Symptomatic asymmetry in the first six months of life: differential diagnosis

Abstract

Asymmetry in infancy is a clinical condition with a wide variation in appearances (shape, posture, and movement), etiology, localization, and severity. The prevalence of an asymmetric positional preference is 12% of all newborns during the first six months of life. The asymmetry is either idiopathic or symptomatic. Pediatricians and physiotherapists have to distinguish symptomatic asymmetry (SA) from idiopathic asymmetry (IA) when examining young infants with a positional preference to determine the prognosis and the intervention strategy. The majority of cases will be idiopathic, but the initial presentation of a positional preference might be a symptom of a more serious underlying disorder. The purpose of this review is to synthesize the current information on the incidence of SA, as well as the possible causes and the accompanying signs that differentiate SA from IA. This review presents an overview of the nine most prevalent disorders in infants in their first six months of life leading to SA. We have discovered that the literature does not provide a comprehensive analysis of the incidence, characteristics, signs, and symptoms of SA. Knowledge of the presented clues is important in the clinical decision making with regard to young infants with asymmetry. We recommend to design a valid and useful screening instrument.

Late neonatal presentation of reduced arm movement due to painful infective lymphadenopathy

“…It is possible that grossly enlarged lymph nodes in the axilla or neck could displace the nerves of the brachial plexus; this would more likely cause paraesthesia rather than pain for the babies, but such fine details of the history are impossible to gain due to the patients’ age. Both cases highlight the importance of infection with painful lymphadenopathy as a differential diagnosis in neonates presenting with reduced arm movement, as an addition to the more common diagnoses of clavicular fracture or brachial plexus injury caused by birth injury 2. In an older child, pain on movement can be elicited in the history, which can be easily missed in babies.…”

Repercussions of plagiocephaly on posture, muscle flexibility and balance in children aged 3–5 years old

“…Children were excluded from the study if they had a diagnosis or a previous history of prematurity, cranyosinostosis, developmental dysplasia of the hip, perinatal fracture of the clavicle, torticollis, obstetric brachial plexus palsy, central nervous system disorders, congenital abnormalities or malformations, disorders in sensory systems, acquired musculoskeletal or non‐musculoskeletal asymmetry, idiopathic scoliosis or a respiratory condition such as asthma. These conditions have reported to cause asymmetry or a postural adaptation . Concurrently, children without plagiocephaly of similar age, sex, height, weight and practising similar physical activity were recruited during well‐child visits at a nearby paediatrician's office and using word of mouth.…”

“…A relationship between the sleep position, position preference, motor development and nonsynostotic plagiocephaly has been previously shown . Neurodevelopmental delay has been observed in infants with nonsynostotic plagiocephaly, especially in motor function .…”

“…Asymmetry in infancy involves an abnormal shape of parts of the body or unequal postures and movements, showing a high prevalence . Nonsynostotic plagiocephaly is defined as a craniofacial deformity involving an asymmetric occipital flattening, ipsilateral frontal bossing and possibly facial asymmetry .…”

Congenital muscular torticollis – an over view of treatment methods

“…Objawy mogą ujawniać się miejscowo, tzn. dotyczyć określonego obszaru ciała (asymetria miejscowa), bądź dotyczyć całego ciała (asymetria uogólniona) [1][2][3]. Kręcz szyi zarówno wrodzony, jak i nabyty jest zaburzeniem miejscowym, które wpływa na motorykę niemowlęcia, często powodując wtórne zaburzenia o charakterze strukturalnym (deformacje części biernej aparatu ruchu) i funkcjonalnym (wtórne zaburzenia motoryki małej i dużej, zaburzenia sensoryczne).…”