Birth traumas

Last updated: July 27, 2023

Summarytoggle arrow icon

Birth trauma is an injury to the newborn caused by mechanical forces during birth. Risk factors include macrosomia, abnormal fetal presentation, prolonged or rapid labor, and forceps or vacuum deliveries. Soft tissue injuries of the scalp include benign cephalohematoma and caput succedaneum, as well as subgaleal hemorrhages, which are associated with a high risk of significant blood loss and require monitoring. The most common skeletal injury is the clavicle fracture, which is often asymptomatic and heals spontaneously within 7–10 days. Skeletal or muscular birth injuries may cause torticollis, a unilateral contraction of the sternocleidomastoid muscle with a resulting head tilt. Other birth injuries include nerve damage, such as brachial plexus injury and facial nerve palsy, which may cause temporary muscle weakness or paralysis. The prognosis of birth traumas is usually favorable, with most injuries resolving spontaneously within weeks to months.

Risk factorstoggle arrow icon


Neonatal soft tissue injuriestoggle arrow icon

Soft tissue injuries of the scalp in infants are mostly caused by shearing forces during vacuum or forceps delivery.

  • Head molding
    • Transient deformation of the head into an elongated shape due to external compression of the fetal head as it passes through the birth canal during labor
    • Typically resolves within a few days after the birth
  • Caput succedaneum: benign edema of the scalp tissue that extends across the cranial suture lines
    • Firm swelling; pits if gentle pressure is applied
    • No treatment required; resolves within hours or days
  • Cephalohematoma: subperiosteal hematoma that is limited to cranial suture lines
    • Complications: calcification of the hematoma, secondary infection
    • No treatment required; resolves within several weeks or months
  • Subgaleal hemorrhage


Birth-related clavicle fracturetoggle arrow icon

  • Epidemiology: most common fracture during birth (∼ 2% of deliveries)
  • Etiology [5][6]
  • Clinical features
    • Usually asymptomatic
    • Possible pseudoparalysis
    • Bone irregularities, crepitus, and tenderness over the clavicle possible on palpation
    • Possible brachial plexus palsy
  • Diagnostics: : clinical diagnosis; X-ray; only indicated in cases of gross bone deformation
  • Treatment
    • Reassurance and promote gentle handling of the arm (e.g., while dressing)
    • To avoid discomfort, pin shirt sleeve to the front of the shirt with the arm flexed at 90 degrees
    • Consider analgesics
    • Follow-up 2 weeks later to confirm proper healing: via clinical findings of a callus formation, and possibly an x-ray
    • Usually self-resolves within 2–3 weeks without surgical intervention or long-term complications


Infant torticollistoggle arrow icon


Facial nerve palsy due to birth traumatoggle arrow icon

  • Epidemiology: most common cranial nerve injury during birth
  • Pathomechanism
    • Injury occurs during forceps-assisted delivery (most common)
    • Prolonged birth in which the head is pressed against the maternal sacral promontory
  • Clinical features
  • Treatment: eye care with artificial tears and ointment
  • Prognosis: spontaneous recovery in 90% of cases within several weeks

Neonatal brachial plexus palsytoggle arrow icon

Brachial plexus injury is associated with shoulder dystocia, which more commonly leads to Erb palsy than Klumpke palsy.

Referencestoggle arrow icon

  1. Nilesh K, Mukherji S. Congenital muscular torticollis. Ann Maxillofac Surg. 2013; 3 (2): p.198-200.doi: 10.4103/2231-0746.119222 . | Open in Read by QxMD
  2. Andersen J, Watt J, Olson J, Van Aerde J. Perinatal brachial plexus palsy. Paediatrics & Child Health. 2006; 11 (2): p.93-100.doi: 10.1093/pch/11.2.93 . | Open in Read by QxMD
  3. Lurie S, Wand S, Golan A, Sadan O. Risk factors for fractured clavicle in the newborn. J Obstet Gynaecol Res. 2011; 37 (11): p.1572-1574.doi: 10.1111/j.1447-0756.2011.01576.x . | Open in Read by QxMD
  4. Beall MH, Ross MG. Clavicle Fracture in Labor: Risk Factors and Associated Morbidities. Journal of Perinatology. 2001; 21 (8): p.513-515.doi: 10.1038/ . | Open in Read by QxMD
  5. Marino BS, Fine KS. Blueprints Pediatrics. Lippincott Williams & Wilkins ; 2013
  6. Chang H-Y, Cheng K-S, Liu Y-P, Hung H-F, Fud H-W. Neonatal infected subgaleal hematoma: An unusual complication of early-onset E. coli sepsis. Pediatrics and Neonatology. 2015; 56 (2): p.126-128.doi: 10.1016/j.pedneo.2013.03.003 . | Open in Read by QxMD
  7. McKee-Garrett TM. Neonatal Birth Injuries. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: September 21, 2015. Accessed: May 11, 2017.
  8. Laroia N. Birth Trauma. In: Rosenkrantz T, Birth Trauma. New York, NY: WebMD. Updated: February 2, 2015. Accessed: May 11, 2017.
  9. Jenkins B, McInnis M, Lewis C. Step-Up to USMLE Step 2 CK. Lippincott Williams & Wilkins ; 2015
  10. Russman B. Neonatal Brachial Plexus Palsy. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: July 15, 2016. Accessed: May 12, 2017.
  11. Semel-Concepcion J. Neonatal Brachial Plexus Palsies. In: Moberg-Wolff EA, Neonatal Brachial Plexus Palsies. New York, NY: WebMD. Updated: June 17, 2016. Accessed: May 12, 2017.
  12. Hollingworth T. Differential Diagnosis in Obstetrics and Gynaecology: An A-Z. CRC Press ; 2008

Icon of a lock3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer