How the twins acquire and digest pain differently:

The same day as Zella’s face trauma and Tirza’s doctor’s appointment for her wrist, Tirza tumbled off the concrete front porch stairs — not down but rather off the side.  The familiar cracking thud of a human child’s bone meeting concrete tipped us off that this might be a big deal.  Visual inspection indicated no bruises or swelling or compound fractures.

That night we had baby sitters so we could attend a class on foster care adoption.  (You have to stay current with your training while you’re fostering.)  When we returned the sitters said Tirza had been very quiet and still all night, keeping to herself, whimpering and favoring her left arm.  We quickly mobilized everyone else to bed and examined the arm.  No shoulder or collarbone pain or irregularity.  No bruising but she screamed when we bent it and when we straightened it.  We tried rotating it from hand-shake position to palm-up begging.  We tried bending it in a bicep-curl.  We compared her two elbows and thought we could discern swelling in the painful one.  No good.

We called the doctor’s after-hours number.  They said a nurse would call back soon.  Soon meant an hour later.  Tirza had fallen asleep on mommy’s chest on the living room couch.  After hearing the symptoms, especially how much she was favoring the arm and the possibility of swelling, they told us to bring her in to an emergency room — because they were open all night, not out of deadly emergency.  We expected a fracture or a sprain.

Nurse-maid’s elbow!  Tug a child’s arm too quickly or forcefully and the elbow can dislocate.  It may have had nothing to do with her concrete stairs tumble.  How does the doctor fix it?  He doesn’t.  It’s already fixed.  While examining her, Christa and I had accidentally popped it back into socket!  The palm-up bicep curl was the trick.  So we get to pay a doctor for doing nothing but double-checking our ignorantly lucky home medicine.

And Tirza got to spend an hour of sleepy one-on-one mommy attention. (It fit well with our class on foster care adoption issues.)

Sources and Details

Nurse-maid’s elbow: avoid jerking a child’s arms, don’t depend on one arm to bear a child’s weight, hold a child’s arm above the elbow — careful not to jerk the shoulder. Without obvious explanation, it happens more to girls and to the left arm (both true in this case).