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[Plagiocephaly associated with infant asymmetry]
1Kinderorthopädische Abteilung, Altonaer Kinderkrankenhaus, Kinderorthopädie, Universitätsklinikum Hamburg-Eppendorf, Bleickenallee 38, Hamburg. ralf.stuecker@kinderkrankenhaus.net
Insights
Infant asymmetry, often linked to plagiocephaly, can cause head rotation and neck muscle issues. Early intervention with positioning and physical therapy is key for managing posture and muscle tone imbalances in babies.
Area of Science:
- Pediatric neurology
- Developmental pediatrics
- Neonatology
Context:
- Infant asymmetry is commonly observed 2-4 weeks post-birth.
- It often develops secondary to plagiocephaly, characterized by unilateral occipital flattening.
- This flattening can lead to persistent head rotation and associated musculoskeletal changes.
Purpose:
- To describe the typical progression and clinical manifestations of infant asymmetry.
- To highlight the link between plagiocephaly and the asymmetric tonic neck reflex (ATNR).
- To outline current management strategies for infant postural and muscle tone imbalances.
Summary:
- Unilateral occipital flattening in infants causes head rotation, neck muscle shortening, and triggers the ATNR (fencer response).
- This results in increased facial muscle tone and decreased occipital tone, potentially leading to neck stiffness, scoliosis, and pelvic obliquity.
- Management involves early positioning, supervised 'tummy time,' and physical therapy.
Impact:
- Provides a clear understanding of the pathophysiology of infant asymmetry.
- Emphasizes the importance of early detection and intervention for plagiocephaly-related issues.
- Informs healthcare providers on conservative management approaches to address infant postural asymmetry and muscle tone imbalances.
Abstract:
The typical asymmetry in infancy is recognized 2-4 weeks after birth and follows the development of a plagiocephaly. The unilateral flattening of the occiput leads to a permanent rotation of the head to one side, shortening of neck muscles and a triggering of the asymmetric tonic neck reflex (ATNR), also known as fencer response. Subsequently a muscle tone increase is forming on the side of the face while a decrease in tone is seen at the occiput side. Clinical signs like increasing neck stiffness, flexible positional scoliosis and pelvic obliquity may ultimately develop. Management includes early positioning, tummy time and physical therapy if asymmetry of posture or muscle tone are present.
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