Questions?
It can be difficult for parents to understand what is normal behavior and what behavior is concerning when caring for their newborn. Sometimes what parents might see as a concern, even with their baby’s appearance, may be completely normal.
It can feel overwhelming to not know which symptoms are expected for a new baby and what signs are a cause for concern. A question I often get asked as a newborn nurse is, “How do I know when something is not right?”
While sometimes a birth injury is easy to spot right away, other times the signs can be subtle or take longer to show. Here are 13 signs after delivery that something is not right and a birth injury may have occurred.
1. Trouble Breathing
Your newborn is breathing too fast, pausing a long time in between breaths, working too hard to breathe (pulling in chest or making noises with breathing), or needs oxygen support after delivery.
This could point to meconium aspiration syndrome, a serious lung condition that occurs when a baby breathes in meconium (amniotic fluid combined with their first stool).
Inhaling meconium can block the airways and make breathing extremely difficult.
2. Floppy and Lethargic
Your newborn has low muscle tone, is not crying and tensing up when you would expect, is not bending or flexing arms and legs when upset, or is difficult to wake up.
One of the most common causes of early floppiness is hypoxic-ischemic encephalopathy (HIE). When a baby suffers oxygen deprivation during labor, their brain may not control muscle tone or reflexes normally, leading to limpness, poor alertness, and weak movement.
3. Weak Cry or No Cry
Your baby is not telling you when they are hungry, not crying when you unswaddle them or try to wake them up, or their cry sounds more like a whimper.
One possible cause of a weak or absent cry is an intraventricular hemorrhage (brain bleed). When bleeding increases pressure inside the brain, it can affect the areas responsible for alertness and vocal response, leading to a faint cry, poor hunger cues, and difficulty waking.
4. Pale or Blue Skin Color
Your baby should have a pink color to their mouth, face, chest, arms, and legs within the first few minutes of birth. Hands and feet can become dusky or have a bluish color off and on in the first few days after birth, and this is often normal.
However, when a baby is deprived of oxygen before or during delivery, their heart and lungs may struggle to deliver oxygen-rich blood to the body, causing bluish skin, poor color, and trouble breathing immediately after birth.
5. Loss of Reflexes
With a loss of reflexes, your baby will not grasp your hand when you push on their palm, or they may not be startled by loud, sudden noises or when you move them around. There are other reflexes that nurses will test for after delivery as well.
One possible cause of absent newborn reflexes is periventricular leukomalacia (PVL). When the white matter in a baby’s brain is damaged, it can interrupt the nerve pathways responsible for reflexes, leading to a weak or missing grasp or suck reflex.
6. Sudden Changes in Behavior
Seizure activity in newborns can be difficult to spot and can look like normal newborn behavior, but you can look for:
- Jerking or twitching movements
- Leg kicking that resembles bicycling
- Mouth movements (chewing or odd positioning of tongue)
- Stiffening of their body
- Sudden changes in eye movements (rolling, staring off)
In some cases, damage to the areas of the brain that control movement and coordination can lead to cerebral palsy (CP). Birth injury signs of CP include twitching, stiffening, or unusual eye or mouth movements.
7. Difficult to Feed
Your baby may not wake up for feeds, even with assistance, or they may have a decreased or absent suck reflex, which will show when you place a bottle to the roof of the mouth and there is no sucking movement as a response.
This could point to brain damage, especially following a prolonged or difficult birth. When the areas of the brain that control sucking and swallowing are injured, a newborn may struggle to coordinate these movements, making feeding difficult and preventing them from waking or responding normally during feedings.
8. Unusual Arm Movement
Your baby may move one arm normally, while having limited or absent movement in the other arm, indicating nerve damage. When the nerves in the shoulder are stretched during a difficult delivery, children may suffer a brachial plexus injury.
In cases involving Erb’s palsy, the affected arm may appear limp, have reduced movement, or show weaker reflexes compared to the other arm.
9. Sharp Cries
Pain from fractures can cause an infant to cry when moving that part of the body, commonly an arm. Your baby may have an increased sensitivity to stimuli and more frequent, reactive cries.
When the baby’s shoulder becomes stuck during delivery, it can lead to clavicle or humerus fractures, causing pain with movement and prompting a high-pitched or sudden cry whenever the injured area is touched or repositioned.
10. Yellow Eyes or Skin
Parents of babies with lighter skin color often say their infant looks like they’re “getting a tan” as their skin color changes in the first few days after delivery. However, it can be a sign that something is wrong.
In babies with darker skin, yellowing known as jaundice may be easier to see in the whites of the eyes, inside the mouth, or on the soles of the feet.
When jaundice isn’t treated, a type of brain damage called kernicterus can occur, leading to serious neurological challenges.
11. Bruising or Changes in Color to the Scalp
Bruising, swelling, or discoloration on your baby’s scalp may indicate birth trauma, especially if delivery assistance tools such as a vacuum extractor or forceps were used.
These tools can put pressure on a newborn’s delicate scalp, leading to visible marks or swelling shortly after birth. When used improperly or with too much force, they can cause lasting harm.
12. Puffiness and Swelling in Head on One Side
Your baby might have trapped blood underneath the scalp from trauma that damaged blood vessels. Mild swelling is normal and expected after delivery, but if it feels defined to a specific spot on the head, it may mean more than just swelling.
A cephalohematoma is bleeding under the scalp that can happen when pressure is applied during delivery. This collection of blood can cause visible bruising or a raised area on the head and may take weeks to go away.
13. Low APGAR Scores
You may have to ask the nurse for the baby’s APGAR score, as it often does not get passed along to parents and is used as a tool between medical professionals.
A low score at 1 minute and 5 minutes of life means that your infant was in distress at delivery (such as poor breathing, blue skin color, weak muscle tone, absent reflexes, or low heart rate) and needed interventions to support life, like receiving oxygen through a mask.
What to Do If You Spot Signs and Symptoms of a Birth Injury
If you notice any of these warning signs in the hospital or after going home, they should be reported to your baby’s doctor or care team right away. Early evaluation is critical.
Prompt medical attention can lead to faster diagnosis, timely treatment, and a better chance of preventing long-term complications. In some cases, recognizing these birth injury symptoms early can even save your baby’s life.
If you ever feel unsure about what you’re seeing, trust your instincts — it’s always safer to have a newborn checked as soon as possible.
Find Out If Your Case Involves Birth Malpractice
If your baby is showing signs of a birth injury, you don’t have to figure out what happened on your own. Our team of registered nurses and legal advocates is here to help you understand what these symptoms may mean.
When mistakes during labor or delivery cause harm, families may be eligible for compensation to help cover medical expenses, care costs, and more.
Financial support can’t undo what happened to your child, but it can help make the road ahead easier.
Call (800) 914-1562 right now or get a free case review to speak with a labor and delivery nurse and get the help you deserve.
