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Updated: Apr 25, 2026

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Published on: March 27, 2026
High prevalence of early language delay exists among toddlers with neonatal brachial plexus palsy
Kate Wan-Chu Chang1, Lynda J-S Yang1, Lynn Driver2
1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
Insights
Neonatal brachial plexus palsy (NBPP) is linked to a higher prevalence of language delay in toddlers. Early identification and intervention are crucial for improving communication outcomes in children with NBPP.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Speech-Language Pathology
Background:
- Neonatal brachial plexus palsy (NBPP) primarily focuses on upper extremity motor recovery.
- Language development is often overlooked in the standard care for NBPP.
- No prior studies have reported an association between language impairment and NBPP.
Purpose of the Study:
- To investigate the prevalence of early language delay in toddlers diagnosed with NBPP.
- To explore potential NBPP-related factors associated with language development.
- To highlight the need for comprehensive developmental assessments in NBPP cases.
Main Methods:
- A cross-sectional pilot study involving 20 toddlers with NBPP (mean age 30 months).
- Utilized the Preschool Language Scale (4th edition) to assess language skills.
- Collected data on NBPP-related factors (palsy side, Narakas grade, etc.) and demographics.
Main Results:
- 30% of toddlers with NBPP exhibited language delay.
- This prevalence is significantly higher than the typical 5-15% in the general population.
- No specific NBPP-related factors were statistically analyzed for association in this pilot.
Conclusions:
- Toddlers with NBPP demonstrate a notably high prevalence of language delay.
- Further research with larger sample sizes is warranted to confirm these findings.
- Early language assessment and targeted interventions are essential for improving communication in this population.
Aim:
An association of language impairment with neonatal brachial plexus palsy has not been reported in the literature. The current treatment paradigm for neonatal brachial plexus palsy focuses on upper extremity motor recovery with little formal assessment of other aspects of development, such as language. We performed a cross-sectional pilot study to investigate early language delay prevalence in toddlers with neonatal brachial plexus palsy and potential neonatal brachial plexus palsy-related factors involved.
Method:
Twenty toddlers with neonatal brachial plexus palsy were consecutively recruited (12 males and eight females; mean age, 30 months). Preschool Language Scale Score (4th edition), demographics, and socioeconomic status were collected. Neonatal brachial plexus palsy-related factors such as palsy side, treatment type, Narakas grade, muscle Medical Research Council score, and Raimondi hand score were reported. Student t test, chi-square test, or Fisher exact test were applied. Statistical significance level was established at P < 0.05.
Results:
Of study participants, 30% had language delay, whereas the prevalence of language delay in the population with normal development in this age range was approximately 5-15%.
Interpretation:
We observed high language delay prevalence among toddlers with neonatal brachial plexus palsy. Although our subject sample is small, our findings warrant further study of this phenomenon. Early identification and timely intervention based on type of language impairment may be critical for improving communication outcome in this population.
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