peds: plagiocephaly & torticollis Flashcards
5 possible causes of plagiocephaly
- mom has odd shaped uterus
- multiple births
- prematurity (since cranial bones aren’t strong yet)
- torticollis
- positioning
if plagiocephaly occurs in the womb, head goes back to normal w/i 6 weeks
3 craniofacial asymmetries caused by plagiocephaly
on flat side:
- ear more forward
- cheek and forehead more prominent & forward
- eyes not level
characteristic feature of plagiocephaly
parallelogram shaped head (from top_ and flattened occiput
when is repositioning most successful to reverse plagiocephaly?
first 3 months
will plagiocephaly self correct w/o intervention?
no!
skull growth
- primarily driven by growth of brain
- grows to 90% of adult size in the first year of life
- bones from mesenchyme tissue
craniosynotosis caused by... named for... clinical presentation (3) red flag
caused by premature closure of cranial sutures, genetic mutation
named for suture that causes deformity **most common is sagittal sutures
signs/symptoms
- craniofacial asymmetries present
- can cause increased cranial pressure
- affects brain development** (vs plagiocephaly which does not)
palpate for soft spot absences
torticollis
cause and nomenclature
presentation
caused by shortened SCM
named for shortened side
lateral flexion to affected side, rotation away from affected side
Congenital muscular torticollis (CMT) sternomastoid tumor (SMT) muscular torticollis (MT) postural torticollis (POST) positional preference
sternomastoid tumor (SMT): non-tender palpable SCM fibrous mass w/ tightness of SCM
muscular torticollis (MT): no palpable tumor but tightness of SCM
postural torticollis (POST): clinical features of CMT but no tumor or tightness
positional preference: baby spends too much time with head turned one way
three most common infant congenital disorders
- hip dislocation
- club foot
- torticollis
risk factors for torticollis (6)
- large birth weight
- multiple births
- breech
- 1st born
- forceps or vaccum delivery
- uterine abnormalities
these are all risks associated with plagiocephaly
what is the main cause for SCM torticollis?
SCM -non-tender fibrous palpable tumor can be caused by positioning in utero, or during labor and delivery
ocular torticollis
presentation
2 types of ocular muscle palsy that causes it
may present with signs of torticollis w/o cervical ROM deficits
ocular muscle palsy can cause this
- superior oblique palsy- baby tilts head away from weak eye
- lateral rectus palsy - baby tilts head towards affected eye
they do this for better alignment of eyes
osseous torticollis
2 causes
presentation
congenital anomalies such as:
- hemivertebrea vertebral formation failure
- klippel-feil syndome (segmentation failure)
presents with head tilt and can be associated with cervicothoracic scolosis
some developmental delays caused by torticollis (6)
- decreased head control
- limited visual tracking
- limited reaching on side
- preference for rolling only to 1 side
- delayed sitting
- asymmetrical WB in supine, sitting, prone & crawling
