Elbow pain in a child can range from simple, quickly resolved injuries to conditions requiring immediate medical attention. The nature of the pain—whether it began suddenly after an event or developed gradually—is a primary factor in determining the source of the discomfort. Understanding pediatric elbow injury patterns, which differ significantly from those in adults, is the first step in addressing the issue. The child’s age and activities also help narrow the possibilities.
Sudden Traumatic Injuries
The most immediate causes of elbow pain result from an acute, traumatic event, such as a fall or a sudden pull on the arm. These incidents can lead to fractures or dislocations, which require prompt medical evaluation. A serious concern is the supracondylar fracture, a break in the humerus just above the elbow joint. This is one of the most common elbow fractures in children, peaking between the ages of five and seven years, and typically results from falling onto an outstretched hand.
A child with a supracondylar fracture will experience sudden, severe pain, and the elbow area may show significant swelling, bruising, and an inability to move the arm. Because this fracture occurs near major blood vessels and nerves, there is a risk of neurovascular complications, making urgent assessment necessary. Another common acute injury is Nursemaid’s elbow (radial head subluxation), which is distinct from a fracture. This injury is most common in toddlers and preschoolers (ages one to four) because the ligaments surrounding their radial head are still loose.
Nursemaid’s elbow occurs when the arm is suddenly pulled, such as when a child is lifted by the hand or wrist. The sudden traction causes the radius to partially slip out of the ligament that holds it in place. The child will refuse to use the arm, often holding it still at their side with a slight bend, but the elbow will not be visibly swollen or bruised. While the injury causes immediate distress, a healthcare provider can often quickly maneuver the bone back into place through a simple procedure.
Overuse and Growth Plate Issues
Pain that develops gradually over weeks or months, particularly in active children, often points to an overuse injury involving the growth plates. Growth plates (physes) are areas of cartilage near the ends of long bones that determine the bone’s future length and shape. Because these areas are weaker than surrounding tendons and ligaments until they harden into solid bone, they are vulnerable to repetitive stress from sports.
The most recognized condition in this category is Little League Elbow, medically termed medial apophysitis. This condition affects the medial apophysis, the growth plate on the inner side of the elbow that serves as the attachment point for the forearm muscles and the ulnar collateral ligament. Repetitive, forceful throwing motions, common in baseball pitchers, place excessive tension on this growth plate, leading to irritation and inflammation. The pain is felt on the inside of the elbow and worsens during or immediately after throwing, often affecting children and teens between the ages of eight and fifteen.
Repetitive stress can also lead to pain on the outer side of the elbow, known as lateral epicondylitis or “tennis elbow,” though this is less common in children than in adults. This occurs when the tendons connecting the forearm muscles that extend the wrist become inflamed or damaged at the lateral epicondyle. Children who participate in racquet sports or activities involving repeated gripping and twisting of the forearm are most at risk. These overuse injuries require a period of rest from the causative activity to allow developing tissues to heal.
Less Common Systemic Causes
While trauma and overuse account for the majority of pediatric elbow pain, some cases may be due to systemic conditions unrelated to physical injury. One serious, though rare, possibility is septic arthritis, an infection within the joint space. This condition is an emergency because the infection can rapidly damage the joint cartilage and the growth plate. Septic arthritis presents with severe joint pain, swelling, redness, and warmth around the elbow, usually accompanied by a fever above 100.4°F (38°C).
Another systemic cause is Juvenile Idiopathic Arthritis (JIA), a chronic autoimmune disease that causes joint inflammation. JIA can affect any joint, including the elbow, and is characterized by persistent joint pain, stiffness, and swelling lasting for more than six weeks. Stiffness is often most noticeable in the morning or after long periods of rest, which helps differentiate it from injury-related pain. In some forms of JIA, symptoms may include a high fever and a rash, indicating a systemic involvement.
Triage: When to See a Doctor and Immediate Steps
Determining the need for immediate medical care depends on the severity and nature of the symptoms, with certain signs indicating an emergency. Seek medical attention right away if the child has a visible deformity, such as an arm at an unusual angle, or if there is severe swelling, significant bruising, or loss of sensation in the hand or fingers. Immediate care is also necessary if the child refuses to move the arm, if they have pain accompanied by a fever, or if the pain woke them from sleep.
For mild pain not associated with emergency signs, first aid can be managed at home using the RICE protocol. This involves Rest from the activity that caused the pain, applying Ice for 15 to 20 minutes several times a day, and Elevation of the elbow above heart level to reduce swelling. Over-the-counter pain relievers can manage discomfort, but if the pain does not improve after a few days of home care, or if it occurs even when the child is not using the arm, a medical evaluation is warranted.