Q. What is Neonatal Brachial Plexus Palsy (NBPP)?
Neonatal refers to the period of time right around the birth of a child. The brachial plexus is a network of nerves from the neck that supplies all function and sensation to the arm. These nerves provide feeling as well as motion to the entire arm. Palsy means weakness or paralysis. NBPP occurs when, during the time of birth, there is an injury to the nerves of the arm that causes weakness or paralysis.
Q. Why do I hear it referred to as Erb’s palsy?
Wilhelm Erb was one of the doctors who first described NBPP. Today, the terms Erb’s palsy, Klumpke palsy, and Total palsy are used to describe different patterns of NBPP.
Q. What causes NBPP?
Between 1 to 2 of every 1,000 babies have NBPP. It is believed to be caused when the nerves that exit the baby’s neck are stretched during a difficult delivery. This may be due to a large baby, breech delivery, a difficult and long labor, or a complicated delivery where the baby must be delivered quickly to save the baby and/or mother’s life. However, there are many babies born with NBPP who do not have any of these risk factors, and NBPP has been found in babies born from cesarean sections.
Q. Does NBPP cause pain to my child?
NBPP does not seem to cause pain in infants. Studies of children or young adults with NBPP show that NBPP does not cause chronic pain or nerve pain as patients get older.
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Q. When should I take my child to the doctor for NBPP?
NBPP is generally diagnosed by the baby’s pediatrician very early, usually in the first few days after birth. A referral to a specialist should occur as early as possible in order to start physical therapy and range of motion exercises within the first month of life.
Q. How is NBPP treated?
Therapy, protection of the arm, and observation are the mainstays of treatment in the early period. It is important to maintain range of motion of all the joints in the arm. Frequent visits to the doctor are needed to examine your baby as the nerves often recover on their own. Sometimes treatments such as injections with botulinum toxin type A (Botox) may be used if some of the joints are becoming stiff and tight. It can take up to 2 years to see full recovery of the nerves on their own.
Q. Will my child need surgery?
If there is no recovery of the nerves in the first 3 to 6 months of your baby’s life, your doctor may recommend surgery to reconstruct the nerves. However, even patients who have nerve surgery do not regain normal function.
Older children with continued weakness or joint stiffness may benefit from surgeries to correct the stiffness or connect good muscles to weak muscles. The type of surgery is different for every patient, depending on what part of the arm is affected.
Q. Will my child be able to participate in sports and activities?
Studies have shown that children with NBPP participate in sports and activities at the same level as children who do not have NBPP.
2 While your child may have difficulty placing his or her affected arm in particular positions for certain motions, most children learn to compensate and participate in activities such as football, baseball, band, orchestra, and cheerleading. Enjoying extracurricular activities and sports is important for your child’s physical and mental health!
Q. Will the NBPP get worse as my child gets older?
Figure 1: Child with left sided NBBP. Theleft arm is smaller in length and width compared to the other side. Photo courtesy of Texas Scottish Rite Hospital.
NBPP does not worsen as your child gets older. You may notice as your child gets bigger, that the arm with NBPP is smaller than the other arm (Figure 1). This is because the nerve injury may affect growth. The affected arm will grow, but it will grow more slowly than the other arm. As children with NBPP get older, the imbalance between weak muscles and strong muscles may lead to loss of motion of joints. Surgery can sometimes help when this happens.