The crooked attitude in children, jameda

The right therapy improves the child’s crooked posture (© S.Kobold – Fotolia)

The physical development is never completely symmetrical, the left and right half of the body are not mirror images. Everyone is familiar with left and right handedness, a preference for one leg to stand and jump, the so-called standing and ankle bone. However, there are often symmetry disorders in children.

Acquired crookedness

In the case of acquired misalignments, there are temporary ones such as the acute torticollis, caused by incorrect positioning or inflammatory changes in the muscles, small vertebral joints and after infections of the nasopharynx. In addition, there are malfunctions, so-called blockages, in the area of ​​the cervical spine. Rheumatic diseases, latent or clear squinting as well as a one-sided hearing disorder often justify the acquired crookedness of the head. Furthermore, there is a genetically caused crooked growth of the spine, the so-called scoliosis.

Inborn crookedness

Infants show an early, sometimes slight, but often clear asymmetry. We differentiate between asymmetry of shape (e.g. one-sided arm / leg shortening) and asymmetry of position. These are by far the most common form of crookedness. What is noticeable is often a bending of the trunk, a constantly asymmetrical posture of the arms or legs and a crooked posture of the head, possibly with deformation. In the recent past, the diagnosis of “KISS syndrome” has become fashionable. These are malfunctions of the cervical spine, which we will explain in more detail later, which justify the inclination of the baby.
The reasons for a crooked children can be diverse, however, and careful analysis is required before any therapeutic measures are taken.

Causes of a crooked baby can be:

  • positional deviations due to forced postures in the uterus
  • Bony malformations of the cervical spine (e.g. Klippel-Feil syndrome), which lead to a bony malposition
  • Paralysis (flaccid or spastic) due to nerve or brain damage e.g. due to lack of oxygen, bleeding or similar.
  • Malfunctions / injuries to the head nodal muscle
  • Disorders of eye motor skills in the sense of latent squint
  • Disorders of the balance organ
  • Unilateral hearing impairment
  • Functional disorders of the cervical spine mobility

This results in a crooked head of small to pronounced shape, with or without physical crookedness.

Symptoms of congenital obliquity

The symptoms of congenital obliquity can be very subtle and can often only be identified by searching for symptoms.
One should be alert when

  • the child has a one-sided preferred block direction and head rotation
  • while breastfeeding, the mother noticed that one side of the chest was preferred and on the other side, drinking problems often occurred.
  • One-sided hair rubbing is noticeable in the area of ​​the back of the head.
  • Skull deformities caused by unilateral position with unilateral flattening of the back of the head and later significant skull deformation with facial deformities occur already at birth or later.
  • during the spontaneous movement of the arms and legs, constant asymmetrical movement patterns are noticed.
  • these additional symptoms appear: maturation problems, sleep disorders, frequent screaming, stereotypical head movements, excessive drooling, frequent vomiting. Occasionally, these symptoms are related to congenital obliquity, but are not meaningful for the diagnosis.
  • in children and adolescents there is a slanted head, a slanted shoulder and a slanted pelvis.
  • when bending forward there is a bulge on the side of the spine, in the lower back as a lumbar bulge or in the area of ​​the lower back as a rib hump. This is an indication of a curvature of the spine.
  • the side slope of the fuselage is asymmetrical.

A detailed diagnosis

A detailed medical history is required to make the diagnosis. It is necessary for the doctor to know whether:

  • it is a spontaneous birth
  • There were difficulties (forceps birth or similar)
  • the child showed abnormalities immediately after birth or later
  • there were problems during pregnancy (e.g. viral infection of the mother).

The child is then inspected. Particular attention is paid to the spontaneous movement patterns of the arms and legs: are there any abnormalities due to a stiff, cramped movement of an arm or leg, are there mostly flaccid movements or immobility? Both a significantly increased muscle tension and a reduced muscle tension can be indications of damage to the nervous system with hidden paralysis or spasticity. The mobility of the eyes, especially with regard to squinting and the opening of the eyes, is assessed. If the child turns the head on both sides, preferably tilts to one side, the trunk is kept straight or bent?

After this inspection, the manual examination is carried out. First the skull shape and the cranial muscle are scanned. The doctor then examines the spine as well the mobility. Only now is the segmental manual therapy examination of the individual vertebral joints, especially the upper head joint, taking place.

Finally, there is a review of the age-related statomotor development, i.e. movement patterns and reflex patterns that are typical of the age are checked. If there are abnormalities in the area of ​​the spine or in the area of ​​the muscles, additional imaging measures are required. For the diagnosis of muscular diseases, e.g. damage to the head nodal muscle, an ultrasound examination is suitable. In the event of malfunctions of the spine, especially the cervical spine, bony malformations of the cervical spine (wedge vertebrae, grown vertebrae or malformations) must be excluded. This is done by means of an X-ray of the cervical spine that is specially tailored to the infant and provided with a high level of protection.

If abnormalities occur during the pediatric orthopedic examination, which suggest a spastic or flaccid paralysis or damage to the brain, a pediatric neurological examination must be supplemented. In the event of eye symptoms or suspected hearing impairment, an ophthalmological or ENT medical examination follows.

treatment options

Each diagnosis is followed by a different therapy.

  1. Positional misalignments of the head are caused by one-sided addressing of the child, e.g. easy and quick to treat through mutual feeding, addressing and awakening the child’s attention as well as through adapted storage.
  2. Damage to the head nodal muscle is caused by a consistent asymmetric response and attention excite the child and treated with consistent physiotherapy treatment. This treatment must be carried out consistently until it heals. Chirotherapy, osteopathy, neck orthoses or similar are not required here.
  3. Has there been no clear regulation of the muscle tension of the head cracker by the end of the 1st year of life, i.e. if there is a further severe shortening on one side, minimal surgical intervention takes place in the area of ​​the insertion of the muscle. This releases the one-sided tension, so that the head is positioned in a central position. The intervention takes place around the 12th month of life.
  4. With bony malformations, i.e. Wedge vertebrae, adhesions of the bony structures or severe malformations cannot be completely eliminated. The doctor must inform the parents that even after the growth has ended, more or less severe crookedness remains.
  5. Heaviest forms such as the Klippel-Feil syndrome, which leads to a variety of undesirable developments in the area of ​​the cervical spine and the transition to the spine, can be partially corrected by surgery. Accompanying physiotherapy comparative therapy is required.
  6. Flaccid paralysis and spastic paralysis require predominantly neurophysiological physiotherapy as well as, if necessary, additional aids and orthotic equipment as well as continuous therapy, depending on the severity of the damage, often necessary during the entire growth.

The joint-induced symmetry disorder (KISS)

In the case of segmental dysfunction of the cervical spine e.g. a KISS child (KISS = head joint-induced symmetry disorder) is a common illness. Mainly due to the effects of force during birth or shortly after birth, there is a functional disorder, especially in the upper, so-called head joints. This is called a blockade. In these children, manual therapeutic treatment of the head-neck transition or the head joints is essential. It is important that a so-called "straightening" of the cervical spine is prohibited in babies! Special, gentle impulse techniques that are tailored to the baby are used, these are painless and safe for the child. The best-known forms of treatment are the Atlas treatment according to Arlen and the treatment according to Dr. Gutmann.

In addition, there is an adapted handling by the parents and a continuously adapted physiotherapy training with balancing the muscle tone. Deformations of the head, so-called skull deformities, are often accompanying symptoms. These are due to the one-sided pressure load, the posture of the head and the force acting on the soft head.

90% of all infant skull deformities heal spontaneously with adequate treatment. Severe deformations, which include facial asymmetry in particular, require additional positioning aids. The measurement of the head such as the 3D head scan or the planimetry of the head provide clues as to whether further aids, e.g. so-called head orthoses (= helmet) are required. This is necessary in less than 5% of the children. A mild and moderate skull deformity heals without or with a helmet.

This article is for general information only, not self-diagnosis and is not a substitute for a doctor’s visit. It reflects the opinion of the author and not necessarily that of jameda GmbH.

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