Ruby at the Pediatric ER

Today we had our first visit to the Pediatric ER. Even though for some kids it's their home away from home, I did not expect that Ruby would be one of the first of her little friends to have an injury-induced visit to the ER given the extreme caution she exercises in her daily activities.

This morning, the nanny took Ruby to the playground as per usual, although they were sans little buddy Ian because he went to visit his grandma on the East Coast. Around 11:30 I got a call from the nanny saying that Ruby fell down and now she cries anytime someone touches her left arm. I was working from home, so I ran out and met them on the street on their way back. Ruby was sitting in her stroller quietly, but when I tried to hold her left hand, she burst into tears. The nanny said she never saw her take a big fall or get hit by something in her arm. She had been playing in a grassy area and seemed to just crouch down, and then she got upset and came over to the nanny wanting to be picked up. She tried putting her in the swing, but as soon as she moved her arm, she would grimace and start crying.

I called Ruby's pediatrician, and she told us that it was likely something called Nursemaid's elbow, which is basically a dislocation of the elbow that is quite common in young children because their joints and ligaments are still weak. She told us to come into the office and that it was something she could fix quickly. Unfortunately, our pediatrician's office is in Noe Valley, which is about a 20-25 minute drive from our house, and I was quite concerned about putting Ruby into the carseat as she did not want her arm touched whatsoever and even moving it a hair caused her to cry. However, we found out that the Pediatric Emergency Department at California Pacific Medical Center is just down the street from us, no more than a 10 minute walk.

By this point, Ruby was getting a bit more distressed, and she definitely did not want me to put her down, so I carried her from our house to the ER. The Pediatric ER at CPMC is actually quite nice, and we were seen immediately by the doctor. Up until that point, I hadn't even tried to take off Ruby's jacket for fear of disturbing her arm, but the doctor needed to examine it, so we gingerly removed her coat. Her shirt seemed much more of a challenge as it would have to go over her head, so I just had them cut it off. It was sad as it was one of her cutest shirts, but I was too anxious since they couldn't be sure what was wrong yet.

It turned out that our pediatrician was right, and it was a dislocation of the elbow. The doctor had one of the nurses distract Ruby with bubbles, and she popped it right back into place. Within minutes, Ruby's arm was back to normal, and she was moving it around and reaching for things again. We were told that this type of injury most often occurs when young children are picked up or swung by their hands, although in Ruby's case it seems like she may have used her arms to break a fall and landed awkwardly. It is most common in toddlerhood and stops being an issue around 5 years of age as the joints and surrounding tissues have strengthened by that point.

As far as trips to the ER go, ours seems to have been as easy as could be hoped for. Ruby left good as new with no residual side effects. It is amazing how resilient a little kid can be, how quickly she bounced back and spent the rest of the day blowing bubbles and giggling. I, on the other hand, still feel a bit weak in the knees.