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A multi-disciplinary study of the ocular, orthopedic, and neurologic causes of abnormal head postures in children
Paolo Nucci1, Burton J Kushner, Massimiliano Serafino
1Pediatric Ophthalmology & Strabismus Unit San Paolo Hospital University of Milan, Italy.
Insights
Orthopedic and ocular disorders are the most common causes of abnormal head postures in children. A multidisciplinary evaluation is recommended when the cause is unclear.
Area of Science:
- Pediatric Neurology
- Pediatric Ophthalmology
- Pediatric Orthopedics
Background:
- Abnormal head posture in children can stem from various underlying medical conditions.
- Determining the precise etiology is crucial for effective management and treatment.
Purpose of the Study:
- To ascertain the comparative prevalence of orthopedic, ophthalmologic, and neurologic origins of abnormal head postures in pediatric patients.
- To investigate the frequency distribution of specific causes within these medical specialties.
Main Methods:
- A prospective, consecutive case series design was employed.
- Sixty-three children with abnormal head posture underwent comprehensive evaluations.
- Specialists included pediatric ophthalmologists, orthopedic surgeons, and neurologists.
Main Results:
- Orthopedic disorders were the most frequent cause (35 cases), primarily congenital muscular torticollis (31 cases).
- Ophthalmologic disorders were the second most common (25 cases), with superior oblique muscle palsy being the leading cause (12 cases).
- Neurologic disorders accounted for 5 cases, and 8 patients had no identifiable cause.
Conclusions:
- Orthopedic and ophthalmologic conditions are the predominant causes of abnormal head posture in children.
- A collaborative, multidisciplinary approach involving ophthalmology, neurology, and orthopedics is beneficial for diagnosing complex cases.
- Early and accurate diagnosis through specialist collaboration can lead to improved patient outcomes.
Purpose:
To determine the relative frequency that abnormal head postures in children are caused by orthopedic, ophthalmologic, or neurologic disorders, respectively.
Design:
A prospective, consecutive case series.
Methods:
Children found to have an abnormal head posture on routine pediatric examination underwent an evaluation by a pediatric ophthalmologist, pediatric orthopedist, and pediatric neurologist. The study was conducted in northwestern Italy.
Results:
In the 63 children evaluated, the cause of the abnormal head posture was orthopedic in 35, ocular in 25, and neurologic in 5. In 8 patients, no specific cause could be found. The most common orthopedic cause was congenital muscular torticollis, which accounted for 31 patients. The most common ocular cause was superior oblique muscle palsy, which accounted for 12 patients. In 2 patients neck muscle contracture suggested an orthopedic cause, however, the tight neck muscles were secondary to a head tilt caused by superior oblique muscle palsy.
Conclusions:
When the cause of an abnormal head posture is not obvious, a multi-disciplinary approach including ophthalmologic, neurologic, and orthopedic specialists may be helpful.
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