Pediatric Medical Library

Pediatric Medical Library

Below you will find information and resources on some of the common diagnoses we treat.

(Click on a heading to view the information)

Congenital Torticollis
Torticollis (23K)

Torticollis is a condition that is rare in newborns and involves shortening/tightening of one of the neck muscles called the sternocleidomastoid. Shortening of this muscle causes the head to be tilted toward the affected side and rotate in the opposite direction. For example, a left Torticollis would cause the child's head to tilt to the left and rotate to the right.

The cause of infant Torticollis is typically a traumatic childbirth or prolonged malpositioning within the womb. The sternocleidomastoid muscle may become damaged and scarred, during child birth, which causes a shortening (also known as a contracture) of the muscle. Abnormal shortening of the muscle during child development within the womb is also a reported cause of this condition. The result of this condition is a child that may experience the following:

  • Weakness
  • Difficulty rotating the head and interacting with the environment
  • Balance problems
  • Poor spatial awareness
  • Delayed development
  • Because prolonged rotation of the head may occur with Torticollis, an abnormal shape of the child's head may occur as well. This condition is called plagiochphally.
  • Possible Treatments for Torticollis
  • Physical therapy is a common intervention for congenital Torticollis. Treatment typically involves:
    • Parent education
    • Range of motion exercises
    • Positioning
    • Passive stretching
    • Purposeful play designed to integrate specific movements and behaviors

More information can be obtained at:

  1. Wikipedia - Torticollis
  2. American Academy of Orthopaedic Surgeons
  3. Instructions for stretching a left sternocleidomastoid Torticollis
  4. Instructions for stretching a right sternocleidomastoid Torticollis
Plagiocephaly (17K)

This is a condition in which there is flattening of one side a child's head. It typically occurs when a child spends a majority of time on his/her back in the crib. Because the cranial bones have not completely fused until the child reaches age two, the head can be molded into a flattened position when a majority of time is spent lying on the back.

While this condition may cause parental anxiety, it almost always resolves. In 1992, the American Academy of Pediatrics launched a public health campaign (called "Back to Sleep") to reduce Sudden Infant Death Syndrome (SIDS), by strongly recommending that babies sleep on their backs. As a result, there has been an increase in the number of Plagiocephaly cases, but the tradeoff is certainly worth it since SIDS has decreased by approximately 40%.

Plagiocephaly signs include a misshapen head when the baby is viewed from the top and the diagnosis should only be made by a qualified pediatrician or physical therapist.

Treatment usually involves encouraging repositioning the baby during sleep so he/she spends more time on the uninvolved side of the head. Additionally, you may choose to move the crib to another area of the room or reposition mobiles/stimulus that encourages the baby to rotate the head away from the involved side while awake.

In severe cases, custom-made helmets may be prescribed to gently remold the head over time.

Additional resources:

  2. Positional Plagiocephaly
Brachial Plexus Injury

Erb's Palsy (Erb-Duchenne Palsy)

Erbs_Palsy (32K)

Brachial Plexus Injury - the brachial plexus (plexus literally means "braid") is a network of arm nerves that exits out of the neck and runs down the arms on each side of the body. Injury to the brachial plexus is rare but may occur during a traumatic birth of the baby.

One type of brachial plexus injury is called Erb's palsy. Injury to the upper brachial plexus (portions of the 5th and 6th neck nerve roots) describes this type of palsy. As a result, the arm hangs limp and is rotated internally. The baby's elbow is straight but the baby can typically still move the wrist and finders when the palm is facing up.

Most cases of Erb's palsy will recover over time. However, in the case of complete rupture or avulsion of the nerves, surgery may be required. Conservative treatment consists of parent education, range of motion to prevent joint stiffness, and therapeutic exercise mostly in the form of purposeful play to facilitate the recovery of muscle strength.

Klumpke's Palsy (Dejering-Klumpke Palsy)

Klumpkes_Palsy (38K)
Like Erb's Palsy, Klumpke's Palsy also involves an injury to the brachial plexus but with Klumpke's Palsy, the lower portions of the brachial plexus are involved. Typically, the 8th cervical nerve root and 1st thoracic nerve root are damaged causing palsy (meaning weakness). The baby is likely to be able to move his/her elbow and wrist but usually has difficulty moving the fingers. A clawing of the hand may occur due to muscular weakness resulting from the involvement of the nerves.

Klumpke's Palsy may also recover over time. However, in the case of complete rupture or avulsion of the nerves, surgery may be required. Conservative treatment consists of parent education, range of motion to prevent joint stiffness, and therapeutic exercise mostly in the form of purposeful play to facilitate the recovery of muscle strength.

Additional Resources:

  1. Medline Plus
  2. American Academy of Orthopaedic Surgeons
Dysfunction of Sensory Integration

Dysfunction of Sensory Integration or Sensory Processing Disorder (formerly known as Sensory Integration Disorder) is a neurological disability in which the brain is unable to accurately process the information coming in from the five senses of vision, hearing, touch, taste, and smell and also the balance and movement senses. Sensory information that is typically perceived as normal is not processed correctly and therefore, one with DSI, may react to sensory stimulation as if they are in pain or confused.

There is a broad spectrum of signs and symptoms associated with DSI. Some are barely affected while others may not be able to function at all because of this condition.

Classically, DSI patients have may be classified as suffering from hypersensitivities in which sensory stimulus is heightened to the point that is may be painful. For example, the simple feeling of clothing touching the body can be perceived as intensely painful. In contrast, one diagnosed with hyposensitive DSI may have an extreme tolerance for environmental stimuli. An example of this might be a child that requires load noises or verbal cues before they will react.

Treatment is commonly provided by a physical or occupational therapist that provides the right amount of stimulus to obtain the desired response.

Additional Resources:

  1. Wikipedia - Sensory Integration Dysfunction
  2. Sensory Processing Disorder
  3. DSI from Health A to Z