Taking good notes on your baby’s recovery is extremely important.  Keep a diary or journal and take photos and video to document daily development in terms of function and apparent sensation.  You will want to record dates to associate with new movements and timing of recovery.  This information is important to your doctors and will be used to formulate a timeline of recovery that correlates with the degree of injury and prognosis for recovery. 

The odds favor a natural spontaneous recovery for your baby as long as full active range of motion occurs within the first 2 weeks of life.  Even if this is the case, you may still want to consider having your baby seen by a brachial plexus specialist.  They may recommend that you incorporate range of motion (ROM) exercise into your daily care for your baby or that you follow up with an occupational therapist with experience in treating babies with OBPIs.

If your baby does not show signs of a full recovery within the first two weeks of life, it is important that you get an early evaluation from a brachial plexus specialist.  You also will most likely be referred to a trained physical and occupational therapist.  Many parents, under the direction of their therapist, will implement a daily routine of ROM.  ROM exercises aim to keep the joints supple and elastic and to keep the muscles and joints moving as normally as possible.

The recovery window between 2 weeks and 3 months is critical.  During this period, you are looking for your baby’s ability to demonstrate anti-gravity biceps contraction (bending the arm at the elbow against gravity).  If this goal is not met, primary surgery may be recommended.  You should discuss this at length with your specialist and seek out a second and perhaps a third opinion. 

If primary surgery is not necessary for your baby but recovery seems to stall or halt, you will want to monitor him or her closely with your doctor.   Incomplete muscle recovery about the shoulder leads to muscle imbalances and there is a risk to the developing shoulder joint.  One way to monitor the development of this joint is to have your baby undergo magnetic resonance imaging (MRI).  MRIs do not use radiation and visualize the cartilaginous structures, whereas X-rays and CT scans identify bony structures.

Secondary surgery may be recommended for joint deformity and/or incomplete recovery.  At this point, you may want to get a second and possibly third opinion before making a surgical decision.  For each injury there may be differing strategies and/or conflicting timelines for surgical intervention.  Again, you will want to understand the potential functional benefits of surgery for your child and what he or she may be giving up in order to gain these improvements.  

It is important to understand that each child’s recovery is unique in and of itself.  While it is important to seek out as many opinions and as much information as possible, it is not safe to say that what worked for one child will work for the next.