The aetiology of brachial plexus injury: what the paediatrician and obstetrician need to know.

The recognition of brachial plexus injury (BPI) after childbirth suggests to parents a causative rather than temporal relationship. This view is supported by textbooks of paediatrics, which state that: 1. "the mechanism of injury is a forceful separation of the head from the shoulder by lateral bending of the neck with simultaneous shoulder depression, during vaginal delivery"; and 2. "these injuries are due to traction on the brachial plexus during delivery."2 Although an obstetrician will talk to a parent when BPI occurs, the ongoing care of the child is within a mutidisciplinary team, where the paediatrician and obstetrician play leading roles. Parents will ask about aetiology, treatment and prognosis; but is the textbook explanation adequate? We illustrate the potential dilemma for the paediatrician and obstetrician through 2 cases of BPI and outline some data on BPI, which is not congruent with current paediatric texts.