Spinal Cord Injuries Related to Birth

When a baby experiences injury during labor and delivery, few complications carry the weight and complexity of spinal cord damage. While these injuries remain rare, they can profoundly affect a child’s ability to breathe, move, and develop. For families navigating this difficult diagnosis, understanding what happened, why it happened, and what comes next can provide both clarity and direction during an overwhelming time.

This page offers a detailed, evidence-based overview of birth-related spinal cord injuries. You’ll find information about how these injuries occur, what symptoms may appear, how doctors diagnose and treat them, and what support is available in New York and beyond. Whether you’re trying to understand a recent diagnosis or seeking information to guide your child’s care, this resource is designed to help you move forward with knowledge and confidence.

What Is a Birth-Related Spinal Cord Injury?

A birth-related spinal cord injury refers to damage that occurs to a newborn’s spinal cord during the labor and delivery process. The spinal cord itself is a critical bundle of nerves running through the protective bones of the spine, carrying messages between the brain and every other part of the body. When this cord is damaged, those messages can be disrupted or blocked entirely, affecting movement, sensation, and essential functions like breathing.

These injuries are uncommon. Current estimates suggest they occur in roughly 1 out of every 29,000 births. However, autopsy studies reveal a more complex picture: spinal cord injury may contribute to up to 10% of neonatal deaths or stillbirths, suggesting that some cases go unrecognized or are attributed to other causes.

The severity of a spinal cord injury depends largely on two factors: where along the spine the damage occurs and how complete the injury is. Some babies experience partial damage that allows for meaningful recovery. Others face complete disruption of the cord, leading to permanent paralysis and loss of function below the injury site.

How Do Doctors Classify Spinal Cord Injuries in Newborns?

Medical professionals categorize these injuries in several ways to help predict outcomes and guide treatment.

Complete vs. Incomplete Injuries

A complete spinal cord injury means the cord has been fully severed or compressed to the point that no signals can pass through. Babies with complete injuries lose all movement and sensation below the level of damage, though some degree of recovery may still occur with time and therapy.

An incomplete injury means the cord retains some ability to transmit signals. These babies may have patches of sensation or movement below the injury, and their prognosis for recovery tends to be more hopeful.

Injury Location and Its Impact

The location of damage along the spine determines which body systems are affected:

• Upper cervical spine (C1 through C4): These are the most serious injuries. Damage at this level can cause quadriplegia, meaning paralysis of all four limbs. It often affects the muscles that control breathing, requiring a ventilator for survival. Many babies with high cervical injuries do not survive.

• Lower cervical and upper thoracic spine (C5 through T1): Injuries here may affect arm and hand function, trunk control, and sometimes breathing, depending on severity.

• Lower spinal levels: Damage further down the spine typically spares upper body function and breathing but may affect leg movement and control of bladder and bowel.

The pattern of injury also varies by delivery type. Upper cervical injuries occur most often in head-first deliveries, while lower cervical and upper thoracic injuries are more common when babies are born breech.

Spinal Cord Injury Without Radiographic Abnormality

Some babies suffer real spinal cord damage even though X-rays and CT scans show no broken bones or displaced vertebrae. This phenomenon is called SCIWORA, which stands for Spinal Cord Injury Without Radiographic Abnormality.

SCIWORA happens because an infant’s spine is more elastic and flexible than an adult’s. During delivery, the bones of the spine can stretch beyond their normal range under stress, injuring the spinal cord inside, then spring back into apparently normal alignment. The bones look fine on imaging, but the cord has been damaged.

This type of injury accounts for 13 to 19% of all childhood spinal cord injuries. In children under 8 years old, SCIWORA tends to involve the upper cervical spine and carries a more serious prognosis. MRI scanning is essential for identifying spinal cord damage in these cases, as standard X-rays will miss it entirely.

What Medical Complications Can Lead to Birth-Related Spinal Cord Injuries?

These injuries typically occur when excessive mechanical forces are placed on a baby’s neck and spine during delivery. The newborn spine is anatomically vulnerable: muscles and ligaments are underdeveloped, bones are not fully hardened, joints are unusually mobile, and the baby’s head is disproportionately large compared to the body. This combination allows the spine to stretch, rotate, or bend beyond safe limits during difficult births, potentially damaging the delicate spinal cord inside.

Delivery-Related Risk Factors

Certain delivery situations significantly increase the risk:

• Breech presentation: When a baby is born buttocks or feet first, the body delivers before the head. If the head becomes trapped in the birth canal, significant pulling and twisting forces can be applied to the cervical spine during attempts to deliver it. Babies in breech position whose heads are tilted far backward (called the “star-gazing” position) face especially high risk.

• Difficult vaginal delivery: Prolonged labor, situations where the baby is too large for the mother’s pelvis, and shoulder dystocia (when the baby’s shoulders become stuck after the head is delivered) all increase the likelihood of injury.

• Forceps or vacuum-assisted delivery: Instrumental deliveries carry recognized risks, particularly when multiple attempts are needed or when significant traction is applied to extract the baby.

• Excessive manipulation during delivery: Any situation requiring forceful rotation, pulling, or extreme bending of the baby’s neck can cause damage.

Fetal Risk Factors

Some characteristics of the baby increase vulnerability:

• Macrosomia: Babies with birth weights over 4,000 grams (about 8 pounds, 13 ounces) are more difficult to deliver and have higher rates of shoulder dystocia.

• Fetal malpresentation: Unusual positions like face presentation, brow presentation, or transverse lie make delivery more complicated.

• Fetal anomalies or bone conditions: Undiagnosed structural abnormalities or conditions affecting bone strength can make the spine more fragile.

Maternal and Labor Factors

Certain circumstances during pregnancy and labor also play a role:

• First pregnancy: Women giving birth for the first time are more likely to experience prolonged labor or need interventions during delivery.

• Failure to progress in labor: When labor stalls, emergency interventions may be needed, sometimes under time pressure.

• Inadequate prenatal care: Failure to detect breech position or estimate fetal size can mean families and providers aren’t prepared for potential complications.

When Injury Occurs Despite Normal Delivery

While most spinal cord injuries occur during obviously difficult births, a small number have been reported after apparently uncomplicated vaginal deliveries or even routine cesarean sections. These rare cases suggest that the normal mechanical forces of birth may occasionally be enough to cause injury in babies with unrecognized vulnerabilities, though this remains poorly understood.

What Symptoms Suggest a Newborn May Have a Spinal Cord Injury?

The signs of spinal cord injury in a newborn vary widely depending on the location and severity of damage. Some injuries are immediately catastrophic and obvious. Others present with subtle symptoms that can be easily missed or mistaken for other conditions.

Severe Presentations

The most serious cases typically show these signs right at birth:

• Complete inability to breathe without mechanical support
• Profound floppiness with no muscle tone in the arms and legs (quadriplegia)
• Absence of normal newborn reflexes, including the Moro (startle) reflex and grasp reflex
• No response to painful stimulation
• No spontaneous movement

Babies with high cervical injuries may be stillborn or die shortly after birth due to respiratory failure before the injury is fully recognized.

Subtle and Atypical Signs

Not every spinal cord injury announces itself dramatically. Some babies show more ambiguous symptoms that can delay diagnosis:

• Hoarse or weak cry
• Difficulty feeding, problems with swallowing, or choking during feeds
• Decreased or absent movement in one or both arms (sometimes mistaken for brachial plexus injury, a different condition)
• Unexplained need for supplemental oxygen or elevated carbon dioxide levels in the blood
• Respiratory distress without another clear cause
• Unequal movement between limbs or between upper and lower body

These subtle presentations can be confused with other serious newborn conditions like hypoxic-ischemic encephalopathy (brain injury from lack of oxygen), brachial plexus injury, neuromuscular diseases, or infection. This overlap makes clinical suspicion and thorough evaluation crucial.

Delayed Symptom Onset

Some babies, particularly those with SCIWORA, may seem relatively normal at birth but develop symptoms hours or even days later. Early warning signs like brief episodes of weakness, unusual positioning, or changes in breathing patterns can be easy to overlook in a newborn, yet they may signal developing spinal cord damage.

How Do Doctors Diagnose Spinal Cord Injuries in Newborns?

Accurate diagnosis requires careful clinical assessment combined with appropriate imaging studies.

Clinical Evaluation

The diagnostic process begins with a detailed review of the birth:

• What type of delivery occurred and what complications arose
• Whether instruments were used and how the delivery progressed
• The baby’s Apgar scores at one and five minutes after birth
• What resuscitation measures were needed

Doctors then perform a thorough neurological examination, checking muscle tone, reflexes, movement patterns, sensation, and breathing effort. They maintain high suspicion for spinal cord injury in any baby with breathing difficulties, abnormal muscle tone, weakness, or absent reflexes, especially following a difficult delivery.

Imaging Studies

MRI (magnetic resonance imaging) is the gold standard for diagnosing spinal cord injury. It can reveal hemorrhage, bruising, swelling, or complete disruption of the cord. MRI is especially critical in SCIWORA cases, where other imaging appears normal but the spinal cord has still been damaged.

CT scans help identify fractures or dislocations of the bones and are often performed first in the acute setting.

Ultrasound can provide rapid initial screening information.

Plain X-rays with special positioning (flexion and extension views) help assess whether the spine is stable or prone to further injury.

Distinguishing From Other Conditions

Because spinal cord injury can look similar to several other serious newborn problems, doctors sometimes need imaging of both the brain and spine to make an accurate diagnosis. Conditions that can mimic spinal cord injury include:

• Hypoxic-ischemic encephalopathy (brain damage from oxygen deprivation)
• Brachial plexus injury (nerve damage affecting the arm)
• Spinal muscular atrophy or congenital muscle diseases
• Severe infection (sepsis)
• Structural abnormalities of the brain or spinal cord present from birth

Careful evaluation helps ensure the correct diagnosis guides treatment.

What Treatment Options Are Available for Newborns With Spinal Cord Injuries?

There is currently no cure for spinal cord injury in newborns. Treatment focuses on preventing further damage, supporting the baby’s vital functions, managing complications, and beginning rehabilitation as early as possible.

Immediate Stabilization

The first priority is keeping the baby alive and stable:

• Airway and breathing support: Many babies with high cervical injuries require a ventilator to breathe. Some can eventually be weaned off mechanical support, but others remain ventilator-dependent throughout their lives.

• Spinal immobilization: The baby’s neck must be carefully immobilized to prevent any additional injury while doctors determine the full extent of damage. This typically involves positioning aids like sandbags or specially designed supports, as standard equipment used for adults is not appropriate for newborns.

• Intensive care monitoring: Babies receive comprehensive NICU support, including help with feeding (often through a tube initially), temperature regulation, and prevention of secondary complications like pressure sores or infections.

Specific Medical Interventions

Research on acute treatment for neonatal spinal cord injury remains limited. Several approaches have been tried:

• Corticosteroids: Some doctors have used medications like dexamethasone in the immediate aftermath of injury, hoping to reduce inflammation and swelling. Results have been inconsistent, and there is no established protocol for routine use.

• Therapeutic hypothermia: When babies have both spinal cord injury and brain injury from oxygen deprivation, some have received cooling therapy. While this treatment is established for brain injury, its benefit for the spinal cord itself remains unclear.

• External bracing: Babies with fractures or unstable alignment may need custom-fabricated braces to support the spine while healing occurs. Standard halo vests and other adult equipment cannot be used safely in newborns.

• Surgery: Surgical stabilization is rarely performed in the newborn period because of the infant’s small size and immature anatomy. Surgery is reserved for extreme cases of instability or bone displacement that cannot be managed any other way.

Rehabilitation and Ongoing Care

Babies who survive the initial injury need immediate and continuing multidisciplinary support:

• Physical and occupational therapy: Early intervention helps maintain joint range of motion, prevent muscle contractures, promote whatever functional movement is possible, and support overall development.

• Respiratory care: Some babies need ongoing ventilator support or assistance clearing secretions from their lungs. Respiratory therapists become essential team members.

• Nutritional support: Many babies struggle with feeding and require tube feeding initially. Some eventually learn to eat by mouth with therapy.

• Bladder and bowel management: As children grow, developing a bowel and bladder routine becomes increasingly important for health and dignity.

• Developmental monitoring: Regular follow-up tracks cognitive, social, and emotional development alongside physical progress, connecting families with early intervention services as needed.

Emerging approaches like activity-based therapy and locomotor training show promise in some pediatric spinal cord injury cases, though research in the neonatal population specifically remains limited.

What Is the Long-Term Outlook for Babies With Birth-Related Spinal Cord Injuries?

The prognosis varies dramatically based on the level and completeness of the injury.

Mortality

Birth-related spinal cord injury carries a high mortality rate. Upper cervical injuries and complete cord damage are especially likely to be fatal. Many affected babies die in the first days or weeks of life from respiratory failure. The true impact may be even higher than reported, as autopsy studies suggest spinal cord injury contributes to a substantial number of unexplained newborn deaths.

Outcomes for Survivors

Among babies who survive the newborn period:

• Those with complete upper cervical injuries typically remain ventilator-dependent and have severe quadriplegia. Long-term survival is limited even with aggressive support.

• Babies with incomplete injuries or damage at lower spinal levels have better prospects. Many show partial or even significant recovery with early intervention and ongoing rehabilitation.

• Some infants with initially mild or incomplete injuries make remarkable progress, particularly when therapy begins early and continues consistently.

The infant nervous system has considerable capacity for adaptation and recovery, especially in the first years of life. However, the spinal cord itself has limited ability to regenerate once damaged.

Long-Term Health Challenges

Children who survive neonatal spinal cord injury often face ongoing medical complications:

• Spinal deformity: Scoliosis (sideways curvature of the spine) develops in nearly all children injured before their bones mature, often severe enough to require surgery.

• Hip problems: Abnormal hip development is common and may need surgical correction.

• Chronic breathing difficulties: Even children not on ventilators may have reduced lung capacity and frequent respiratory infections.

• Bladder and bowel dysfunction: Recurrent urinary tract infections and difficulties with bladder control require ongoing management.

• Bone health: Weak bones (osteoporosis) can develop early, increasing fracture risk.

• Pressure sores: Areas of skin breakdown require vigilant prevention and treatment.

• Developmental delays: Many children need educational support and services as they grow.

Life expectancy for children with spinal cord injury is reduced compared to typically developing children, but varies significantly depending on injury severity and available medical care.

Can Birth-Related Spinal Cord Injuries Be Prevented?

Not all birth-related spinal cord injuries are preventable, but advances in obstetric care have significantly reduced their occurrence.

Prenatal Detection and Planning

Modern prenatal care includes:

• Routine ultrasound examinations to identify breech position, estimate fetal weight, and detect anatomical abnormalities

• Management of high-risk pregnancies in facilities equipped with Level III or IV NICUs

• External cephalic version: ACOG (American College of Obstetricians and Gynecologists) recommends offering this procedure to turn breech babies to head-first position before labor begins, when it can be done safely

Safe Delivery Practices

Several evidence-based approaches reduce injury risk:

• Avoiding vaginal breech delivery when risk factors are present, such as a hyperextended fetal head, estimated large size, or delivery in a facility without appropriate resources
• Using vacuum and forceps judiciously, following established protocols, and proceeding to cesarean delivery if instrumental extraction is not progressing safely
• Performing cesarean delivery promptly when indicated by failed labor progress or concerning fetal status
• Following established protocols for shoulder dystocia, which reduce traction injuries to both the spine and the brachial plexus nerves
• Immobilizing the cervical spine immediately at birth if injury is suspected

Regionalized Perinatal Care in New York

New York State maintains a system of Regional Perinatal Centers designated by the Department of Health. These Level IV facilities provide the highest level of maternal-fetal and neonatal care, with expertise in managing complicated deliveries, immediate advanced resuscitation, and specialized NICU care for seriously injured babies.

Major Regional Perinatal Centers include NewYork-Presbyterian (both the Columbia and Weill Cornell campuses), Mount Sinai Kravis Children’s Hospital, NYU Langone, Stony Brook University Hospital, and Albany Medical Center. This regionalized system helps ensure that the highest-risk deliveries occur in facilities with the resources and expertise to minimize complications and respond rapidly when problems arise.

How Is Spinal Cord Injury Different From Brachial Plexus Injury?

Brachial plexus injury often comes up in discussions of birth injuries because it can also cause arm weakness and may occur during similar types of difficult deliveries. However, these are distinct conditions with different implications.

The brachial plexus is a network of nerves running from the neck through the shoulder and into the arm. When these nerves are stretched, compressed, or torn during delivery (usually during shoulder dystocia or breech extraction), the result is weakness or paralysis of the affected arm. The two main types are Erb-Duchenne palsy, affecting the shoulder and elbow, and Klumpke palsy, affecting the hand and forearm.

Most brachial plexus injuries involve stretching rather than tearing and recover spontaneously within three to six months. Some require physical therapy, splinting, or occasionally surgery, but the prognosis is generally favorable.

Spinal cord injury is fundamentally different and more serious. It involves damage to the central nervous system itself rather than peripheral nerves. Recovery is typically more limited, and the impact on breathing, multiple limbs, and body systems can be profound and permanent.

What Resources and Support Are Available for Families in New York?

Families dealing with birth-related spinal cord injury need access to specialized medical care, rehabilitation services, and community support. New York offers comprehensive resources across all these areas.

Specialized Medical Centers

New York’s major pediatric hospitals provide the highest level of neonatal neurology and rehabilitation services:

• NewYork-Presbyterian Morgan Stanley Children’s Hospital and Alexandra Cohen Hospital for Women and Newborns: Level IV NICUs, Regional Perinatal Centers, advanced neurologic care, ECMO support, therapeutic hypothermia programs, and comprehensive neonatal support

• Mount Sinai Kravis Children’s Hospital: Level IV NICU with specialized follow-up programs and family support groups

• NYU Langone Hassenfeld Children’s Hospital: Level IV NICU, comprehensive neonatal care programs, and spinal cord injury rehabilitation through Rusk Rehabilitation

• Albany Medical Center: Level III NICU with High-Risk Infant Follow-Up Program

• Stony Brook University Hospital: Regional Perinatal Center with Level III NICU

• NYC Health + Hospitals/Bellevue: Level I Trauma Center with spinal cord injury expertise and Regional Perinatal Center designation

Early Intervention and Rehabilitation Services

New York State’s Early Intervention Program provides developmental services for infants and toddlers with disabilities or delays at no cost to families. Services include physical therapy, occupational therapy, speech therapy, and developmental support tailored to each child’s needs.

Hospital-based rehabilitation programs and outpatient centers throughout the state offer specialized pediatric therapy. Some centers provide newer approaches like activity-based therapy and locomotor training for children with spinal cord injuries.

Support Organizations and Community Resources

Several organizations serve families affected by spinal cord injury:

• Greater New York Chapter, National Spinal Cord Injury Association: Offers peer support, information, and advocacy specific to the local community

• United Spinal Association: Provides peer support groups (including virtual options), advocacy, and practical resources

• Christopher & Dana Reeve Foundation: Maintains virtual support groups, educational materials, and resources designed specifically for families with children

• Burke Rehabilitation Spinal Cord Injury Support Group (White Plains): Local support and connection with other families

• Brain Injury Association of New York State: Offers support for families dealing with neurological injuries

• Kennedy Krieger Institute: Provides family-friendly educational materials explaining spinal cord injury to children

The National Institute of Child Health and Human Development (NICHD) also maintains comprehensive online resources about pediatric spinal cord injury.

Moving Forward With Information and Support

Birth-related spinal cord injury represents one of the most challenging complications a family can face. While these injuries remain rare, their impact on a child’s life and a family’s journey is profound. Understanding what happened, recognizing the signs early, and accessing appropriate specialized care can make a meaningful difference in outcomes.

NYBirthInjury.com exists to provide families with accurate, compassionate information about birth injuries and to help connect you with qualified medical and support resources throughout New York and beyond. Whether you’re seeking clarity about a recent diagnosis, looking for the right specialists, or trying to understand what services are available to support your child’s development, reliable information is an essential first step.

If your child has been diagnosed with a spinal cord injury related to birth, know that you are not alone. Medical teams across New York’s Regional Perinatal Centers and rehabilitation specialists throughout the state have experience supporting families through this journey. Community organizations and parent support groups can connect you with others who understand what you’re facing. While the road ahead may be difficult, connecting with the right resources and support can help you navigate it with greater confidence and hope.