Objective:
How do infants with infantile postural asymmetry develop during the first three years of life? Is there an association between osteopathic and clinical findings at three years of age? Are there variables that determine the clinical course of postural asymmetry that can be identified by multivariate analysis?

Study design:
Prospective observational study.

Setting:
The study was conducted at Children’s University Hospital, Johannes Gutenberg University Mainz, Germany.

Patients:
Sixty-one infants aged six to twelve weeks were enrolled and osteopathic treated in the intervention study performed by Pabst and Schleupen (2002). This sample was followed for three years. During the years 2002 to 2005 the sample decreased; 33 of the 61 infants made use of all examinations and could be included for observation.

Intervention:
The yearly check-ups consisted of a standardized pediatric and neurological examination, osteopathic evaluation (U0 and U3), medical history, interviews, and video documentation of posture and movement patterns.

Outcome parameter:
Qualitative and quantitative standardized analysis of postural asymmetry during the first three years of life of infants with infantile postural asymmetry. To develop of a specific children asymmetry scale based on the existing infantile asymmetry scale. To evaluate correlations of osteopathic and clinical findings at three years of age in formerly asymmetric infants. Explorative analysis of variables known to have effects on the course of postural asymmetry.

Results:
The Children asymmetry scale showed an acceptable ICC of 0.76 (Cronbach Alpha 0.67). An improvement of postural asymmetry could be confirmed mainly during the first year of life (+1.2 points). Verticalisation induced a typical scoliotic posture in children with infantile postural asymmetry. We found a significant correlation between head tilt and osteopathic signs (e.g. functional transverse line, p=0.0001 – 0.043). The three different therapeutic interventions during the first year of life were identified as main determinants of postural asymmetry using a multivariate regression model (p=0.018).

Conclusions:
The newly constructed Children asymmetry scale is more useful in a scientific than in a clinical setting. Early osteopathic treatment during the first year of life seems to be useful for infants with postural asymmetry. Functional transversal lines of the cranium should be considered during treatment.