During the happy first few days of your baby's life, you or your doctor might notice that one of your baby's arms isn't moving as much as the other. It might be held in a classic "waiter's tip" position. New parents may be scared and overwhelmed when they find out their baby has Erb's Palsy, a common birth injury that affects the nerves in the arm. But the most important thing to remember is that most babies will do very well, especially if they get help early and get therapy. To get better, you need a medical partner who will be there for you. Direct Primary Care (DPC) is the perfect "medical home" for your family because it will guide you with care and attention.
Erb's Palsy is the most common type of injury to the brachial plexus. This is the complicated network of nerves that runs from the neck down into the arm and controls all movement and feeling in the arm, hand, and fingers. This injury usually happens when these nerves are stretched during a difficult delivery. It happens to about 1 to 2 out of every 1,000 babies.
The Classic Sign:
The "waiter's tip" posture is the most common way to show it. In this position, the affected arm hangs limply at the baby's side, with the shoulder rotated inward and the elbow straight and the wrist bent. The baby can't often bend their elbow, lift their arm, or turn their palm up.
The good news is that most babies get better completely.
Most babies with Erb's Palsy have a very good chance of getting better. An estimated 80–90% of babies who get early and regular physical and occupational therapy get their arm function back completely or almost completely, usually within the first year of life.
The Key to Success: Getting Help Early
If the child isn't clearly getting better by the time they are one month old, the modern standard of care is to start gentle therapy as soon as possible and make sure the child is seen by a multidisciplinary specialty center.
Warning: DPC doctors do not do the nerve surgery or specialized physical therapy for Erb's Palsy. A specialized multidisciplinary team takes care of that. DPC's most important job is to be the first person to diagnose, coordinate care, and coach families. Here are some reasons why DPC is the best choice for a family on this journey:
Early and correct diagnosis:
A DPC doctor's slow newborn and well-child exams give them time to do a full neurological and musculoskeletal exam. They can tell right away that the arms are moving differently, which helps them make a quick diagnosis and avoid the "wait and see" approach that could delay the start of important therapy.
A quick, well-planned referral to a specialty center:
Time is very important when a baby needs special care.
Your DPC doctor can help you get a quick referral to a multidisciplinary brachial plexus clinic, which usually has pediatric neurologists, orthopedic surgeons, and specialized therapists, in the first month of your child's life.
They are the main way for your family to talk to the whole specialty team.
A "Home Coach" to help with therapy and support:
This is one of the most important benefits of DPC. A home exercise program of gentle, passive range-of-motion exercises that parents do with their baby several times a day is the most important part of recovery.
During follow-up visits, your DPC doctor has time to go over these exercises with you, give you support, answer your questions, and help you fix any problems.
Families need ongoing coaching and support to stick with the therapy program, which is the only way to stop permanent joint stiffness (contractures).
A medical home for the whole child:
Your DPC doctor takes care of all of your child's other regular pediatric needs, like well-child visits, vaccinations, and colds. They always know exactly what your child needs because they know about their neuromuscular condition and therapy schedule.
Case 1: During baby David's first week-of-life DPC visit, his doctor sees that he isn't moving his left arm well and that it is in the classic "waiter's tip" position. The doctor quickly diagnoses Erb's Palsy, shows the parents the first set of gentle range-of-motion exercises to do at each diaper change, and sends them to a brachial plexus specialty clinic the same day.
Case 2: The parents of 5-month-old Chloe, who has Erb's Palsy, are feeling down about how slowly she is getting better and how hard it is for them to do her home therapy every day. During Chloe's DPC well-child check, the doctor spends 30 minutes giving her emotional support, going over her exercises with her parents, praising the small but important progress she has made, and reminding them how important their daily work is. This kind coaching keeps the family motivated and on track with her therapy.
Q: Did I do something wrong while I was pregnant that made my baby have Erb's Palsy?
A: No way. Erb's palsy is a nerve injury that can happen during birth and delivery. It is often caused by things like a big baby or a hard position. The mother is not to blame.
Q: Will my child's arm stay paralyzed forever?
A: It's very, very unlikely. The vast majority of infants (80–90% or more) with this type of birth injury recover almost all of their function in the first year or two of life, especially if they get early and regular physical and occupational therapy.
Q: Why is it so important to get physical therapy right away?
A: The injured nerve will heal on its own, but it is very important to keep the shoulder, elbow, and wrist joints flexible and to stop the muscles from getting permanently tight (a contracture). Parents do gentle, passive range-of-motion exercises every day to make sure that when the nerve function comes back, the arm is in perfect, mobile condition to start working properly again.
For a family dealing with this unexpected birth injury, DPC is a clear advantage because:
Making it easier to get important early diagnoses and referrals: DPC's thorough newborn exams and proactive approach make sure that a child is sent to a specialty center within the first month of life, which is very important.
Being a "Home Coach" to Help People Stick to Their Therapy: The DPC model gives families the time and support they need to get through the long and hard home exercise program that is so important for recovery.
Offering a full, helpful medical home: Taking care of the whole child and giving families the psychosocial support they need when they get a stressful diagnosis.
It can be scary to find out that your newborn has Erb's Palsy, but most of these kids will be fine in the end. Therapy, patience, and working together are all important parts of the road to recovery. Direct Primary Care offers careful early detection, expert coordination, and ongoing support to help your child and family get the best possible result.
Previous Post
Next Post
