Key takeaways: A broken collarbone is the most common bone injury at birth and usually heals quickly on its own. Brachial plexus injuries affect the nerves of the arm; many improve in the first months, but some need specialist care. Early evaluation and follow-up matter.
Birth is hard work for babies too. Occasionally, a baby’s shoulder or arm is injured during delivery, especially when the shoulders are difficult to deliver (shoulder dystocia) or the baby is large. These injuries can also happen without any known risk factors.
Collarbone (Clavicle) Fractures
Signs:
- Fussiness when the arm is moved or the baby is lifted.
- Not moving the arm as much.
- Swelling or a bump over the collarbone.
- A one-sided startle (Moro) reflex.
- Sometimes no signs; the fracture is found when a firm lump (healing bone) appears days later.
Treatment: usually none besides gentle handling. Some doctors suggest pinning the sleeve to the shirt to limit movement for a week or two. Pain usually improves in days. The bone typically heals within a few weeks, often with a temporary bump.
Tips: lift your baby with support under the bottom and head rather than under the arms, and dress the injured arm first.
From the author
From First Breath to First Birthday is my month-by-month guide to your baby’s first year, written as a NICU and postpartum nurse. My book starts in the first hours after birth and walks you through every newborn check and the weeks that follow.
Brachial Plexus Injuries
The brachial plexus is a group of nerves from the neck to the arm. Stretching these nerves during birth can cause weakness or paralysis of the arm. The most common type is Erb’s palsy, affecting the shoulder and upper arm.
Signs:
- The arm hangs limp or is held close to the body, with the elbow straight and wrist turned inward (“waiter’s tip”).
- Decreased movement of the arm.
- One-sided Moro reflex.
Outlook: many babies recover significantly in the first weeks to months as the nerves heal, though some have lasting weakness.
Treatment:
- Physical or occupational therapy with gentle range-of-motion exercises to prevent stiffness.
- Specialist follow-up, often at a brachial plexus clinic, especially if there’s limited improvement in the first few months.
- Surgery may be considered for some babies who don’t recover enough.
Other Considerations
Doctors may also check for injury to the phrenic nerve (which affects breathing) or Horner syndrome (affecting the eye) with more extensive nerve injuries.
Call your baby’s doctor if: your baby isn’t moving an arm, seems in pain when the arm is moved, or has trouble breathing or feeding.
The Bottom Line
Collarbone fractures usually heal quickly with gentle care. Brachial plexus injuries need early evaluation and therapy, and many improve over time. Keep all follow-up appointments.
Want more support for your baby’s first year? My book, From First Breath to First Birthday, is available on Amazon.
Related Articles
- Left- or Right-Handed? Hand Preference in Babies
- Newborn Reflexes Explained: Startle, Rooting, Grasp, and Step
- Flat Head Syndrome and Torticollis: Prevention and Treatment
- Clubfoot and Other Foot Positions in Newborns
Sources
- American College of Obstetricians and Gynecologists. Neonatal Brachial Plexus Palsy. 2nd ed. ACOG; 2014.
- American College of Obstetricians and Gynecologists. Practice Bulletin No. 178: Shoulder dystocia. Obstet Gynecol. 2017;129(5):e123-e133.
- Abzug JM, Kozin SH. Evaluation and management of brachial plexus birth palsy. Orthop Clin North Am. 2014;45(2):225-232.
- Lewis ML. A comprehensive newborn exam: part II. Skin, trunk, extremities, neurologic. Am Fam Physician. 2014;90(5):297-302.
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
