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Diagnostic strategies for the evaluation of asymmetry in infancy—a review


Asymmetry in infancy is a diagnosis with a large spectrum of features, expressing an abnormal shape of parts of the body or unequal postures and movements. Symptoms may be structural and/or functional, with localised or generalised expression. Within the last decade, many professionals have focused on the adverse consequences on motor performance of infants, associated with the recommendations on the prevention of sudden infant death. The purpose of the present study was to highlight different aspects of asymmetry in infancy based on best available evidence in the current literature and to present a flow chart illustrating different diagnostic pathways of asymmetry in infancy. Conclusion:we conclude that asymmetry in infancy is a diagnosis with a large spectrum of features and a multifactorial aetiology without consensus in definition, nomenclature and classification. Systematic diagnostic management of asymmetry in infancy is indicated. The presented diagnostic flow chart might serve as a basis.

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Fig. 1



congenital muscular torticollis

DP :

deformational plagiocephaly


pseudotumour of infancy

PT :

positional torticollis


sternocleidomastoid muscle


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The authors thank Marja AGC Schoenmakers and Sonja Raaff of the Department of Paediatric Physiotherapy, Wilhelmina Children’s Hospital/University Medical Centre Utrecht, The Netherlands, for their contribution to the development of the diagnostic flow chart.

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Correspondence to Raoul H. H. Engelbert.

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van Vlimmeren, L.A., Helders, P.J.M., van Adrichem, L.N.A. et al. Diagnostic strategies for the evaluation of asymmetry in infancy—a review. Eur J Pediatr 163, 185–191 (2004).

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  • Craniofacial abnormalities
  • Infant
  • Physical therapy
  • Psychomotor disorders
  • Torticollis