cool down and before/after a participation in a sporting event.

When is stretching not encouraged?

  • When someone has excessive movement in their joint(s)
  • An athlete who has experienced a recent fracture
  • After sudden onset of inflammation or swelling
  • When you feel a sharp pain when attempting to stretch

 Tips on how to stretch

It is important to remember that just because you perform stretches doesn’t mean that you will never get injured. Stretching won’t prevent an overuse injury that is predominant in sports that involve the repetition of similar movement patterns. There are other important factors such as strength and endurance training, essential to reducing the risk of injury. Please consult your pediatrician for a referral to physical therapy if you and your child need assistance with an exercise and stretching program.

Learn more about rehabilitation services at CHOC.

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Keeping Little Ones Safe This Holiday Season

The holiday season can be one of the busiest times of year for families. Keeping these safety tips from CHOC’s community educators in mind can help ensure your family stays safe while partaking in all the fun and festive experiences the season has to offer.

holiday safety tips for kids

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CHOC Named One of the Safest Hospitals in the Nation

CHOC Children’s Hospital has once again been named a “Top Hospital” by The Leapfrog Group for providing the safest and highest quality health care services to patients.  CHOC is one of only nine children’s hospitals in the nation—and the only one on the West Coast— to earn the prestigious distinction.

leapfrog award

“CHOC is committed to becoming the world’s safest children’s hospital. While this is a never-ending journey, being named as a Top Children’s Hospital for the eighth time by the Leapfrog Group suggests we are on the right track. Leapfrog has always emphasized patient safety as the top priority, one with which our patients, families and partners would no doubt agree. It’s a humbling honor, and serves as both encouragement and motivation to continue our efforts to provide the safest, highest quality care possible,” said Dr. James Cappon, chief quality officer, CHOC.

The selection of Top Hospitals is based on the results of the 2016 Leapfrog Hospital Survey. Performance across many areas of hospital care is considered in establishing the qualifications for the award, including infection rates and a hospital’s ability to prevent medication errors. The rigorous standards are defined in each year’s Top Hospital Methodology.

“Being acknowledged as a Top Hospital is an incredible feat achieved by less than three percent of hospitals nationwide,” said Leah Binder, president and CEO of The Leapfrog Group. “With this honor, CHOC has established its commitment to safer and higher quality care. Providing this level of care to patients requires motivation and drive from every team member. I congratulate CHOC’s board, staff and clinicians, whose efforts made this honor possible.”

To see the full list of institutions honored as 2016 Top Hospitals, please visit www.leapfroggroup.org/tophospitals.

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Year-Round Water Safety Reminders

By Justin Pick, pediatric resident at CHOC Children’s

Living in Southern California affords us some of the best weather in the world, with year-round access to beaches, pools, and hot tubs. However, these privileges come with risk. Drowning is the second leading cause of death in children between the ages of five and 24. Even though summer may technically be over, keep in mind these year-round water safety reminders to ensure your children are safe around water.

Above all, it is most important to learn how to swim by finding a swim class nearest to your home.

Pool Safety

 Remind your teen about the importance of swimming in a pool with an on-duty lifeguard who is adequately trained in CPR.

  • CPR training for all teenagers and caregivers is important in the event of an emergency. Locations for training include: hospitals, The Red Cross, YMCA, YWCA
  • Avoid running around the wet edges of pools to avoid falls with severe head injuries.
  • Drink plenty of fluids because people often do not realize how much they are sweating, even when temperatures have dipped after summer months. On a typical day, kids should drink the number of 8 oz. cups of water equal to their age. For example, a five-year-old should drink five 8-oz. glasses of water every day.
  • Consistently reapply sunscreen since the sand and ocean can act to concentrate the rays of the sun. Everyone should wear sunscreen whenever they’re outdoors, all year long.
  • Always have access to a phone with cell reception to dial 9-1-1 in the event of an emergency.

Open Water Safety

 Never swim alone in the ocean! Even good swimmers need buddies.

  • Know your swimming ability and do not try to swim in deep water (where your feet are unable to touch the ground) if it is not safe for you to do so.
  • Pay attention to warning signs in the area. Only swim in designated swim areas.
  • Stick to beaches with an on-duty life-guard
  • Avoid diving into water in which the depth is unknown or if there are any potential objects (i.e. rocks, debris) that may cause injury.
  • Avoid swimming near fast moving waters, especially rip tides. If trapped in a rip tide, swim parallel to the shore until you have escaped the rip tide and then adjust your course and safely swim to shore.

Boating Safety

  • Be mindful of other drivers who may be under the influence of alcohol or other substances.
  • Always obey local boating laws
  • Review the boating safety manual in the event of a capsizing
  • Always have a cell phone in case of emergencies
  • Be aware of the direction of land; we recommend always having land within vision.
  • Always have access to life preservers on the vessel in the event of an emergency
  • Always let someone know where you intend on going in the event of an emergency, so an efficient search and rescue can be initiated.

Download your copy of CHOC’s guide to drowning prevention.

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CHOC Experts to Share Parenting, Safety Tips at Festival of Children

Parents and families can join the team of community education experts from CHOC Children’s at Festival of Children, to be held every weekend in September at South Coast Plaza, Costa Mesa. CHOC will host an informational booth offering health tips for families and an opportunity to meet CHOC’s beloved pet therapy dogs. Every Friday in September at 11 a.m. on the Carousel Court Stage, free Mommy & Me Classes will be offered, including coffee and tea. Hear first-hand from CHOC experts on the following topics:

Sept. 2 – Child Passenger Safety

Sept. 9 – Water Safety

Sept. 16 – Home Safety  

Sept. 23 – When to Take Your Child to the ER, offered by a registered nurse and manager of the trauma program

Festival of Children highlights all children charities serving our community for National Child Awareness Month in September. The event at South Coast Plaza will also feature other activities and crafts for children. Learn more about the Festival of Children event.

Learn more about upcoming events at CHOC.

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Home Safety Tips for the Whole Family

Kids have more freedom as they get older, which teaches them independence and nurtures their curiosity, but they can often overestimate what they’re capable of doing. Most injuries for kids up to five years old occur in or around the home, so keep in mind these home safety tips for older children, to protect kids of all ages in your home.

“Older children tend to take more risks, so we as parents must walk a fine line between bubble-wrapping our kids and protecting them,” says Amy Frias, community educator at CHOC Children’s and Safe Kids Orange County coordinator.

  • Batteries. Keep batteries and battery-operated devices out of sight and out of reach. If your child ingests a battery, seek emergency medical attention or call the National Battery Ingestion Hotline, 202-625-3333.
  • Burns. Getting kids involved in cooking your family’s meals can be a great way to encourage healthy eating habits later in life, but should be done under careful supervision. Don’t hold a small child when using the stove, and always keep sharp and hot objects out of reach.
  • Carbon monoxide. In addition to a working smoke alarm, ensure your home has a carbon monoxide detector and check its batteries regularly.
  • Choking. Even when kids are old enough to start learning how to use utensils themselves, make sure food is cut into bite-size pieces. When purchasing a toy or game, take into account the size of its pieces. Keep small items such as magnets, makeup or batteries out of reach, as they could be confused for a toy or candy. Cords and strings from window blinds should also be kept out of reach to prevent choking. Move furniture away from windows to prevent choking on cords, or falls.
  • Falls. Install window locks that prevent openings greater than four inches, yet could still be easily removed by an adult in the event of an emergency. Children under 10 years old should not be on a top bunk of a bunk bed. Use liners underneath rugs and in the bathtub to prevent falls. Secure-top heavy furniture to the wall.
  • Fire. Make a fire escape plan. Establish a place to meet in the event of a fire in your home, and remind children that getting out safely should be their first priority.
  • Medicine. Remind children that medicine is not candy. Medication should be stored out of reach and out of sight, and in a locked location. Keep in mind that medicine is usually stored in more places than just a medicine cabinet, and can usually also be found in a purse, nightstand, etc.

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Beach Safety 101

Trips to the beach can be a great source of family fun, but be mindful of these safety tips before you head for the sand, courtesy of CHOC Children’s community education team.

Know Before You Go

Always check weather reports for the beach and surrounding area before heading out for a day of fun in the sun. Never visit the beach or swim in the ocean during extreme weather, such as thunder or lightning. Be aware of posted signs and warning flags, or ask the nearest lifeguard if you’re not sure what they mean. Try to set up your home base for the day in a spot that’s close to a lifeguard station. Brightly covered umbrellas can be an easy way for swimmers to spot your group’s location from the water, as well as offering added sun protection.

What to Bring

Everyone over six months of age should wear sunscreen whenever they’re outdoors, so be sure to pack enough sunscreen with SPF 30 or higher. Apply every two hours, and more often if you’re in and out of the water. Wide-brimmed hats and sunglasses can provide extra protection.

Drink plenty of water to avoid heatstroke. CHOC recommends that children drink the number of 8 oz. cups of water equal to their age. For example, a six-year-old should drink six 8 oz. glasses of water every day. Pack healthy snacks for added fuel.

Injury Prevention

Running and playing in the sand can be fun for both children and kids at heart, but always make sure to wear shoes at the beach. Hidden dangers in the sand like broken glass can ruin a fun beach day in no time, and on especially hot days, the temperature of the sand itself is enough to burn your feet. Some beachgoers using fire pits may inadvertently leave hot coals in the sand, which can retain heat and burn feet long after they were in use.

Swim Safely

The most common beach injuries occur in the water due to strong waves. Remember that swimming skills are different for the pool and the ocean, so even though you may be an experienced pool swimmer, in the ocean you could face strong currents, rip tides, and unpredictable conditions. If you are caught in a rip current, swim parallel to the shore until you get out of it, and then you can safely change course and swim towards shore.

If your child is not a strong swimmer, be sure they are wearing a U.S. Coast Guard Approved, properly fitting life vest and are under close supervision. Always use the buddy system when swimming and never go alone. Not all beaches are suitable for swimming, so be sure to check posted signage.

You might be sharing the water with ocean life, so be aware of animal life in the area you are visiting.

Hold off on swimming in the ocean with a cut or open wound, as it could lead to infection. Any abrasions must be closed and healing before you go in the water. Although rinsing small cuts or wounds with salt water is generally encouraged, the ocean’s water is not clean enough to get the job done. Instead, wait for any wounds to close before taking a dip in the ocean.

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