Symptomatic asymmetry in the first six months of life: differential diagnosis

Eur J Pediatr. 2008 Jun;167(6):613-9. doi: 10.1007/s00431-008-0686-1. Epub 2008 Mar 4.


Asymmetry in infancy is a clinical condition with a wide variation in appearances (shape, posture, and movement), etiology, localization, and severity. The prevalence of an asymmetric positional preference is 12% of all newborns during the first six months of life. The asymmetry is either idiopathic or symptomatic. Pediatricians and physiotherapists have to distinguish symptomatic asymmetry (SA) from idiopathic asymmetry (IA) when examining young infants with a positional preference to determine the prognosis and the intervention strategy. The majority of cases will be idiopathic, but the initial presentation of a positional preference might be a symptom of a more serious underlying disorder. The purpose of this review is to synthesize the current information on the incidence of SA, as well as the possible causes and the accompanying signs that differentiate SA from IA. This review presents an overview of the nine most prevalent disorders in infants in their first six months of life leading to SA. We have discovered that the literature does not provide a comprehensive analysis of the incidence, characteristics, signs, and symptoms of SA. Knowledge of the presented clues is important in the clinical decision making with regard to young infants with asymmetry. We recommend to design a valid and useful screening instrument.

Publication types

  • Review

MeSH terms

  • Diagnosis, Differential
  • Female
  • Functional Laterality
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Male
  • Musculoskeletal Abnormalities / diagnosis*
  • Musculoskeletal Abnormalities / epidemiology
  • Nervous System Malformations / diagnosis*
  • Nervous System Malformations / epidemiology
  • Posture*
  • Prevalence