When you break a bone, you can set it in the proper position and it will heal. When you get a cut, your skin will heal. When you damage a nerve, the process is not so easy. Nerve cells don’t heal the same way the rest of your body does. That makes treatment for nerve damage difficult. Severe damage is usually irreparable.
Some babies will suffer nerve damage due to trauma from the delivery process or due to a birth defect. Let’s take a look at how those injuries are treated.
Treating Nerve Damage Due To Trauma
Babies are at risk for nerve damage during delivery if the doctor needs to twist or pull on the baby to ease the passage through the birth canal. That’s a tight fit even in ideal circumstances, but a breech (feet-first) position or a high birth weight can cause the baby to get stuck along the way. Leaving the baby stuck in the birth canal for more than a few minutes is dangerous because the baby can’t breathe and the umbilical cord is too compressed to deliver oxygenated blood. That lack of oxygen can cause brain damage. Unfortunately, twisting and pulling the baby comes with its own risks – nerve damage.
Damage to the cranial nerves is most common. The cranial nerves control everything above your neck – your face, eyes, tongue, ears, and jaw. Damage to these nerves can lead to facial paralysis. The good news is that most cranial nerve damage is minor. Most injuries are “neuropraxias,” where the nerves are stretched or compressed but not torn. A neuropraxia of the cranial nerve will generally heal on its own within a few weeks.
If the symptoms don’t clear up within a few weeks, that means the nerve may have actually ruptured or torn. In rare cases, surgery may be used to reconnect torn nerves. In most cases, surgical intervention is not appropriate. If the damaged nerves cause palsy of the eyes, injections of botulinum toxin (Botox) can ease the palsy and improve eye mobility. Corrective lenses can also increase vision and ease eye strain.
In rare cases, pulling on the baby during delivery can cause damage to the spinal cord. In most cases, this damage cannot be repaired. The baby may need treatment for secondary issues arising from the spinal cord injury, including pain management and physical therapy. Injuries to the spinal cord affect the body at and below the level of the injury. An injury to the lower back may affect the child’s ability to walk, necessitating physical therapy and mobility aids. Injuries higher on the spine may affect the child’s ability to breathe; these are usually fatal.
Trauma during delivery can also damage the brachial plexus nerves. For more information, check out the section on Brachial Plexus Injuries and Erb’s Palsy.
Treating Nerve Damage Due To Birth Defects
As with trauma, nerve damage due to birth defects is difficult to treat. In some cases, no treatment at all is possible. Birth defects that affect the nerves include neural tube defects and brain malformations.
Treating Neural Tube Defects
The “neural tube” is the part of the embryo that eventually develops into the brain and spinal cord. The tube starts as a groove and eventually closes over to make a complete tube. In some children, the tube doesn’t close completely. That leaves part of the spinal cord unprotected by the vertebrae of the spine. This is called “spina bifida.”
There are several different types of spina bifida. In “spina bifida occulta,” the skin closes over the hole in the spine. There may be a patch of hair or darker skin over the location of the hole. Most children don’t have any side effects from spina bifida occulta and don’t require any treatment. In fact, many cases of spina bifida occulta are never even diagnosed. In some cases, the spinal cord may become fused to the skin. Surgery is required to separate the nerves from the surrounding tissue. This surgery is difficult and may leave the child with damage to the spinal cord at the site of the hole.
“Spina bifida cystica meningocele” and “spina bifida cystica myelomeningocele” are more severe versions of the disease. In the first, the meninges and fluids from the spinal cord bulge out of the hole to form a “meningocele,” but the spinal cord is left in place. In the second, the spinal cord bulges out with the meninges and fluid to form a “myelomeningocele.” You will be able to see the bulge on the baby’s spine.
Your doctor will perform scans and testing to determine whether the bulge is a meningocele or a myelomeningocele. In either case, surgery will be required to return the contents of the bulge to their place in the spine and close up the hole in the spine. Children with meningoceles usually have some level of disability after the surgery. Children with myelomeningoceles are often severely disabled due to the damage to the spinal cord. In addition, these types of spina bifida are frequently accompanied by hydrocephaly, or fluid buildup in the brain that can cause pain, seizures, and brain damage.
Treating Brain Malformations
In most cases, brain malformations are not treatable. If your child has evident symptoms such as macrocephaly or microcephaly (a very large or very small head), an encephalocele (a hole in the skull through which part of the brain bulges), or obvious swelling, your doctor may order MRI scans and other tests to determine whether your child has a birth defect. In other cases, symptoms such as seizures or developmental delays appear later on, at which point a scan or test can point to a diagnosis.
In very rare cases, children are born with a condition called “anencephaly.” This occurs when the neural tube fails to close at the end. These children are born without large portions of their brains and skulls. Anencephaly is always fatal.
While brain malformations are often untreatable, they cause secondary conditions that do respond to treatment. Brain malformations commonly cause epilepsy, which can be controlled by anticonvulsant medication. Children with limited mobility may need mobility aids such as walkers and wheelchairs. Occupational therapy can help children learn strategies for tackling daily tasks and physical therapy can help strengthen their muscles and maintain joint flexibility.