The questions you meant to ask, answered.

A head turn preference is common in young babies — it’s when a baby preferentially turns their head to one side more than the other. It might be caused by positioning in-utero, or by the setup of their environment drawing them to look one way.

Why we look for it

When a baby has a head turn preference they neglect their non-preferred side. The muscles around the neck shorten because they aren’t being stretched by looking both ways equally — this is known as torticollis. Babies who favour one side also tend to develop a flat spot on the back of the head.

What is a flat spot?

Babies are born with very soft skull bones, so the skull changes shape easily. Lying on one side of the head more than the other creates a flat spot, known as plagiocephaly. There are various types. It’s important to raise it with your support team as soon as you notice it.

What is developmental dysplasia of the hip (DDH)?

DDH is a spectrum of abnormalities that stop the hip joint developing properly, leaving the thigh bone unstable in the hip socket.

What causes it?

During pregnancy, hormones that relax the mother’s ligaments ready for delivery can pass through the bloodstream to the baby, relaxing their ligaments too. That can leave the hip joint loose and unstable in the socket.

How do I know if my baby has DDH?

All babies should be screened by a paediatrician at birth. Your community nurse, GP or physio can also physically assess for signs and decide whether a hip scan is needed. If your baby has three or more risk factors, or any positive signs on physical assessment, they may need a hip ultrasound or x-ray. If imaging confirms DDH, your baby will be referred to an orthopaedic specialist.

Positional talipes is a common condition affecting one or both feet. It’s considered a “packaging issue” — the foot gets stuck in one position for an extended period in-utero, which tightens some of the muscles in the foot. There are various types depending on which muscles are tight.

Metatarsus adductus is another “packaging issue” that affects babies and young children. The outside border of the foot curves inwards, giving it a bean-shaped appearance, and there may be a wide gap between the big toe and the second toe (known as a “searching great toe”).

Gentle exercises may help, and in most babies the condition resolves over the first three to four years. Sometimes it persists and contributes to toddlers who walk “pigeon-toed”. In rare cases, casts, splints or specific footwear are indicated.

The brachial plexus is a large network of nerves running from the neck to the arm. Its five large nerves are responsible for movement and feeling in the arm and hand. Each nerve contains many nerve fibres that carry signals from the brain. If those fibres are injured the signal doesn’t reach the muscle, so the muscle loses strength and the skin loses some feeling.

How is it caused?

Most brachial plexus injuries happen during birth, when the arm is stretched too far from the shoulder — often when the baby’s arm gets trapped within the mother’s pelvis after the head is delivered. Most hospitals report one to two babies per 1,000 births.

Will it resolve?

Brachial plexus nerves have some ability to repair themselves. As long as the outer sheath of the nerve is preserved, damaged fibres can regrow — at roughly 1mm per day, or an inch per month, so it can take many months to reach the hand. If the entire nerve including the sheath has torn, it cannot grow back and the muscle will not work.

Most function returns within the first year of life. Where function returns rapidly in the first few months, your child will be able to use the affected arm for almost everything they want to do — though some muscle weakness usually remains, and the affected arm may not move quite like the other one.

What type does my child have?

There’s no single test that determines the extent of the injury. Instead, your child’s arm movement is assessed and monitored over time by your physiotherapist and doctor. The faster function returns, the greater the likelihood of complete recovery.

Treatment

Physiotherapy improves the range of motion of the arm and avoids stiffness, so that when nerve function recovers the arm is ready to work. Physiotherapy cannot make the nerves grow faster. As your child gets older, muscle imbalances can cause tightness that may need more stretches or a splint.

What if surgery is recommended?

Only around 10% of babies with brachial plexus palsy require surgery. Where there has been little or very slow progress, surgery may be considered from 4 months of age onwards — removing scar tissue and performing nerve grafting microsurgery, where a section of healthy donor nerve replaces the damaged nerve. Children selected for surgery are those not expected to keep improving without it. Sometimes a second surgery is considered when the child is older.

We also see developmental delay, neurological conditions, cerebral palsy and spasticity, movement disorders, toe walking, casting and turtle brace management, growth-related aches and pains, hypermobility and sports injuries — from 0 to 18 years.