The most common signs that a baby may have suffered a birth injury fall into four categories: immediate post-delivery signs, neonatal-period signs, infancy signs, and missed developmental milestones. These may include a low Apgar score, need for resuscitation, seizures within 24 hours, feeding difficulties, abnormal muscle tone, irregular breathing, developmental setbacks, asymmetric movement, persistent reflexes, or missed milestones beyond 6 months. Any of these signs warrant immediate evaluation by a pediatrician.
While some birth injury signs are apparent right after delivery, others may appear gradually in the first few weeks or months of life. It can be hard for parents to know what is normal newborn behavior and what needs medical attention.
During such times, you shouldn’t panic. Instead, recognize patterns and get them checked. Early healthcare and legal resources are required to identify medical malpractice, file a case within strict time deadlines, preserve evidence, and secure compensation for long-term care.
Read on to learn more about signs of birth injury in babies and when they usually appear. Get an answer to a common parent question: how do you know if your baby has a birth injury? And more insights.
The Four Categories of Birth Injury Signs Parents Should Know
Birth injury signs are easiest to understand when they are grouped by when they appear. Parents must understand the distinction between a symptom in the delivery room that may point to a different type of concern and a developmental delay noticed months later. If you suspect a birth injury, watch for signs in these four categories.
- Post-Delivery Signs Within 24 Hours: A low Apgar score, resuscitation, therapeutic hypothermia, seizures, poor breathing, or low oxygen levels. AAP and ACOG describe a 5-minute Apgar score of 0 to 3 as low, but it must be reviewed with the full medical picture.
- Neonatal-Period Signs Within First 4 Weeks: These include feeding trouble, poor suck-swallow coordination, abnormal muscle tone, irregular breathing, severe jaundice, scalp swelling, or a high-pitched cry.
- Infancy Signs From 1-6 Months: There is stiffness, floppiness, poor head control, one-sided movement, clenched fists, scissoring legs, or reflexes that last too long.
- Missed Milestones Clearer After 6 Months: The CDC advises parents to track milestones and talk to a doctor about concerns.
Although these symptoms don’t always prove a birth injury, they deserve a medical review.
Immediate Post-Delivery Signs (First 24 Hours)
The first 24 hours matter because serious birth-related problems, such as oxygen deprivation, neonatal encephalopathy, brain bleeding, or nerve injury, may show up quickly. These signs do not always prove that a preventable medical error happened, but they do show that the baby needs careful medical review.
Some signs of a possible birth injury may appear in the delivery room or during the first day. Parents may notice visible concerns like cuts, swelling, bruising, a misshapen head, or one arm moving less than the other. They should be checked. However, the most important early warning signs are found in the baby’s delivery records, vital signs, NICU notes, and neurological exam. Here are a few symptoms you should never ignore.
Low Apgar Scores
The Apgar score is a quick newborn check scored on a 0 to 10 scale done at 1 minute and 5 minutes after birth. It reviews heart rate, breathing, muscle tone, reflex response, and skin color.
- A 5-minute Apgar score of 7 to 10 is generally reassuring.
- A score of 4 to 6 is moderately abnormal.
- A score of 0 to 3 at 5 minutes is low and may be one early sign of neonatal encephalopathy.
- A low Apgar score alone does not prove oxygen deprivation or a birth injury. It must be reviewed with the full medical picture.
Need for Resuscitation or Therapeutic Hypothermia
While some newborns need help breathing right after delivery, resuscitation may be needed if the baby has poor breathing, a slow heart rate, low oxygen levels, or signs of distress.
- Needing resuscitation does not always mean the baby has a lasting injury, but it is an important event to review in the delivery record.
- Therapeutic hypothermia, also called brain cooling, is used for some newborns with moderate-to-severe hypoxic-ischemic encephalopathy.
- AAP guidance states that cooling works best when started within 6 hours after birth.
- A baby who receives cooling therapy should have close neurologic monitoring, imaging, and follow-up care.
Newborn Seizures
Newborn seizures may look like jerking, stiffening, lip-smacking, repeated eye movements, pauses in breathing, or movements that do not stop with gentle touch.
- Seizures in a newborn are never normal and need urgent medical evaluation.
- Some seizures are subtle and may only be found through NICU monitoring or EEG testing.
- AAP medical literature identifies hypoxic-ischemic encephalopathy (HIE) as the most common cause of neonatal seizures.
- Other possible causes include stroke, intracranial hemorrhage, infection, or metabolic problems.
- Parents should ask whether pediatric neurology follow-up is needed after discharge.
Neonatal-Period Signs (First 4 Weeks)
Many early signs of birth injury become apparent after the baby leaves the delivery room. During the first 4 weeks, parents may see problems with feeding, breathing, muscle tone, alertness, skin color, jaundice, or scalp swelling. These signs do not always mean a birth injury happened. They can also be linked to prematurity, infection, genetic conditions, low blood sugar, or normal newborn adjustment. Still, they should be taken seriously when they persist, worsen, or appear with other warning signs.
Feeding and Swallowing Difficulties
- Some newborns need time to learn feeding, especially if they were premature or had a difficult delivery.
- Feeding trouble becomes more concerning when the baby cannot latch, tires quickly, coughs or chokes during feeds, or has trouble coordinating suck and swallow.
- Poor feeding can be linked to abnormal muscle tone, neurologic injury, prematurity, infection, or an anatomic issue.
- Parents should call the pediatrician if feeding problems last beyond 2 weeks, the baby is not gaining weight well, or the baby is unusually sleepy during feeds.
- Feeding concerns should be evaluated sooner if they appear with jaundice, breathing problems, seizures, limpness, stiffness, or poor alertness.
Abnormal Muscle Tone, Floppy or Stiff
- A floppy baby may feel limp when held, slip through the hands, rest with loose “frog-leg” posture, or struggle with feeding and head control.
- A stiff baby may arch backward, keep the fists clenched, hold the legs tightly, or show scissoring of the legs.
- Mild tone differences can improve, but persistent floppiness or stiffness should be checked.
- Abnormal tone may be linked to HIE, cerebral palsy, nerve injury, infection, genetic conditions, or other neurologic problems.
- ACOG and AAP note that neonatal encephalopathy can have multiple causes, so doctors must review the full medical picture before linking symptoms to an intrapartum event.
Irregular Breathing or Color Changes
- Irregular breathing may include repeated pauses, grunting, flaring nostrils, fast breathing, or pulling in around the ribs.
- Color changes may include blue lips, gray skin, poor color, or a baby who looks pale and weak.
- These signs may point to low oxygen levels, infection, heart or lung problems, seizure activity, or neurologic injury.
- Occasional brief changes can happen in newborns, but repeated breathing pauses or blue color are not signs to watch for at home.
- Parents should seek emergency care if the baby turns blue, has repeated pauses in breathing, struggles to breathe, becomes hard to wake, or feeds poorly with color changes.
The table below groups the most common signs by timing, possible concern, severity, and when parents should seek medical evaluation.
| Sign | When It Typically Appears | What It May Indicate | Severity Indicator | When to Seek Evaluation |
| Low Apgar score of 3 or less at 5 minutes | First 5 to 10 minutes after birth | Severe newborn depression or possible HIE | A 5-minute score of 7 to 10 is reassuring. A score of 4 to 6 is moderately abnormal. A score of 0 to 3 is low and may be an early sign of encephalopathy | Ask the care team if HIE evaluation, MRI, or neurology follow-up is needed |
| Need for resuscitation or brain cooling | Minutes to hours after birth | Oxygen deprivation or suspected moderate-to-severe HIE | Therapeutic hypothermia is used for selected newborns with moderate-to-severe HIE. | Ask about cooling criteria, MRI results, and neurology follow-up before discharge. |
| Newborn seizures | Usually first 24 to 72 hours | HIE, stroke, brain bleeding, infection, or metabolic problems | Newborn seizures are always abnormal and need urgent evaluation. | Seek emergency care or confirm NICU and neurology follow-up. |
| Feeding or swallowing difficulty | First days to 4 weeks | Oral-motor difficulty, abnormal tone, neurologic injury, prematurity, or anatomy issue | More concerning if it lasts beyond 2 weeks, causes poor weight gain, or requires tube feeding. | Call the pediatrician if feeding remains difficult or weight gain is poor. |
| Floppy muscles | Newborn period through early infancy | Hypotonia, HIE, neuromuscular disorder, infection, or central nervous system injury | Concerning if the baby feels limp, slips through the hands, or has poor head control. | Ask for evaluation if floppiness persists at 1 to 2 months or appears with feeding trouble. |
| Stiff muscles | Often clearer by 1 to 6 months | Spastic cerebral palsy, neurologic injury, or brain malformation | Concerning if legs scissor, fists stay clenched, or the body arches often. | Ask for evaluation if stiffness persists or worsens. |
| Irregular breathing or color changes | First days to 4 weeks | Low oxygen, heart or lung problem, seizure activity, infection, or neurologic concern | Blue lips, repeated pauses in breathing, or gray skin are urgent signs. | Seek emergency care for blue color, repeated breathing pauses, or poor responsiveness. |
| Bulging or tense fontanelle | Any time in newborn period | Increased pressure, bleeding, infection, or hydrocephalus | A firm or bulging soft spot when calm and upright is serious. | Seek immediate medical evaluation. |
| Severe or worsening jaundice | Often days 2 to 5 | High bilirubin, with risk of kernicterus if untreated | Jaundice in the first 24 hours, worsening after day 3, or spreading below the chest is concerning. | Seek same-day care if jaundice worsens, feeding is poor, or the baby is very sleepy. |
| Misshapen head or scalp swelling | Minutes to days after birth | Molding, caput, cephalohematoma, subgaleal bleeding, or skull injury | Rapidly expanding, boggy swelling is an emergency. | Seek urgent care for fast-growing swelling, paleness, weakness, or poor feeding. |
| High-pitched cry | First days to weeks | Neurologic irritation, infection, jaundice complication, or withdrawal | Concerning if shrill, persistent, and difficult to console. | Call the pediatrician the same day if paired with poor feeding, fever, jaundice, or lethargy. |
| Asymmetric arm or leg movement | Birth through early infancy | Brachial plexus injury, fracture, stroke, or nerve injury | Limp arm, weak grip, or one-sided movement needs review. | Ask for prompt evaluation if one arm or leg moves less than the other. |
| Persistent primitive reflexes | Usually noticed at checkups | Cerebral palsy, motor delay, or neurologic injury | Moro, palmar grasp, or other reflexes lasting too long may be concerning. | Ask about evaluation if reflexes persist beyond expected age. |
| Poor head control | Around 2 to 4 months | Hypotonia, motor delay, cerebral palsy, or neuromuscular concern | Concerning if the baby cannot lift or steady the head by 4 months. | Ask about pediatric evaluation and early intervention referral. |
| Missed motor milestones | 6 months and beyond | Motor delay, cerebral palsy, or central nervous system injury | Not rolling, sitting, or reaching as expected may need review. | Ask the pediatrician about developmental screening and referrals. |
Infancy Signs (1 to 6 Months)
Some symptoms of birth injuries become clearer after the newborn stage, when parents can compare daily movement, feeding posture, and early motor control. From 1 to 6 months, the most useful signs to watch are body symmetry, reflexes, and head control. For example, the CDC reports that cerebral palsy is the most common motor disability in childhood and affects about 1 in 345 children in the United States. Let’s discuss some of the most common signs that may appear during this time.
Asymmetric Movement
- One arm or leg moves less than the other.
- One hand stays clenched while the other opens.
- The baby favors one side during kicking, reaching, or turning.
- Consistent hand preference before 12 months should be discussed with a pediatrician.
- Possible causes include brachial plexus injury, fracture, perinatal stroke, nerve injury, or cerebral palsy.
Persistent Primitive Reflexes
- Newborn reflexes should fade as the nervous system develops.
- Reflexes that remain strong may affect reaching, rolling, feeding position, or movement control.
- Persistent reflexes can be linked to cerebral palsy, motor delay, or neurologic injury.
Difficulty Holding Up the Head
- Poor head control may appear during tummy time or when the baby is held.
- CDC lists steady head control as a 4-month milestone.
- Ask for evaluation if head control remains poor by 4 months.
Missed Developmental Milestones (6+ Months)
After 6 months, birth injury concerns may become clearer through missed motor milestones. Parents may notice that the baby is not rolling, sitting, reaching, crawling, or using both sides of the body evenly. Some babies may also show poor balance, weak coordination, excessive drooling, or trouble eating as they get older.
CDC’s revised 2022 developmental milestone checklists include milestones that most children, about 75% or more, are expected to reach by a certain age. Parents should track milestones and speak with a doctor if a baby is missing skills, losing skills, or showing delays across more than one area.
Missed milestones don’t prove birth injury because they may be linked to prematurity, genetic conditions, infection, or other medical issues. Still, delayed movement, poor coordination, or uneven development after 6 months should be evaluated early so the child can receive support if needed.
Learn How to Detect Infantile Spasms
Early detection is crucial for treating birth injuries before they get worse. One possible symptom that’s particularly difficult to detect is infantile spasm. PA Homepage posted a story that talks about the condition and how you can detect it. Infantile spasms affect 1 in 2000 children under the age of one and are considered a medical emergency. It is a subtle form of seizure.
However, it’s often misdiagnosed as colic or hiccups. It can be caused by a brain injury during birth but also by metabolic or genetic disorders. Occasionally, it can be detected prior to birth. We suggest readers look at the video linked in the article to see examples of babies during a seizure.
If you see your baby doing things like this, it is recommended that you videotape the seizure with a smartphone, then take your baby and the video to a doctor for a diagnosis. Since these seizures appear randomly, a video will help the doctor see what is happening. Furthermore, if your child receives a misdiagnosis, the video will serve as valuable evidence.
There are several treatments for the condition, depending on the reason for the seizures. However, without diagnosis and treatment, the seizures can lead to lifelong damage. See a doctor if your child moves like the children in the videos.
When to Take Your Baby to the Pediatrician
Call your baby’s pediatrician whenever a symptom feels persistent, unusual, or different from your baby’s normal pattern. Parents don’t need to prove a birth injury before asking for help. If you notice the following signs, seek medical advice sooner rather than later.
- Feeding trouble that lasts, worsens, or affects weight gain.
- Stiffness, floppiness, poor head control, or one-sided movement.
- Repeated breathing pauses, blue lips, gray skin, or poor color.
- Seizure-like movements, unusual eye movements, or repeated stiffening.
- Severe jaundice, unusual sleepiness, or a high-pitched cry.
- Missed milestones, loss of skills, or delays in more than one area.
The CDC advises parents to track how a child plays, speaks, acts, and moves, then share concerns with a doctor at every checkup. AAP Bright Futures uses developmental surveillance during preventive care visits to help pediatricians review milestones, listen to parent concerns, and decide whether a child needs screening or referral.
When Birth Injury Signs May Point to Preventable Medical Errors
Birth injury signs may raise legal concerns when they appear after a difficult labor, delayed response, or poor newborn monitoring. A symptom alone does not prove malpractice, but the full timeline may show whether preventable harm occurred because the proper standard of care wasn’t provided.
- Warning patterns or signs to look for if you suspect birth injury.
- Abnormal fetal heart tracings that were not addressed.
- Delayed C-section despite signs of fetal distress.
- Prolonged oxygen deprivation before or during delivery.
- Failure to treat severe jaundice, infection, or low blood sugar.
- Improper use of forceps, vacuum extraction, or excessive traction.
- Missed signs of shoulder dystocia, brain bleeding, or newborn seizures.
- Lack of follow-up after low Apgar scores, resuscitation, or brain cooling.
ACOG and AAP explain that neonatal encephalopathy can have several causes, so doctors must review the full clinical picture, including Apgar scores, cord blood gases, imaging, organ injury, before linking injury to an intrapartum event.
Medical records can help show what happened, when warning signs appeared, and whether care met accepted standards.
You May Be Entitled to Compensation
If your child suffered a birth injury caused by another party, you may be able to recover compensation. There are a variety of damages you will likely be able to claim, depending on the specific details of your case. Identifying the exact damages that apply is essential for recovering the full amount to which you are entitled.
Fortunately, when you hire an experienced birth injury lawyer to help you on your case, they will be able to easily determine what damages apply. Some of the birth injury damages most frequently recovered include:
- Permanent disability
- Emotional distress
- Pain and suffering
- Mental anguish
- Medical bills
- Future medical expenses
- Decreased quality of life for you and your child
- Lost wages for time missed from work to provide additional care for your child
- Lost future income that your child’s birth injury will likely prevent them from earning
Furthermore, a small percentage of birth injury cases also qualify for punitive damages. These damages are used to punish the liable party for the role they played in causing your child’s injury. An experienced attorney will be able to determine whether these damages are available in your case.
Be Sure to File Your Lawsuit on Time
When attempting to recover compensation through a lawsuit, it is critical that you check the medical malpractice statute of limitations for the state in which you are filing. Whatever amount of time you have, the clock will begin running from the time that you become aware of your child’s injury or when you reasonably should have become aware of the injury.
If you fail to file your lawsuit on time, you will likely be unable to recover compensation. Of course, there are exceptions that apply in some cases. Additionally, if you don’t recover compensation while your child is still young, they will be able to file themselves when they turn 18, upon which date the clock for the statute of limitations will begin to run.
Birth Injury Symptoms Lawsuit
It can be concerning when you notice birth injury symptoms in your son or daughter. An attorney can help you correctly assign liability for your child’s birth injury and understand your potential for a successful lawsuit.
To discuss your child’s birth injury, medical expenses, and potential financial compensation, call the Birth Injury Lawyers Group or contact us online to connect with a lawyer in your state. We offer free consultations, so don’t hesitate to get started today.