Psychosocial Factors Are an Important Aspect of Parent and Patient-Reported Outcomes in Neonatal Brachial Plexus Palsy

Abstract

Neonatal brachial plexus palsy is a common occurrence. Some children have complete spontaneous recovery without long-term sequelae and others have life-altering functional limitations and appearance differences between their arms. The permanent nature of these limitations and appearance differences can be quite taxing to new parents who were expecting a “normal” newborn child. Beck1 interviewed twenty-three mothers of children with neonatal brachial plexus palsy and found that six themes emerged: “(a) In an Instant: Dreams Shattered; (b) The Arm: No Escaping the Reality; (c) Tormented: Agonizing Worries and Questions; (d) Therapy and Surgeries: Consuming Mothers’ Lives; (e) Anger: Simmering Pot Inside; and (f) So Much to Bear: Enduring Heartbreak.” The first theme, “In an Instant: Dreams Shattered,” identifies with the fact that these new parents have lost their “perfect” child. The loss of a “perfect” child can lead to a parent experiencing intrapsychic problems including mourning, regression, rage, and, ultimately, depression2. Depression has been shown to negatively correlate with self-reported upper extremity health status, specifically as measured by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire3. Ultimately, many parents of children with neonatal brachial plexus palsy may have underlying depression, or even posttraumatic stress disorder, following their intense experience of …