Failure to Consider Everyday Pediatric Practice

Positional Skull Deformities Etiology, Prevention, Diagnosis, and Treatment by PD Dr. med. Dr. med. dent. Christian Linz, Dr. med. dent. Felix Kunz, Dr. med. Dr. med. dent. Hartmut Böhm, and PD Dr. med. Tilmann Schweitzer in issue 31–32/2017

I am glad to see that asymmetry disorders in infants are arousing interest. But as is often the case, this “review article” is merely a “selective literature review” (1); it does not mention what constitutes everyday pediatric practice: the postulated “blockages,” widely used osteopathic treatment, manual therapy, atlas therapy for “kinetic imbalances due to suboccipital strain” (KISS syndrome), or the various positioning rings and aids available.

In terms of developmental biology, infants are “intended” to be carried rather than to lie down. If an infant is simply placed on its back without ensuring that it faces in both directions, and if a prone position (“tummy time”) is not frequently trained, a preferred side develops, particularly if the infant is already “lopsided” as a result of constrained posture in utero or events during birth. Common asymmetries (plagiocephaly) are thus mostly the result of unawareness to the point of neglect, because far too little value is attached to providing guidance for handling neonates. It is rare that there are (also) genuine “blockages.”

Since the introduction of the recommendation to place infants only on their backs in order to prevent sudden infant death syndrome (SIDS), there has been a major increase in asymmetries. SIDS is rare during the neonatal period, which is the most significant time for the development of asymmetry disorders. The old recommendations to place neonates on alternating sides, in addition to tummy time, should therefore not be rejected on the basis of evidence of a risk of SIDS.
Let us hope that in the future review articles will earn that description by reflecting actual everyday situations and practices, empirically and confirmed by field research, rather than being based only on a literature review. One cause of bias is that things that make money, such as helmet therapy, are featured in publications, whereas unspectacular prevention measures such as positioning and handling are not reflected in the literature.

DOI: 10.3238/arztebl.2018.0038a

Dr. med. Stephan Heinrich Nolte

Pediatrician, Germany

References

1. Linz C, Kunz F, Böhm H, Schweitzer T: Positional skull deformities— etiology, prevention, diagnosis, and treatment. Dtsch Arztebl Int 2017; 114: 535–42