Position as a cause of deformity in children with cerebral palsy (1976)

Deformities in the child with cerebral palsy have been ascribed to muscle imbalance (Sharrard 1961) and increased tone (Pollock 1959) or to the type of cerebral palsy (Bobath and Bobath 1975). As far as we know, the position in which the child is nursed, especially during the first year of life, has not been considered as a cause of deformity. It is generally agreed that position in the postnatal period can be a cause of deformity in the normal baby. Paine (1961) suggested that plagiocephaly was caused by postnatal head posture, and Hay (1971) found that plagiocephaly was present in 10 percent of normal babies. Scott (1956) reported that infants commonly had lateral curvatures of the spine which could be seen on x-rays but not on clinical examination, all of which had resolved by the age of two years. Other asymmetries associated with plagiocephaly are unilateral fisting, asymmetrical groin creases, apparent shortening of one lower limb and asymmetry of gait (Robson 1968). We accept the asymmetrical deformities of plagiocephaly, unilateral bat ear, facial and thoracic asymmetry, pelvic obliquity and apparent shortening of one leg--some or all of which may be present in normal babies--as forming the 'squint' baby syndrome. Because asymmetrical deformities also occur in children with cerebral palsy, we thought it worthwhile to compare the pattern of deformity in a group of 'quint' but otherwise normal babies with a group of cerebralpalsied children with asymmetrical deformities to see if there is any relationship.