What to Do About Brachial Plexus Injury in Newborns

Brachial plexus injury in newborns, often caused by birth trauma during delivery, is a condition that affects the network of nerves responsible for controlling movement and sensation in the arms and hands. This type of injury typically occurs when excessive force is applied to the baby's head and neck during a difficult vaginal delivery, especially in cases of shoulder dystocia or macrosomia (larger-than-average babies).

Recognizing the Signs of Brachial Plexus Damage

One of the most common symptoms is limited or no movement in the affected arm. In typical cases, the infant's arm appears limp and hangs by the side, with noticeable difficulty in performing basic motions such as lifting, rotating outward, bending at the elbow, or bringing the arm across the body. The absence of the Moro reflex on the affected side may also be observed during a physical examination.

Diagnosing the Condition Accurately

To confirm brachial plexus injury, healthcare providers perform a thorough clinical evaluation followed by advanced imaging and nerve function tests. These include cervical spine MRI to assess nerve root integrity and electromyography (EMG) to evaluate muscle response and nerve conduction. Early diagnosis is crucial for determining the severity and guiding appropriate treatment strategies.

Effective Treatment Approaches for Recovery

Immediate management focuses on protecting the affected limb and preventing joint stiffness. The injured arm is usually immobilized gently against the baby's body to avoid further strain. Within the first week after birth, parents are often guided by physical therapists to begin gentle massage and passive range-of-motion exercises. These movements help maintain joint flexibility and stimulate neural recovery.

In addition to physical therapy, some infants benefit from medication support. For instance, gangliosides—compounds that support nerve regeneration—are sometimes prescribed to enhance neurological healing. While this treatment remains under study, many clinicians find it beneficial when combined with early intervention protocols.

Prognosis and Long-Term Outcomes

The good news is that the majority of newborns with mild to moderate brachial plexus injuries experience significant improvement within the first three months of life. Studies show that up to 90% of affected infants regain full or near-full function without surgical intervention. However, progress should be closely monitored by a pediatric neurologist or orthopedic specialist.

If there is little to no improvement by 3–6 months, further evaluation is necessary. In more severe cases involving nerve avulsion or rupture, surgical options such as nerve grafting or nerve transfer procedures may be recommended between 3 and 9 months of age. Early surgery has been shown to improve long-term motor outcomes significantly.

Supporting Development Through Therapy

Ongoing physical and occupational therapy plays a vital role in maximizing recovery. Customized exercise programs help strengthen muscles, improve coordination, and prevent contractures. Parents are encouraged to participate actively in their child's rehabilitation journey, learning techniques that can be safely performed at home.

With timely diagnosis, consistent therapy, and proper medical care, most children with neonatal brachial plexus injury go on to lead normal, active lives. Awareness among expectant parents and healthcare providers remains key to ensuring the best possible outcomes.