Parents of Newborns

This page is written for parents whose baby has been diagnosed with, or is suspected of having, an obstetric brachial plexus injury (OBPI), including Erb’s palsy. Learning that your newborn is not moving an arm normally can be upsetting and overwhelming, particularly in the days immediately after birth. Our aim is to provide clear, compassionate information about what this injury is, why it can happen, what you may notice in your baby, and what the next steps usually involve. You are not alone, and support is available.

What is obstetric brachial plexus injury?

The brachial plexus is a network of nerves that runs from the neck into the shoulder, arm and hand. These nerves control movement and sensation in the arm. An obstetric brachial plexus injury occurs when these nerves are injured around the time of birth.

Erb’s palsy is the most common type of OBPI. It usually affects the upper nerves of the brachial plexus and can cause weakness or loss of movement in the shoulder and upper arm. Some babies recover quickly and fully, while others may have a more serious injury that requires longer‑term treatment. The range of outcomes can be wide, and it is often not possible to predict early on exactly how an individual child will recover.

How does this injury happen?

OBPI most often occurs during a difficult delivery in which the baby’s shoulders become stuck after the head is born. This situation is known as shoulder dystocia. When this happens, additional manoeuvres are needed to help the baby be born safely.

The injury is associated with stretching of the nerves in the baby’s neck and shoulder area before the shoulders are delivered. It is important for parents to know that this is not caused by anything they did or did not do during labour, and it is not something that could have been predicted with certainty in advance.

Sometimes shoulder dystocia is not clearly identified or named at the time of birth, but the presence of an arm weakness afterwards can indicate that the shoulders were difficult to deliver.

What might you notice in your baby?

Babies with an obstetric brachial plexus injury often show signs soon after birth. These may include:

Little or no movement of one arm compared with the other.
The affected arm being held close to the body, sometimes turned inward.
Difficulty bending the elbow or lifting the arm.
Normal movement of the hand and fingers in milder injuries.

Your baby is not usually in pain from the nerve injury itself, but they may be uncomfortable if the arm is handled awkwardly. Your care team or physiotherapist can show you how to hold and dress your baby safely.

What happens next?

In the early days and weeks, the focus is on careful assessment and gentle support. This usually includes:

A detailed examination of your baby’s arm movements.
Referral to a physiotherapist who can guide you on positioning, handling and gentle exercises.
Regular follow‑up to monitor recovery over time.

Many babies show improvement in the first few weeks or months. If recovery is slower or incomplete, your baby may be referred to a specialist brachial plexus service for further assessment. In a small number of cases, surgery may be considered, but this decision is made carefully and only after specialist review.

Uncertainty is frustrating but we can help

One of the hardest aspects of this injury is not knowing what the outcome will be at the start. It is normal to feel anxious, to search for information, and to have many questions.

It is reasonable to expect honest explanations from your healthcare team, even when the answer is that more time is needed to understand how your baby will recover. Early reassurance should not dismiss your concerns, and you are entitled to clear follow‑up plans and explanations in language you can understand.

Supporting yourselves as parents

Caring for a newborn with an arm injury can be emotionally and practically challenging. Many parents find it helpful to:

Ask for written information and clear follow‑up appointments.
Keep a simple record of questions or observations to discuss at reviews.
Seek support from specialist services and parent support organisations.
Talk openly about how you are coping and ask for help when you need it.

Some families later wish to look more closely at how the injury occurred, or to seek independent advice. This is a normal part of trying to understand what happened and to plan for your child’s future, and it does not mean that you are being disloyal or confrontational.

Our message to parents

Your baby is far more than a diagnosis. Many children with obstetric brachial plexus injuries go on to lead full and active lives, with the right support. Early, compassionate care, honest communication and appropriate referral all make a difference.

Erb’s Palsy Ireland is here to support you with information, understanding and connection to others who have walked this path. If you have concerns or need further support, please reach out to us.