Signs and Symptoms of Brachial Plexus Injury in Children
Brachial plexus injury in infants and young children is a condition that often occurs during a difficult childbirth, especially when there's shoulder dystocia or excessive pulling on the baby's head during delivery. This type of nerve damage affects the network of nerves responsible for controlling movement and sensation in the arm, leading to a range of physical and developmental symptoms. Early recognition of these signs is crucial for timely diagnosis and effective intervention.
Common Clinical Indicators of Brachial Plexus Injury
Limited or Absent Movement in One Arm
One of the most noticeable signs is the inability of the child to move one arm. Parents may observe that the affected limb remains limp, with no active motion during play or while lying on a flat surface. The infant might not be able to bring the hand to the mouth, lift the arm, or perform basic movements such as flexing or extending the elbow and wrist.
Visible Muscle Atrophy and Limb Asymmetry
Over time, reduced use of the injured arm can lead to muscle wasting. Caregivers may notice that the affected arm appears thinner or smaller compared to the unaffected side. This difference in size becomes more apparent as the child grows, signaling possible long-term neuromuscular impairment if left untreated.
Inability to Suck or Bring Hand to Mouth
A key developmental milestone in newborns is self-soothing through hand-to-mouth actions, such as finger sucking. In cases of brachial plexus injury, this behavior may be absent on the affected side. The child may consistently favor the healthy arm, avoiding use of the weaker limb altogether.
Restricted Range of Motion
Children with this condition often exhibit limited mobility in the shoulder and hand. They may struggle with essential movements like raising the arm above the head, moving it away from the body (abduction), or controlling individual finger motions. These limitations can hinder daily activities and delay motor skill development.
Reduced Sensory Response
Due to impaired nerve function, sensory perception in the affected arm may be diminished. When the injured hand is gently stimulated—using a soft toy or toothbrush—the child may not react, showing no signs of discomfort or distress. In contrast, stimulating the unaffected side typically triggers a normal pain response, such as crying or pulling away, which helps clinicians identify the asymmetry.
Diagnosis and Next Steps
If a child displays any of the above symptoms—especially following a complicated birth involving forceps or vacuum extraction—healthcare providers should consider brachial plexus injury as a likely cause. A thorough medical history, including details about labor and delivery, plays a vital role in early suspicion of this condition.
Diagnostic Evaluation
To confirm the diagnosis, physicians typically recommend imaging studies such as X-rays to rule out associated injuries like clavicle fractures. Additionally, electromyography (EMG) and nerve conduction studies are performed to assess the extent of nerve damage and guide treatment planning.
Importance of Early Intervention
Timely referral to a pediatric neurology or orthopedic specialist is essential. With proper diagnosis, most children benefit significantly from early initiation of physical therapy, occupational therapy, and, in some cases, surgical repair. Early rehabilitation improves the chances of full functional recovery and helps prevent long-term complications such as joint contractures or permanent muscle weakness.
Parents are encouraged to monitor their child's arm movement closely and seek medical evaluation at the first sign of asymmetry or motor delay. Awareness and prompt action can make a profound difference in the child's long-term outcomes.