Common Birth Injuries in Neonates

When a baby enters the world, the birthing process can sometimes result in physical injuries. While most newborns come through delivery without complications, certain factors like a large baby, difficult labor, or the use of delivery instruments can lead to birth injuries. The good news is that most birth injuries are minor and heal quickly, often without needing any special treatment. Understanding these common injuries helps parents and healthcare providers ensure newborns receive appropriate care for optimal recovery.

What are birth injuries? 🔗

A birth injury refers to any structural damage or functional impairment in a newborn that occurs during labor, delivery, or both. These injuries result from mechanical forces such as compression, contractions, and traction applied to the baby as it moves through the birth canal. The incidence of birth trauma has decreased significantly over the decades thanks to improved obstetric techniques and better prenatal monitoring.

Several factors increase the risk of birth injuries. Fetal factors include large birth weight (macrosomia), abnormal presentations like breech position, and prematurity. Maternal factors include prolonged or difficult labor, cephalopelvic disproportion, and first-time pregnancies. Delivery-related factors include the use of forceps or vacuum extractors during assisted deliveries. According to research, birth injuries account for fewer than 2% of neonatal deaths, and mortality rates from birth trauma have dropped dramatically since the 1970s.

Clavicle fractures in newborns 🔗

The clavicle, commonly known as the collarbone, is the bone most frequently fractured during labor and delivery. This injury typically occurs when there is difficulty delivering the baby’s shoulders after the head has emerged-a situation called shoulder dystocia.

How clavicle fractures happen 🔗

Risk factors for clavicle fractures include large birth weight, shoulder dystocia during delivery, and instrument-assisted births. The fracture is usually of the “greenstick” type, meaning the bone bends and partially breaks rather than completely separating. Despite appearing concerning to parents, these fractures have an excellent prognosis.

Signs and symptoms 🔗

Parents and healthcare providers may notice several signs indicating a fractured clavicle. The baby typically will not move the affected arm and may hold it still against the body. This protective behavior is sometimes called “pseudoparalysis” because the arm appears paralyzed, but the baby is simply avoiding movement due to discomfort. Other signs include tenderness, swelling, and a crunching sensation when the area is gently touched. An asymmetric Moro reflex may also be observed during examination.

Treatment and recovery 🔗

The reassuring aspect of neonatal clavicle fractures is that full recovery typically occurs without any formal treatment. No cast, splint, or surgery is needed. Healing usually occurs on its own within 7-10 days, though complete bone healing takes about four to six weeks. Parents may be advised to pin the baby’s sleeve to their clothing to limit arm movement and reduce discomfort. A small bump may remain over the healed area, which gradually disappears over time.

Erb’s palsy: brachial plexus injury 🔗

Erb’s palsy is a condition affecting arm movement that occurs when nerves in the brachial plexus are stretched or damaged during birth. The brachial plexus is a network of nerves near the neck that controls movement and sensation in the shoulder, arm, hand, and fingers. When these nerves are injured, the result is weakness or paralysis in the affected arm.

Causes and risk factors 🔗

Erb’s palsy specifically involves injury to the upper trunk of the brachial plexus, affecting the fifth and sixth cervical spinal nerve roots (C5-C6). The injury typically occurs when the baby’s neck is stretched to one side during a difficult delivery. Risk factors include high birth weight, maternal diabetes, prolonged labor, and shoulder dystocia. The condition affects approximately 1-2 babies per 1,000 live births.

Clinical presentation 🔗

A newborn with Erb’s palsy displays characteristic signs that healthcare providers can identify during the initial examination. The affected arm hangs limply at the side with the elbow extended and the forearm rotated inward. This posture is sometimes described as the “waiter’s tip” position, where the palm faces backward and the fingers may curl. The baby cannot lift the arm away from the body or bend the elbow effectively. An asymmetric Moro reflex is a key diagnostic indicator, as the affected arm will not respond normally when the startle reflex is triggered.

Types of nerve injury 🔗

The severity of Erb’s palsy depends on the type of nerve damage sustained. Neurapraxia, the mildest form, occurs when the nerve is stretched but not torn and typically recovers completely. Rupture involves tearing of the nerve but not at the spinal cord, while avulsion-the most serious type-occurs when the nerve root is torn from the spine. Understanding the type of injury helps predict recovery outcomes.

Management and prognosis 🔗

Daily physical therapy is the primary treatment for Erb’s palsy. Since the baby cannot move the affected arm independently, parents play an active role in keeping the joints flexible and maintaining muscle function through gentle range-of-motion exercises. For 70 to 80 percent of children, the condition resolves within the first year of life when therapy begins within four weeks of birth.

Recovery depends on the severity of the nerve injury. Most babies recover fully within the first one to three months, though some may have ongoing mild impairment. Children who do not show improvement within three to six months may require surgical intervention, which can include nerve grafts or nerve transfers. Complete recovery may take up to two years as nerves regenerate slowly.

Facial nerve palsy in newborns 🔗

Facial nerve palsy is weakness or paralysis affecting the muscles on one side of the face. The facial nerve is the nerve most often injured during birth, typically due to pressure during delivery.

Causes of facial palsy 🔗

The most frequent cause of facial palsy in newborns is birth trauma related to difficult delivery. Risk factors include forceps delivery, birth weight exceeding 3,500 grams, and first-time pregnancies. The injury occurs from pressure on the facial nerve as it exits near the ear-either from forceps blades or from the baby’s own shoulder or the mother’s pelvic bones during passage through the birth canal.

Signs and symptoms 🔗

The most common form affects only the lower part of the facial nerve, which controls the muscles around the lips. This weakness becomes most noticeable when the infant cries, as the mouth appears to pull to one side. Other symptoms include drooping of the mouth on the affected side, difficulty closing the eye on the affected side, absence of forehead wrinkling, and flattening of the nasolabial fold. Some babies may have difficulty feeding due to impaired sucking ability.

Treatment and outcomes 🔗

The prognosis for traumatic facial nerve palsy is generally excellent. More than 90% of infants with traumatic facial nerve palsy recover spontaneously without any specific treatment. Recovery typically occurs within three to six months, though some cases resolve within weeks.

Management focuses on protecting the affected eye, as incomplete eyelid closure can lead to dryness and corneal damage. Eye drops and padding may be used to keep the eye moist and protected. In rare cases where no improvement occurs by three months, additional testing such as electromyography may be performed. Surgical exploration is considered only for complete paralysis with no improvement by five weeks of age.

Assessment and early detection 🔗

Early identification of birth injuries is essential for initiating appropriate management and ensuring optimal outcomes. Healthcare providers perform thorough newborn examinations that include checking for symmetry of movement, assessing reflexes, and evaluating facial expressions during crying.

The Moro reflex (startle reflex) is particularly useful for detecting both clavicle fractures and brachial plexus injuries, as asymmetry in the arm response suggests possible injury. Facial assessment during crying reveals any weakness in facial muscles. Physical examination also includes gentle palpation of the clavicles to detect tenderness, swelling, or crepitus.

Parents should inform their healthcare provider if they notice their newborn avoiding movement of one arm, crying more than usual when handled, having an asymmetric facial expression, or showing difficulty with feeding. Early intervention with appropriate therapies significantly improves outcomes for most birth injuries.

Long-term outlook 🔗

The vast majority of birth injuries resolve completely with appropriate care and time. Clavicle fractures heal within weeks without complications. Most cases of Erb’s palsy improve substantially with physical therapy, and facial palsy typically resolves spontaneously. However, ongoing monitoring is important to identify any children who may need additional interventions.

For families dealing with birth injuries, early involvement of pediatric specialists, physical therapists, and occupational therapists provides the best foundation for recovery. Children affected by birth trauma benefit from coordinated follow-up care to support their developmental progress and address any residual concerns.

What do you think? Have you encountered situations where early recognition of these birth injuries made a difference in a newborn’s recovery? How might healthcare teams better prepare parents for the possibility of minor birth injuries during delivery?

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