As a parent, you wish to have a healthy baby, but sometimes the unexpected happens. There are some babies who are born with Erb’s Palsy. Erb’s palsy belongs to the group of conditions called Obstetrical Brachial Plexus Injury. Most of these injuries can be effectively treated, but treatment usually takes a long time. This means if your baby has Erb’s palsy, you need to be patient and dedicated to treatment for the best outcomes.

 What is Obstetrical Brachial Plexus Injury (OBPI)?

OBPI refers to damage to some of the nerves in the arm of a new born baby.  It is the most common birth-related nerve injury. OBPI is commoner in vaginal deliveries than caesarean deliveries. Additionally, it is commoner among babies born big. It is also commoner among mothers who have diabetes during pregnancy, and mothers who have difficult deliveries. During these deliveries, force may be applied to a baby’s arms. This force can stretch and injure the nerves in your baby’s arm. Erb’s palsy is the most common form of OBPI. According to the American Academy of Orthopedic Surgeons, 1 or 2 out of every 1000 babies has this.

How Can You Tell Your Baby Has Brachial Plexus Palsy?

You should suspect OBPI if your baby is not able to raise his arm. Also, your baby will not be able to take his hand to his mouth, close and open his fingers, and move his wrist. Your baby holds his arm in a way described as the waiters’ tip, as if he were a waiter discreetly asking for a tip. But OBPI is not the only reason your baby may not be able to move his arm, so take your baby to see a doctor.

When your Baby has OBPI, What Should you Do to Help?

You have to perform all prescribed exercises and activities. Within the first two weeks after birth, handle and position your baby appropriately. Your physiotherapist will teach you some gentle exercises and how to handle your baby. When dressing your baby, start with the affected arm. However, while undressing, unclothe the unaffected arm first. In addition, at bath time, protect the affected arm by supporting it on the chest of your baby. Likewise, during feeding, place the baby’s affected hand on the breast or feeding bottle.

Below are examples of exercises for a baby who has OBPI

A. Shoulder and elbow range of motion exercises
SOURCE: Understanding brachial plexus injury info from Royal Children Hospital, Melbourne

These exercises take baby’s affected arm through shoulder and elbow movements gently, being mindful not to pull on the shoulder.

B. Finger movements as part of therapy
SOURCE: Understanding brachial plexus injury info from Royal Children Hospital, Melbourne
Play therapy commensurate with age and development
SOURCE: Understanding brachial plexus injury info from Royal Children Hospital, Melbourne

Play activities in side-lying, prone, supine, and sitting positions  promote reaching, grasping, and arm extension, which are necessary skills that the baby needs to function.

Your baby will probably receive treatment until he is one year old, then reviews are scheduled as needed.


Unexpected situations like birth injuries present challenges to parents, especially in the early days after delivery. However early referral, coupled with appropriate treatment, improves the chances of good recovery for your baby. Do not despair.

Co-authored with
Bridget Numarce, physiotherapist.


  • Seyram June 19, 2022

    Very good reading. Thank you


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