Reviewed By: The Spiros Law Team | Last Reviewed & Updated: September 18, 2026
Quick answer: Most cases of nursemaid’s elbow happen accidentally. This common childhood injury can occur when a toddler’s arm is suddenly pulled during ordinary activities such as lifting or hand-holding.
Other injuries, including certain fractures, repeated dislocations, or injuries that do not match the reported explanation, may require closer medical evaluation. Examples include classic metaphyseal lesions, some spiral fractures, rib fractures, and multiple fractures at different stages of healing.
If your child has a swollen, misshapen, painful, or immobile limb, seek medical care promptly.
This article is for informational purposes only and is not medical or legal advice. If you believe a child is in immediate danger, call 911. To report suspected child abuse, contact your state’s child abuse hotline or the Childhelp National Child Abuse Hotline at 1-800-422-4453.
If you need your Illinois injury case reviewed? Contact Spiros Law, we offer a free, no-obligation case review to discuss your legal options.
What Is Nursemaid’s Elbow?
Nursemaid’s elbow, medically known as radial head subluxation, is a common upper-limb injury in toddlers.
It most often occurs between ages 1 and 4. A young child’s elbow ligament is relatively loose, allowing the radial head to partially slip out of its normal position after a sudden pull on the arm.
Common accidental causes include:
- Swinging a child by the hands during play
- Catching a child who is falling
- Pulling a child away from a hazard
- Lifting a resistant toddler by one arm
- Pulling an arm through a jacket sleeve
A child with nursemaid’s elbow may:
- Suddenly cry or show pain
- Refuse to use the affected arm
- Hold the arm slightly bent and turned inward
- Have little or no bruising
- Have little or no swelling
Doctors can often diagnose nursemaid’s elbow based on the child’s symptoms and examination. An X-ray may not be necessary in a typical case.
A healthcare provider can usually restore the radial head to its normal position with a simple reduction maneuver. Many children begin using the arm normally soon afterward.
A single episode of nursemaid’s elbow does not, by itself, establish that abuse occurred.
When Does a Pulled Arm Injury Need More Evaluation?
The circumstances surrounding an injury matter.
A healthcare provider may look more closely at a pulled-arm injury when:
- It happens repeatedly: Multiple episodes in the same child may require additional evaluation.
- A fracture is present: Nursemaid’s elbow is a joint injury and is not itself a fracture.
- The child is very young: Radial head subluxation is less typical in infants who are not yet mobile.
- There is swelling or significant bruising: These findings are not typical of uncomplicated nursemaid’s elbow.
- There is point tenderness: Localized pain may indicate a fracture or another injury.
- The explanation does not fit the child’s development: The reported event should be consistent with what the child could physically do.
These factors do not independently establish abuse. They can indicate that a more complete medical evaluation is appropriate.
Fractures That May Require an Abuse Evaluation
Certain fracture patterns can be associated with physical abuse, particularly in infants who are not yet walking.
The child’s age, developmental abilities, medical history, reported mechanism, and other findings are important when interpreting any fracture.
Classic Metaphyseal Lesions
Classic metaphyseal lesions (CMLs) are fractures near the growth plate at the end of a long bone.
They are sometimes called:
- Corner fractures
- Bucket-handle fractures
CMLs can result from significant pulling or twisting forces involving a limb. In a non-ambulatory infant, this type of fracture can be an important finding during an evaluation for possible physical abuse.
A CML should be interpreted by an appropriately trained medical professional along with the child’s complete history and other findings.
Spiral and Oblique Fractures
A spiral fracture extends around the shaft of a bone and can result from a twisting force.
The humerus, or upper arm bone, is one location where a spiral fracture may occur.
The significance of a spiral fracture depends on factors such as:
- The child’s age
- Whether the child is walking
- The location of the fracture
- The reported mechanism
- Other injuries
- The child’s medical history
A fracture pattern should not be interpreted in isolation.
Rib Fractures
Rib fractures are uncommon in infants without significant trauma.
When rib fractures are identified, particularly in a young or non-mobile child, healthcare providers may investigate possible causes, including accidental trauma, medical conditions, and physical abuse.
Posterior rib fractures, located toward the back near the spine, can be an important finding in an abuse evaluation.
Clavicle Fractures
A clavicle fracture, or broken collarbone, is common in children and can occur for many reasons.
Possible causes include:
- Birth-related trauma
- Falls
- Direct impact
- Other accidental injuries
A clavicle fracture by itself does not establish abuse.
Additional evaluation may be appropriate when the fracture occurs in a very young infant without an adequate explanation, appears alongside other concerning injuries, or does not fit the reported timeline.
Multiple Fractures at Different Stages of Healing
Multiple fractures that appear to have occurred at different times can provide important information during a child injury evaluation.
Radiologists can assess signs of bone healing and compare the estimated timing of injuries with the history provided by caregivers.
This may help determine whether multiple injuries could have resulted from one event or whether they appear to have occurred at different times.
Why a Skeletal Survey May Be Recommended
Young children may not be able to explain how an injury occurred. Some fractures may also produce few or no visible external signs.
For children under 24 months with certain suspicious injuries, healthcare providers may recommend a skeletal survey.
A skeletal survey is a series of X-rays that can examine areas such as:
- Skull
- Spine
- Chest
- Pelvis
- Arms
- Legs
Healthcare providers may also order laboratory testing when appropriate to evaluate conditions that can affect bone health.
A follow-up skeletal survey may be recommended in some circumstances because healing can make certain fractures easier to identify later.
The decision to perform these tests depends on the child’s age, injury, medical history, and clinical findings.
What to Do If You Suspect a Fracture Happened at Daycare
If you believe your child’s injury may have occurred while the child was in someone else’s care:
1. Get a medical evaluation.
Ask the healthcare provider whether additional imaging or a skeletal survey is appropriate based on your child’s age and injuries.
2. Document the explanation.
Write down what the caregiver told you, including the date and specific details. Note if the explanation later changes.
3. Request daycare records.
Ask for relevant records, including:
- Incident reports
- Staffing records
- Sign-in and sign-out information
- Names of employees who cared for your child
- Available video or other documentation
4. Preserve medical evidence.
Keep copies of:
- X-rays and other imaging
- Radiology reports
- Medical records
- Photographs
- Discharge instructions
- Other relevant documents
5. Report suspected abuse when appropriate.
You can contact the Illinois Department of Children and Family Services (DCFS) hotline and local law enforcement when appropriate.
6. Consider speaking with an attorney.
An experienced attorney can help evaluate potential claims and identify evidence that may need to be preserved, including daycare records and video.
Legal Options for a Child Injury in Illinois
If a child’s fracture or joint injury occurred at a licensed daycare or while under another caregiver’s supervision, potential legal issues may include:
- Negligent hiring
- Negligent supervision
- Failure to maintain required staffing levels
- Failure to follow applicable safety requirements
- Direct liability for the individual responsible for the injury
The legal options available depend on the circumstances and evidence.
How Long Do You Have to File a Child Injury Claim in Illinois?
Illinois generally applies a two-year statute of limitations to personal injury claims under 735 ILCS 5/13-202.
Special rules apply when the injured person is a minor. Under 735 ILCS 5/13-211, the limitations period is generally tolled until the child reaches age 18. In many cases, this can result in a filing deadline around the child’s 20th birthday.
Different deadlines or notice requirements may apply in certain circumstances, including claims involving government entities.
Because the applicable deadline depends on the facts, families should have a potential claim reviewed rather than relying solely on a general timeline.
Frequently Asked Questions
Nursemaid’s Elbow
Does nursemaid’s elbow mean my child was abused?
No. A single episode of nursemaid’s elbow, also called radial head subluxation, does not establish abuse. It is a common childhood injury that can occur when a young child’s arm is suddenly pulled during ordinary activities.
Additional medical evaluation may be appropriate if the injury:
- Happens repeatedly
- Is accompanied by a fracture
- Involves unusual bruising, swelling, or other findings
- Has an explanation that does not fit the child’s age or developmental abilities
These factors do not by themselves establish abuse. A healthcare professional should evaluate the child’s complete medical history and circumstances.
If your child experienced nursemaid’s elbow while in daycare or another person’s care, Spiros Law can review the medical records, reported history, and available evidence to help determine whether the circumstances warrant further investigation.
Fractures and Possible Physical Abuse
What is a classic metaphyseal lesion?
A classic metaphyseal lesion (CML) is a fracture involving the metaphysis near the end of a growing long bone. It may also be called a “corner fracture” or “bucket-handle fracture” based on its appearance on imaging.
CMLs can be an important finding when doctors evaluate possible physical abuse, particularly in infants who are not independently mobile. The child’s medical history, developmental abilities, physical examination, and other imaging findings should also be considered.
Spiros Law can review your child’s medical records and imaging and, when appropriate, work with qualified medical professionals to understand the significance of the findings and whether the circumstances may support a legal claim.
Can a clavicle fracture happen without abuse?
Yes. Clavicle fractures can result from birth-related trauma, falls, and other accidental injuries. A clavicle fracture alone does not establish abuse.
Doctors may consider the child’s age, medical history, reported mechanism, fracture characteristics, and whether other injuries are present when determining whether additional evaluation is appropriate.
If your child’s clavicle fracture occurred while in daycare or another person’s care, Spiros Law can review the medical evidence and reported circumstances to determine whether the explanation is consistent with the available evidence and whether further investigation may be appropriate.
How do doctors estimate how old a fracture is?
Radiologists examine changes that occur as a bone heals. Findings associated with healing may help doctors estimate when a fracture occurred.
The estimated age is not necessarily an exact date. Doctors consider the imaging findings together with the child’s medical history, developmental stage, and explanations provided by caregivers.
Spiros Law can review radiology reports, medical records, and the reported timeline with qualified professionals when appropriate to determine whether the documented findings raise questions about when or how the injury occurred.
Daycare Injuries and Legal Options
What should I do if I think my child’s fracture happened at daycare?
First, have your child medically evaluated. Ask the healthcare provider whether additional imaging or a skeletal surveyis appropriate based on your child’s age and injuries.
Preserve relevant information, including:
- Medical records and imaging
- Radiology reports
- Photographs of visible injuries
- The caregiver’s explanation of what happened
- Daycare incident reports
- Relevant communications
- Names of caregivers or potential witnesses
If you suspect abuse, you can report your concerns to Illinois DCFS. If the child is in immediate danger, contact 911.
Spiros Law can investigate the circumstances surrounding a daycare injury, review medical and facility records, help identify potentially responsible parties, and take steps to preserve evidence that may be relevant to a civil claim.
Talk to Spiros Law About a Child Injury Case
If your child suffered a suspicious fracture, repeated joint injury, or another unexplained injury while in someone else’s care, contact Spiros Law for a confidential case review.
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Sources
Sources & Legal Authority
- 735 ILCS 5/13-211 — Illinois Code of Civil Procedure (Statute of Limitations; Minors & Persons Under Disability): Governs the tolling of personal injury statutes of limitations for minors, generally granting claimants until two years after reaching the age of 18 (their 20th birthday) to initiate legal action.
- 325 ILCS 5/ — Illinois Abused and Neglected Child Reporting Act (ANCRA): Sets statutory reporting mandates for medical professionals and caregivers, and establishes the investigative authority of the Illinois Department of Children and Family Services (DCFS).
- American Academy of Pediatrics (AAP) — Clinical Report: The Evaluation of Suspected Physical Abuse in Children: Benchmark pediatric guidance outlining the clinical thresholds for ordering complete skeletal surveys, laboratory workups, and distinguishing accidental trauma from non-accidental fractures (such as CMLs and posterior rib breaks).
- American Academy of Orthopaedic Surgeons (AAOS) — Nursemaid’s Elbow (Radial Head Subluxation): Clinical overview of the annular ligament anatomy in young children, standard manual reduction procedures, and common accidental traction mechanisms.
- Illinois Department of Children and Family Services (DCFS) — Day Care Licensing Standards (89 Ill. Adm. Code 407): Outlines mandatory caregiver-to-child staffing ratios, supervision regulations, and mandatory incident-reporting requirements for licensed child care centers.
Learn More About Daycare Negligence & Child Injury Law in Illinois
- Spiros Law — Daycare Abuse: What Parents Can Do in a Civil vs. Criminal Case: Breaks down the differences between state criminal prosecutions and civil injury lawsuits, emergency evidence preservation steps for parents, and legal options for holding negligent child care facilities accountable.
- Spiros Law — Unexplained Bruising Patterns on Infants & Toddlers: Warning Signs: Details how pediatric specialists distinguish normal toddler bumps from non-accidental physical trauma using the validated TEN-4-FACESp screening rule, what steps to take if abuse is suspected, and when to seek legal representation.
- Spiros Law — Shaken Baby Syndrome (Abusive Head Trauma) at Daycare: Details the clinical warning signs and triad of abusive head trauma, emergency evidence gathering, and how parents can take legal action against negligent child care centers under Illinois law.
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