Clavicle fracture in newborns

How does this happen?

The collarbone runs from the breastbone to the shoulder and is the strut that holds the shoulder out from the body. During birth, the shoulder passes through the pelvis, and the collarbone takes the force.

Sometimes it breaks. This can happen when the shoulder is tight against the pubic bone, during a shoulder dystocia, during a breech delivery, or in an otherwise uncomplicated birth of a large baby. It can also happen deliberately: in a severe shoulder dystocia, breaking the collarbone is a recognized last-resort maneuver to free the shoulder, and it is preferable to the alternative. ³

A newborn's bone is different from an adult's. It is more flexible, it has a thick outer covering that holds the pieces in place, and it heals extremely fast. That combination is why treatment is usually nothing more than gentle handling. ¹

The lump that forms is new bone bridging the break. It appears within a couple of weeks, feels hard and alarming, and remodels away over months.

What causes it?

Two different questions get mixed together here. The first is what leads to this injury in the body. The second is whether anyone could have prevented it. They are not the same question, and the answer to the first does not settle the second.

Happens even with perfect care

• shoulder dystocia, including one that was managed correctly. ³
• A deliberate maneuver. Fracturing the clavicle is a recognized option in a severe shoulder dystocia when other maneuvers have not worked. In that situation the fracture is a solution, not a complication. ³
• A large baby, where weight cannot be estimated accurately before birth. ⁴
• breech birth, where the arms and shoulders are delivered under different forces. ⁵
• An uncomplicated vaginal birth, where these fractures also occur.
• Cesarean birth, in which clavicle fractures are less common but do happen.

Associated with gaps in care

These are situations where published standards say what the care team should watch for and do. A gap here does not prove anyone caused your child's injury. It points to where the medical records will have an answer.

• A shoulder dystocia managed outside the recognized sequence. ³
• The fracture not identified before discharge. A newborn examination before going home is standard practice, and an asymmetric startle or a lump over the collarbone should prompt assessment. ⁶
• A limp arm attributed to the fracture alone, without assessing for a brachial plexus injury. This is the error that matters most on this page, because the nerve injury has a treatment timetable and the fracture does not. ²
• Gestational diabetes not screened for or not managed, where it contributed to a large baby. ⁷
• The delivery not documented, including whether a shoulder dystocia occurred and what maneuvers were used.

Whether any of this amounts to a departure from the standard of care takes a physician expert reading the whole record. A clavicle fracture on its own is a common event and is frequently unavoidable.

What are the signs, by age?

Signs change as a child grows. A newborn cannot show you a walking problem. Some children look fine at first and show differences months later.

At birth and the first hours

• The baby cries or seems uncomfortable when that arm is moved or when they are dressed.
• Reduced movement of the arm on that side.
• An asymmetric startle response.
• Sometimes a grating feeling over the collarbone.
• Swelling or tenderness over the collarbone.
• Some fractures produce no signs at all and are found later.

The first week

• A hard lump appearing over the collarbone as new bone forms. This is healing, not a new problem. ¹
• Less discomfort as the days pass.
• If the arm remains completely limp, think about a nerve injury rather than the bone. ²

Around 3 months

• The lump is usually still present and starting to smooth out.
• Full arm movement should have returned.
• Persistent lack of movement at this point is a nerve question, not a bone question.

Around 6 months

• The lump is usually much less noticeable.
• No functional limitation expected.

Around 12 months

• The collarbone has usually remodeled and looks normal on examination.

Toddler years

• No expected effects from a newborn clavicle fracture.

School age

• No expected effects. A newborn clavicle fracture does not typically cause shoulder problems later in life. ¹

How is it diagnosed?

Often the diagnosis is made on examination: tenderness, a grating feel, reduced movement, or an asymmetric startle.

X-ray confirms it, and is usually done when the diagnosis is uncertain or when other injuries are suspected.

The essential second step is a careful assessment of arm nerve function. A baby with a clavicle fracture and a limp arm may have both a fracture and a brachial plexus injury. Check the shoulder, elbow, wrist and hand separately, and check for a droopy eyelid on that side. ^{2 1}

Some fractures are found weeks later, when a parent feels a lump. That is common and is not a sign of poor care. By that point the bone is already healing.

If a fracture is found in a baby with no clear birth-related explanation, or if there are multiple fractures, the team will consider other causes including bone fragility conditions. That is thoroughness rather than suspicion.

What is the treatment?

Usually nothing beyond comfort.

• Gentle handling. Support the arm and shoulder when lifting. Dress the affected arm first and undress it last.
• Pain relief as advised by your pediatrician for the first days.
• Pinning the sleeve to the front of the shirt is sometimes suggested to limit movement. Ask your team whether they recommend it, because practice varies.
• No cast, no splint, no surgery in the great majority of cases. Newborn bone heals fast and remodels well. ¹

If a brachial plexus injury is present alongside, that drives the plan, and it needs daily range of motion and specialist follow-up. ²

Follow-up is usually a check at a few weeks to confirm healing and full movement.

What is the long-term outlook?

Excellent. Newborn clavicle fractures heal completely, generally within weeks, and do not cause lasting problems with shoulder function or appearance once remodeling is complete. ¹

The lump of new bone is the part that worries families most, and it is the part that means healing is working.

Where the outlook is different, it is because of an accompanying nerve injury rather than the fracture. That is the reason this page keeps returning to the same point.

What does daily life look like?

A few weeks of careful handling: supporting the shoulder, dressing the sore side first, and settling the baby on the unaffected side.

Feeding positions may need adjusting for comfort.

After that, nothing. Most families forget about it within a couple of months except for the lump, which fades.

What does care cost over a lifetime?

A newborn clavicle fracture that heals normally generates almost no cost beyond the initial X-ray and a follow-up visit.

No agency publishes a cost estimate for this injury and this site does not invent one.

Where a brachial plexus injury accompanies it, the cost follows that injury. See brachial plexus injury.

What can you do this week?

1. Ask specifically whether the arm nerves were assessed, not just the bone.
2. Ask whether shoulder, elbow, wrist and hand were each checked.
3. Ask about a droopy eyelid or smaller pupil on that side.
4. Ask how to hold, dress and feed your baby comfortably.
5. Expect a lump. Ask what it should feel like and when it should fade.
6. Request the delivery note, including any shoulder dystocia documentation.
7. Book the follow-up check to confirm full movement has returned.

What should you ask each specialist?

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the pediatrician

• Was the arm nerve function checked separately from the bone?
• Is the hand gripping normally? Is the elbow bending?
• When should the lump appear and when should it fade?
• What pain relief, and for how long?
• When do we come back to check movement?

For the obstetric team

• Was there a shoulder dystocia, and what maneuvers were used?
• Was the clavicle fractured deliberately as a maneuver?
• Is all of that documented in the delivery note?

You can also build a printable list with the question generator.