How damage occurs
The newborn's neck is supported by weak muscles and elastic ligaments, and the head is relatively large. During labor, the cervical spine may be subject to excessive traction, flexion, or rotation, especially if the baby's shoulders are difficult to move through or obstetric aids are used. More often soft tissues and ligaments are damaged, less often - the nerve roots of the brachial plexus, and very rarely - the vertebrae and spinal cord. The severity directly depends on which structures are involved, so the picture varies from mild torticollis to severe motor impairment.
- Excessive extension and rotation of the neck during childbirth
- Sprained ligaments and muscles
- Brachial plexus injury
- Rarely - damage to the vertebrae and spinal cord
- Difficult birth of shoulders
Signs that really indicate injury
Reliable signs are objective and noticeable to the doctor during examination. This is a forced position of the head with tilting and turning, absence or sharp limitation of movements in the hand, a hanging hand, decreased muscle tone on one side, lack of reflexes on the affected hand. There may be stiffening and soreness of the neck muscles, anxiety and crying when changing position, and difficulty sucking. Severe spinal cord injuries are accompanied by lethargy, breathing difficulties and lack of movement - such children are observed in the intensive care unit.
- Persistent tilting and turning of the head
- Fixed or limp hanging hand
- Asymmetry of muscle tone
- Lack of reflexes on one side
- Anxiety when changing body position
- Difficulty sucking and swallowing
When overdiagnosed
Birth trauma to the neck is often explained by the most common conditions of newborns: regurgitation, restless sleep, crying in the evening, trembling chin, marbling of the skin. These phenomena in most cases reflect the immaturity of the nervous system and go away on their own. It is not general complaints that should be alarming, but objective findings during examination. Overdiagnosis leads to unnecessary procedures, medications and parental anxiety. If the discharge indicates an injury, but the child is eating well, gaining weight and moving his arms and legs symmetrically, it makes sense to calmly clarify the diagnosis with a pediatric neurologist.
- Regurgitation and restless sleep are usually not an injury
- Trembling chin and marbling of the skin - immaturity
- Landmark - objective findings during examination
- Weight gain and symmetrical movements are a good sign
- A more accurate diagnosis is better than unnecessary treatment.
Survey
The initial assessment is carried out by a neonatologist in the maternity hospital, and then by a pediatric neurologist: they check posture, range of motion, reflexes, muscle tone, and reaction to touch. Ultrasound examination helps evaluate the condition of the soft tissues of the neck and brain structures. X-ray of the cervical spine is indicated for suspected vertebral injury, and magnetic resonance imaging for persistent movement disorders and suspected involvement of the spinal cord or nerve roots. Additionally, infections, metabolic disorders and congenital diseases with a similar picture are excluded.
- Examination by a neonatologist and pediatric neurologist
- Ultrasound of soft tissues of the neck and neurosonography
- X-ray of the cervical spine according to indications
- MRI for persistent movement disorders
- Elimination of infections and metabolic diseases
- Examination by a pediatric orthopedist for torticollis
Treatment and recovery
In the acute period, the main thing is rest and careful handling: carefully support the head when feeding and changing clothes, avoid sudden turns. If instability is confirmed, the doctor may prescribe soft fixation of the neck for a certain period of time. After the acute phenomena subside, physical therapy and gentle massage are included, which are performed by a specialist trained in working with infants. For brachial plexus injuries, early initiation of exercise and monitoring is important, and if there is no recovery, surgical options are discussed. Sharp manual manipulations on a child’s neck are unacceptable.
- Gentle handling and head support
- Soft neck fixation as prescribed by a doctor
- Therapeutic exercise after the acute period
- Gentle massage from a specialist for children
- Observation by a pediatric neurologist over time
- Inadmissibility of sharp manual manipulations
- Surgical treatment for persistent plexus lesions