LGA

Nursing Management

1. If IDM, observe for potential complications 2. Monitor for, and manage, birth injuries and
complications of birth injuries.

a. Clavicle fracture

Confirm by x-ray.

Assess the infant for crepitus, hematoma, or deformity over the clavicle; decreased movement of arm
on the affected side; and asymmetrical or absent. Moro reflex.

Limit arm motion by pinning the infant’s sleeve to the shirt.

Manage the pain

b. Facial nerve injury

Assess for symmetry of mouth while crying.

Wrinkles are deeper on the unaffected side.

The paralyzed side is smooth with a swollen appearance.

The nasiolabial fold is absent.

If the eye is affected, protect it with patches and artificial tears.

c. Erb-Duchenne palsy and Klumpke paralysis

Erb-Duchenne palsy. Assess for adduction of the affected arm with internal rotation and elbow
extension. The Moro reflex is absent on the affected side. The grasp reflex is intact.

Klumpke paralysis. Assess for absent grasp on the affected side. The hand appears claw-shaped.