Reasons why babies neglect one arm and hand
There are two main reasons why an infant has difficulties with moving one arm. The first is Erb's Palsy, an injury to the nerves going to the arm that occurs during birth. Because the baby does not move the arm at all, the injury is usually picked up early and the baby is referred to a specialist doctor for assessment and referral to physical therapy. Read more
The other reason for weakness and neglect of one arm is damage to the developing brain, either before or at birth. A disturbance in development of the brain may be associated with preterm birth. Full term infants may suffer a perinatal stroke before or just after birth. A perinatal stroke causes neglect and weakness in the arm and leg on the one side, and is often missed because the signs and symptoms may be very subtle in the young baby, but become more prominent over time.
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Early diagnosis of cerebral palsy Historically, the diagnosis of cerebral palsy (CP) was made between age 12 and 24 months when movement dysfunction was clearly apparent. At the same time the prevailing attitude to early parental concerns was a "wait and see" and intervention was delayed until a diagnosis had been made. However in 2017 a systematic review of the literature showing that a diagnosis of cerebral palsy can be accurately made before 6 months’ corrected age was published. This review showed that early diagnosis can be made using a combination of standardized tools along with clinical history. These tools include magnetic resonance imaging, the Prechtl Qualitative Assessment of General Movements and the Hammersmith Infant Neurological Examination. It is important to recognize that in 50% of all infants with cerebral palsy, the pregnancy and labor may have appeared to be uneventful. It is only when the infant's motor milestones are delayed, especially sitting, standing, and using the two hands together to manipulate objects that parents and health care professionals became concerned that the possibility of a CP diagnosis is considered. This finding may be especially true for infants with unilateral cerebral palsy, who often master early rudimentary motor skills, such as smiling, swallowing, and head control, and it is not until they attempt more complex motor skills, such as sitting, standing and bilateral grasp, that asymmetries become observable. |
If you notice that your baby is not using the one hand in the same way as the other one, it is a good idea to take some time to observe how your baby uses their hands for different activities.
Then, if you still have concerns that your baby is neglecting the one hand, and the abilities of one do not match those of the other hand, it is a good idea to ask your child's primary health care professional to assess your baby's motor development and make a referral to a pediatrician or early intervention occupational or physical therapist for a full assessment.
Bibliography
Novak, I., Morgan et al , N. (2017). Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment. JAMA pediatrics, 171(9), 897–907. Full text
McIntyre S, Morgan C,Walker K, Novak I. Cerebral palsy –don’t delay.(2011) Developmental Disabilities Research Reviews. 17(2): 114-129.
Basu A. P. (2014). Early intervention after perinatal stroke: opportunities and challenges. Developmental medicine and child neurology, 56(6), 516-21.
Hoare B, Greaves S. (2017) Unimanual versus bimanual therapy in children with unilateral cerebral palsy: Same, same, but different. J Pediatr Rehabil Med. 2017;10(1):47-59.
Greaves S, Imms C, Krumlinde-Sundholm L, Dodd K, Eliasson AC. (2012) Bimanual behaviours in children aged 8-18 months: a literature review to select toys that elicit the use of two hands. Res Dev Disabil. Jan-Feb;33(1):240-50.