Patterns of infantile postural asymmetry: A standardized video-based analysis

Objectives: Infantile scoliosis, plagiocephaly, torticollis, oblique body position, unilateral hip dysplasia, unilateral foot malposition, positional preference and/or restricted head rotation are features of infantile postural asymmetry (IPA) which becomes more prevalent since sleeping in the supine position is recommended for SID prevention. However, only few data addressing the entire symptom complex is currently available. Therefore a standardized video based analysis of patterns of IPA was performed.

Material and Methods: Forty-five asymmetric infants (27 male) with an asymmetry score of ≥ 12 points (scale 4–24) at a median post term age of 10 weeks (range 6–16) were video based analysed. Cervical rotation deficit (CRD) and trunk convexity (TK) as reactive movements to an orienting head turn in the prone and supine position were assessed by three independent observers using a 6 points- scale for each item (reliability: ICC 78%). Plagiocephaly, oblique body position and asymmetric foot position were descriptively assessed by consent of the same observers. The data for hip dysplasia was derived from sonography screening charts.

Results: The assessment of the reactive movements showed a “scoliosis“ pattern in 6 infants, a “torticollis“ pattern in 9 infants, a “mixed prone“ pattern in 13 infants and a “mixed“ pattern in 26 infants. Fifteen infants were able to decrease their CRD at dispense of the degree of convexity. Side agreement in the prone and supine position of TC and of CRD was only seen in 50% of the infants. Two thirds of these congruent infants showed a left-sided TC and a left-sided CRD. Plagiocephaly was present in 27 infants, oblique body position in 13 infants, strabism in 4 infants, hip dysplasia in 4 infants, calcaneus foot in 11 infants, adducted foot in one infant.

Conclusions: Our data shows that generalized asymmetry including functional and morphological features which may be focally accentuated is the most common clinical picture of IPA. This has to be considered by planning and evaluating specific diagnostic and therapeutic procedures.