Pediatric Library

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

Congenital Torticollis

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:

Brachial Plexus Injury

Erb’s 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

Klumpkes_Palsy (38K) Like Erb’s Palsy, Klumpke’s Palsy also involves an injury to the brachial plexus but the lower portions of the brachial plexus are involved. Typically, the 8th cervical nerve root and 1st thoracic nerve root are damaged causing the 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 the muscular weakness resulting from 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:

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 loud noises and constant 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:

Autism

People on autism spectrum disorders in general have social, communication and behavioral issues which can range from mild, moderate to severe.

There are 4 main disorders on the autistic spectrum:

  1. Asperger’s Syndrome: Children on this spectrum has usually a higher IQ level and may be even be able to function within normal range on his daily activities. They are usually able to focus on topics of their interest without any difficulty but may have a hard time with social connection.
  2. Pervasive Developmental Disorder ( PDD-NOS) : Children on this spectrum are more severe than Asperger’s Syndrome , but not necessarily as severe as in autistic disorder.
  3. Autistic Disorder: Usually children were diagnosed with this on a large basis, but now it constitutes of the same symptoms as Asperger’s and PDD, but on a more intense level.
  4. Childhood Disintegrative disorder: Children on this spectrum are described to be developing normally and then quickly loose many of the social, language and mental skills and it usually occurs between the age of 2-4.

Common myth:

Is Rett Syndrome an ASD ?

Children tend to have similar behaviors as autistic population but it has been proven to be caused by a genetic mutation and hence is no longer part of the ASD group.

Earlier Autism Treatment Is Better Autism Treatment

There have been many research studies proven that early intervention and early recognition of this diagnosis especially between 2-4 years is crucial in effective treatment implementation.

There are many interventions which include Behavioral therapy, Sensory Integrative Therapy, Drug Treatments, Nutrition Supplement use, Gluten Free diet implementation via Nutritionist, Occupational Therapy, Speech Therapy and Music Therapy just to mention few that have proven very effective if they are implemented together as needed for the child. Also kids on this spectrum need ongoing Psychological and Developmental Pediatric evaluation. Some on this spectrum may also need Feeding therapy due to sensory issues with food textures which can hinder their food intake causing other medical complications like lack of attention and constipation just to mention a few.

Cerebral Palsy

What is Cerebral Palsy also called as CP?

CP is a group of disorders that affect balance, movement and muscle tone. CP happens when the area in the brain that controls the ability to move muscles doesn’t develop as it should or when it is damaged right around the time of birth or very early in life. Mostly it is Congenital , means a person is born with it and it is called Congenital CP. If it starts after birth it is referred as Acquired CP.

The symptoms fluctuate from low muscle tone where muscles have hyper laxity and it is called Hypotonia or some have increased muscle tone with tightness in different gross motor and fine motor muscles and it is called Hypertonia.

What Causes it?

There has not been enough evidence on what happens to damage the brain or disrupt development causing CP.

Some suggested causes are

  1. Bleeding in the brain when the baby is in the womb, during birth or later.
  2. A lack of blood flow to important organs
  3. Seizures at birth or the first month of life
  4. Traumatic brain injuries
  5. Some genetic conditions

Treatment:

As with any condition early detection and early intervention is the best strategy.

If you as a parent notice your child is not developing as you expect with other kids at home , in the family or as you may have observed with kids in the community, please ask your doctor or caregivers like social worker, teachers etc. to diagnose and then provide appropriate community resources.

Therapy: Kids with CP may have gross motor delay like delay in sitting/ standing/crawling/ walking , fine motor delay like difficulty holding a cup, grasping toys/ objects, visual motor coordination issues like clumsy when bringing hand to mouth while eating or unable to do this due to increased muscle tone and or have cognition and language delay like unable to follow commands or retain information, unable to formulate words or sentences and may need PT/OT and ST services. Please ask doctor for therapy intervention if needed and early intervention will show significant progression in milestones.

Down Syndrome

What is Down’s Syndrome?

People with Down’s Syndrome are born with an extra chromosome. This can cause a range of issues that can affect both mentally and physically. Down’s Syndrome is a lifelong condition. People with Down’s have certain facial characteristics e.g. they often have flat noses, small ears or flat affect. Their mental abilities fluctuate from low intellectual to moderate to severe intellectual disability and hence their functional capabilities for life will vary.

Causes

In Down’s Sydrome the child has a extra copy of the chromosome 21. There is no evidence to what causes this and no link to environmental or genes in the parents to relate it with. There is a study that believes women 35 and older have a higher chance of having a baby with Down ’s syndrome and if you have one child with Down’s your likelihood of having another one is higher.

Types

There are 3 types of Down Syndrome:

  1. Trisomy 21 : This is the most common one where every cell in the body has 3 copies of chromosome 21 instead of two.
  2. Translocation Down syndrome: In this type each cell has part of an extra Chromosome 21, or an entirely extra one. But it is attached to another chromosome instead of being on its own.
  3. Mosaic Down syndrome: This is the rarest type, where only some cells have an extra chromosome 21.

Interventions:

There is no treatment for this condition unless the child has medical symptoms like heart issues or other conditions that can be treated with medical intervention.

These population symptoms may range from Mild IQ deficits – Severe IQ deficit and some have gross motor development delay , Fine motor and Visual Perceptual delay and they usually have Cognitive deficits with Language concerns and may need PT/OT and ST services to address these concerns.

If you notice your child to not developing as you expect for his age level, have a doctor examine the child and consult for interventions including therapy to assist with your child’s age appropriate development.

Congenital Hydrocephalus

What is Congenital Hydrocephalus?

It means there is too much fluid buildup in the brain and a person is born with this condition. The liquid is CSF or cerebrospinal fluid and with hydrocephalus there is a imbalance between how fast fluid is made and how quickly it is absorbed resulting in a buildup and can cause a head to enlarge and increase pressure around the brain.

Causes:

  1. The ventricles – spaces in the brain where CSF is made- produce too much fluid.
  2. Something blocks the normal flow of fluid and causes it to buildup.
  3. The bloodstream cannot absorb all the fluid.

Common reasons causing congenital hydrocephalus include:

  • AQUEDUCTAL STENOSIS
  • NEURAL TUBE DEFECTS
  • ARACHNOID CYSTS
  • DANDY-WALKER SYNDROME
  • CHIARI MALFORMATIONS ( Please refer to Web MD for details on these conditions )

Treatment:

The most common treatment is a Shunt System. Another possible treatment is called ETV ( endoscopic third ventriculostomy ) , which includes fiber-optic technology.

Other treatments: Children may have developmental disabilities like delayed gross motor including delayed crawling, walking and delayed fine motor, visual perceptual skills and delayed language with cognitive deficits and can need PT/OT/ST services to address these concerns. As with all diagnosis, early detection and early intervention is the best strategy. Ask doctor/ Social worker or any other professional involved in your child’s care if you notice delay in these areas and they will recommend you appropriate resources to assist your child with therapy personnel.