Positional asymmetry in an infant can be both a physiological condition that will even out over time, and a symptom of abnormal development or even severe pathology. Thanks to the early detection of asymmetry and the implementation of appropriate therapy, it is possible to stop its deepening and prevent the abnormal development of the child.

Infant positional asymmetryis a condition in which the child, despite reaching the age of three months, still shows structural or motor symptoms of lack of body symmetry.

An infant up to three months of age learns the skills of symmetrical anti-gravity activity, joining hands, converging eyeballs and aligning the head in the axis of the body.

The lack of noticeable progress in a child's development in this regard is an alarming factor. This may indicate a disturbance in muscle tone or positional asymmetry.

Symptoms of positional asymmetry

Each of us shows a functional asymmetry in our lives, which manifests itself in preference and using one arm and leg more often.

In the development of a child, it is extremely important to differentiate the symptoms of asymmetry within the range of physiology from those outside it.

They can often indicate symptoms of a serious pathology, sometimes even related to the central nervous system.

The symptoms described below should be of concern to parents if they persist for more than 3-4 months after the birth. We are talking then about pathological, permanent positional asymmetry.

Pay attention when you notice any of the following characteristics in your child:

  • the child looks to one side more often
  • has her preferred breast for feeding
  • puts one hand in his mouth more often, leaving the other straight and clenched into a fist
  • lay down on the back in the shape of a banana
  • turns from supine over one shoulder only
  • turns his head to one side more often while lying on his stomach
  • has a flattened head on one side

Causes of positional asymmetry

Determining the causes of postural asymmetry allows you to choose an appropriate treatment strategy, as well as to estimate the prognosis of its development.

Most commonthe causes of the asymmetry are:

  • physiological asymmetry that occurs in most infants and passes by the end of 2 months of life
  • improper care (laying on one side of the baby, constantly latching onto the same breast during feeding)
  • asymmetry of unknown origin
  • increased muscle tension as a result of perinatal complications
  • a reduced amount of amniotic fluid during pregnancy may cause the fetus to remain in one position for a long time
  • hearing or vision impairments lead to more frequent use of the part of the body on the side of the he althy eye or ear
  • perinatal damage to the brachial plexus, leading to sensory and movement disorders on the damaged side
  • joint and muscle contractures, including torticollis
  • scoliosis and structural disorders of the spine symmetry
  • hip dislocation
  • cerebral palsy
  • other neurological disorders causing impaired motor skills

Recognition of infant positional asymmetry

Infant positional asymmetry is a complex clinical problem that requires the involvement of specialists in various fields of medicine.

If you notice symptoms of asymmetry in your baby that last longer than 3-4 months, the first step is to see your GP.

The primary care physician may refer the child to specialists:

  • neurologist
  • orthopedic
  • physiotherapist
  • rehabilitation clinic

For the purposes of confirming asymmetry, some centers use the PodoBaby podoscopy stand.

It shows whether the infant placed on the device exerts an even and symmetrical pressure on the surface of the podoscope.

The finding of a child lying on its back with increased pressure on one of the sides, especially in premature babies, is associated with the asymmetric elongation of a given side of the body.

Treatment of infant positional asymmetry

The speed of development of a child in infancy and the possibility of consolidating adverse changes forces doctors to undertake early diagnosis and determine the method of treatment.

The nervous system shows the greatest plasticity up to the age of 3, which is why early diagnosis and treatment of children with asymmetry of neurological origin are so important.

With proper therapy, up to 95 percent of them have a chance of getting much closer to their normal state of symmetry.

The main point of treatment in most cases are the appropriate instructions for parents:

  • turns from tummy toback and vice versa - both through the right and left shoulder
  • showing the baby with his hand where his forehead, nose, mouth, heart are
  • alternate placing the baby in the crib
  • breastfeeding change
  • frequent laying on the tummy
  • correct diaper and clothes change
  • approaching the child from different sides
  • encouraging to play with both hands

The two most popular therapeutic methods used by rehabilitators in children with positional asymmetry are:

  • neurokinesiological, according to Vojta, which is based on the use of specific positions in the child and directing the movement of muscles in particular body parts. This leads to the use of muscles in a different way than during spontaneous activity and the formation of correct movement patterns in the child.
  • neurodevelopmental NDT-Bobath, which consists in regulating muscle tension, inhibiting abnormal reflexes and guiding movement by a physiotherapist close to normal.

The goal of rehabilitation treatment in infants with positional asymmetry is to obtain:

  • symmetry in the head-torso-pelvis axis
  • physiological weight distribution in different positions
  • possibility of symmetric support on the upper limbs
  • joint mobility
  • reduce muscle contractions

In most cases, children who have been diagnosed with asymmetry early and given appropriate treatment, notice a regression of asymmetry and tendency to develop properly.

This is why it is so important for parents to be vigilant in their daily play and care for their babies.

Bibliography:1. M. Borkowska, Z.Szwilng, NDT-Bobath method, 2nd Edition, Warsaw, PZWL Medical Publishing, 20122. H. Orth, Vojta Therapy, trans. P. Żukrowski, 2nd Edition, Wrocław, Elsevier Urban & Partner, 20133. J.Stępowska, A.Pudłowska, et al., Analysis of the distribution of tension in prematurely born muscles based on the PodoBaby study, [in] Postępy Rehabilitacji (4), ed. B.Molik, Warsaw, 2022, pp. 69-77 4. W.Kasprzak, Clinical physiotherapy, Warsaw, PZWL Medical Publishing, 20105. J.Szczapa, Neonatology, Warsaw, Medical Publishing House PZWL, 2015

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Pregnancy