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Original article

Torticollis, facial asymmetry and plagiocephaly in

normal newborns
L Stellwagen,1 E Hubbard,1 C Chambers,2 K Lyons Jones3
1
Division of Neonatology, ABSTRACT
University of California, San Objective: To evaluate the incidence and characteristics What is already known on this topic
Diego, Medical Center,
California, USA; 2 Departments
of torticollis, plagiocephaly and facial asymmetry in normal
of Pediatrics and Family and newborn infants. c Infants may be born with asymmetries due to
Preventative Medicine, Design: 102 healthy newborn infants were examined their intrauterine position.
University of California, San prospectively during their birth hospitalisation for torticollis c Asymmetries from early infancy can lead to
Diego, School of Medicine, permanent deformation of the head, neck and face.
California, USA; 3 Division of
with neck range of motion (ROM) assessment and for
facial, mandibular and cranial asymmetry by photographic c There is a connection between torticollis and
Dysmorphology Teratology,
University of California, San analysis. posterior cranial deformation.
Diego, School of Medicine, Results: 73% of newborns had one or more asymmetry:
California, USA
torticollis (16%), asymmetry of the mandible (13%), facial
Correspondence to: asymmetry (42%) and asymmetry of the head (61%).
Dr L Stellwagen, Mail Code Torticollis was associated with maternal report of the What this study adds
8774, Division of Neonatology, fetus being ‘‘stuck’’ in one intrauterine position for more
University of California, San As many as one in six newborns have torticollis.
Diego, Medical Center, 200 than 6 weeks before delivery. Moderate facial asymmetry c

West Arbor Drive, San Diego, was associated with a longer second stage of labour, c Most newborns have mild or moderate
CA 92103, USA; lstellwagen@ forceps delivery, a bigger baby and birth trauma. craniofacial asymmetries.
ucsd.edu c Early detection of torticollis is possible, and may
Moderate cranial and mandibular asymmetries were
associated with birth trauma. More than one significant present an opportunity to prevent deformational
Accepted 25 March 2008 posterior plagiocephaly.
Published Online First 1 April 2008 asymmetry was found in 10% of newborns.
Conclusions: Asymmetries of the head and neck are
very common in normal newborns, and sixteen (16%) of
102 study newborns were found to have torticollis. Such craniofacial malformations and torticollis in the
newborns, especially if they sleep supine, are thought to immediate newborn period. Establishment of these
be at risk of developing deformational posterior plagio- estimates can support future research evaluating
cephaly. Identification of affected infants may allow early the effectiveness of therapeutic interventions in
the first months of life.
implementation of positioning recommendations or
physical therapy to prevent the secondary craniofacial
deformations that are part of an increasingly common METHODS
phenomenon. The study design was a prospective, cross-sectional
hospital-based study of newborns born between
January and June of 2004.
In 1992 the American Academy of Pediatrics and All parents of newly born infants available for
the National Institutes of Health issued the examination were asked to participate. Parents
recommendation for supine sleep position in provided written consent for the study and were
infancy to prevent sudden infant death syndrome.1 questioned about maternal history before the
Soon thereafter, an increase in the incidence of newborn was examined. Maternal and infant
posterior cranial deformation was noted, and the medical records were reviewed for demographics,
possibility that this trend was related to supine delivery details, infant size, examination and out-
sleep position has been suggested.2 However, it has come. Mothers were questioned about fetal activ-
long been recognised that torticollis present at ity including whether or not the baby felt ‘‘stuck’’
birth can lead to secondary cranial deformation.3 In in a position during the third trimester, and if so,
fact, it is now appreciated that most infants with how long and in which position.
deformational posterior plagiocephaly (DPP) have Photographs of the infant were taken by LS or
abnormalities of their neck range of motion EH. Infants were swaddled, and their heads
(ROM); however, this association is not well extended slightly for the facial photograph. An
defined or widely accepted.4–7 The extent to which assistant then gently opened their mouths to allow
torticollis and other craniofacial asymmetries are visualisation of alveolar ridges for the mandibular
present at birth is not well known, although older photograph. The vertex photograph was obtained
studies quote rates of torticollis of ,1%.8 9 Nor is it with the swaddled infants placed supine.
well known the extent to which specific cranio- Neck ROM assessments were performed by pla-
facial asymmetries persist beyond the newborn cing the swaddled infants supine with the shoulders
period and may be amenable to therapeutic at the edge of a warming table. All neck assessments
intervention. The purpose of this study was to were performed by LS. Infants were calmed and
establish estimates of the prevalence, range of positioned by an assistant. The infants’ necks were
severity, co-occurrence and predictors of specific examined for the presence of a sternocleidomastoid

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Original article

Table 1 Demographic, pregnancy and delivery Table 2 Characteristics of 102 infants*

characteristics in 101 mothers* n (%) or
Mean (range) Characteristic mean (range)
Characteristic or n (%){
Gender
Maternal age (years) 28.1 (15.0–41.0) Male 56 (55)
Maternal race/ethnicity Female 46 (45)
White non-Hispanic 33 (33) Birth weight (g) 3479 (2140–4969)
Hispanic 54 (54) Birth length (cm) 51.0 (44.0–56.0)
African American 8 (8) Birth head circumference (cm) 34.4 (30.0–37.5)
Asian/Pacific Islander 5 (5) Apgar scores .7
Other 1 (1) 1 min 84 (82)
Parity: primiparous 42 (42) 5 min 100 (98)
Delivery type Head presentation at delivery{
Vaginal 74 (73) Vertex
Normal 64 (63) Vertex NOS 16 (16)
Forceps-assisted 10 (10) Occiput anterior NOS 25 (25)
Caesarean section 26 (26) Left occiput anterior 26 (26)
Elective 15 (15) Right occiput anterior 20 (20)
Failure to progress 8 (8) Occiput posterior NOS 3 (3)
Emergency 3 (3) Left occiput poster 3 (3)
Minutes pushing 2nd stage Right occiput posterior 0
labour{ Left occiput transverse 1(1)
0–5 22 (26) Right occiput transverse 3 (3)
6–30 22 (26) Breech 3 (3)
31–60 17 (20)
*Includes one set of twins.
61–270 24 (28) {Missing values for two infants on head presentation at delivery; all
Baby active 99 (98) percentages calculated using total size of 102 as denominator.
Baby ‘‘stuck’’ 3rd trimester 36 (36) NOS, not otherwise specified.
Number of weeks baby stuck
0 69 (68) Descriptive statistics were generated for means, percentages
1–6 9 (9) and proportions. Univariate analyses were conducted using x2 or
7–12 19 (19)
Fisher exact tests. All analyses were performed using SPSS V11.0
.12 4 (4)
for the MAC. Approval for the study was obtained from the
Birth trauma 10 (10)
hospital human research protection committee.
Lie
Vertex 92 (91)
Breech 3 (3) RESULTS
Transverse 1 (1) The cohort consisted of 101 mothers and their 102 healthy
Other 4 (4) newborns who had neck ROM assessment and photographic
Gestational age at delivery 39.6 (36.4–42.1)
analysis during their initial birth hospitalisation. Tables 1 and 2
(weeks)
show the maternal and newborn study population character-
*Includes one twin gestation counted as one pregnancy.
istics, respectively.
{Missing value for one subject each for delivery type and lie; all
percentages calculated using total size of 101 as denominator. One in three mothers related that their newborns felt ‘‘stuck’’
{Excluding elective caesarean section and one missing value for or remained in the same orientation for the last weeks of
length of 2nd stage labour. pregnancy, and were able to describe the stuck position in all
but one case (table 1). Ten newborns had birth trauma (table 1):
(SCM) tumour. The infants’ heads were laterally rotated, chin to cephalohaematoma (6), clavicular fracture (1), brachial plexus
each shoulder. Neck rotation was quantitated: chin moves past injury (1), cheek abrasion (1), scalp swelling (1). One or more
shoulder (100%), to shoulder (90%), or to mid-clavicle (70%). To asymmetries was found in 73% of study newborns. A limitation
assess lateral neck flexion, a board with graph paper was positioned of lateral flexion of the neck, or torticollis, was found in 16% of
under the head. The infants’ heads were tilted ear to shoulder with infants, with a range of 15u to 33u in difference from right to
gentle, steady pressure until resistance was appreciated. Sagittal left. Lateral rotation of the neck, chin to shoulder, was normal
suture positions were marked in neutral and at maximal lateral in the subgroup of newborns in whom this measurement was
flexion on the graph paper. This was repeated three times on each performed. No subject was found to have an SCM tumour. Jaw
side. Neck flexion measurements were calculated by assessing the tilt and facial asymmetry are common findings (table 3). Jaw tilt
angles from the neutral position to the maximum flexion achieved. varied from 5u to 13u.
Torticollis was defined as .15u of difference in neck mobility The incidence of torticollis was higher when the mother
comparing right with left.10 reported the baby to be stuck in a position for more than 6
Photographs were analysed by one blinded investigator (KLJ) weeks relative to a shorter length of time or not at all. Infants
for facial asymmetry, flattening of jaw line, elevation of eye or with torticollis had slightly longer body lengths than infants
cheek, deviation of nose or chin point, and flattening or bulging with symmetric neck ROM. Jaw tilt was associated with birth
of cranial contours. Asymmetries were visually rated qualita- trauma (table 4). Moderate facial asymmetry correlated with a
tively as mild, moderate or severe. Alveolar ridge photographs second stage of labour lasting longer than 60 min versus less, a
were assessed for mandibular inclination (jaw tilt), defined as forceps delivery relative to a normal vaginal delivery, the
.5u of angulation between maxilla and mandible. presence of birth trauma, and a larger baby. Moderate vertex

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Original article

Table 3 Prevalence of torticollis, jaw tilt and facial and vertex adults.10 13 Normal newborns can laterally rotate their head well
asymmetry in 102 newborn infants past the shoulder, 100–110u from the midline, and laterally flex
Variable n (%) their head 50–60u towards the ear. Newborns with torticollis
can have some limitation of lateral rotation, but generally not
.15u difference in lateral flexion between right and left sides 16 (16) preventing the chin from reaching the shoulder (90u). Lateral
.15u difference in lateral rotation between right and left sides* 0
flexion of the neck (ear to shoulder) away from the tight neck
Jaw tilt angle .5u{ 13 (13)
muscle is much more likely to show restricted movement in the
Facial asymmetry
newborn with torticollis. We suspect that many newborns with
Mild 37 (36)
Moderate 6 (6)
limited neck ROM are missed because of an incomplete
Vertex asymmetry examination. For example, a recent study investigating risk
Mild 51 (50) factors for DPP failed to find limited neck ROM in 7-week-old
Moderate 11 (11) infants with deformational plagiocephaly (newborns were not
*Measurement performed for subset of 59 infants.
assessed because of concern about vulnerability of cervical
{Missing values for three infants; all percentages calculated using total size of 102 as structures). They defined normal neck ROM as lateral rotation
denominator. of 90u, or lateral flexion of 30u (rather than looking at
differences left to right) and found that all infants met this
asymmetry was associated with birth trauma and forceps criterion. Interestingly, they found that positional head
delivery (table 5). preference, while the baby was awake or asleep, strongly
Ten percent of study newborns had more than one significant correlated with DPP at 7 weeks of age.14
asymmetry (torticollis, jaw tilt, moderate cranial or facial Our findings support the theory that torticollis at birth is
asymmetry): four newborns had three different significant related to a constrained intrauterine position rather than
asymmetries and six newborns had two significant asymme- delivery trauma. Torticollis was not associated with type of
tries. Figure 1 shows representative photographs of normal and delivery, or any particular head presentation, but maternal recall
affected newborns. that the infant was ‘‘stuck’’ in position for more than 6 weeks
correlated with the presence of torticollis. Newborns with
DISCUSSION torticollis were longer than unaffected babies, but we did not
Although previously thought to be a relatively rare occurrence, find that first-borns, male gender, breech presentation or
our study indicates that most newborns have asymmetries, and instrumented delivery were predictive as has been found by
as many as one in six have restricted movement of the neck. others.12 15 16 Unlike torticollis, other measures of craniofacial
There is a spectrum in severity of torticollis and other asymmetry correlated with a difficult birth. However, it is not
craniofacial asymmetries, and variability in the co-occurrence clear from our data whether a traumatic, prolonged or
of these findings. Previous studies have reported torticollis rates instrumented delivery caused the asymmetry, or if the
of 0.3–3.92%.8 11 12 However, in that most of the infants in those constrained fetus was more likely to have a difficult delivery.
studies had a more severe form of neck involvement or a SCM Fifty percent of study newborns had mild, and 11% had
muscle tumour, the true incidence of the broader spectrum of moderate, asymmetries of the vertex. Such asymmetry may be
torticollis is likely to be much higher. Furthermore, the complex related to transient scalp swelling, haematomas, moulding, or
movement of the SCM muscle and the difficulty in assessing flattening from the delivery process. However, half of the
neck ROM in newborns has led to an underestimation of newborns with moderate cranial asymmetry also had torticollis,
torticollis in infancy. Most studies have looked at lateral facial asymmetry or jaw tilt, suggesting intrauterine constraint.
rotation of the neck in infants, chin to shoulder, as is done in The cranial asymmetry that we noted at birth is relatively

Table 4 Univariate analysis of measures of torticollis and abnormal jaw tilt in relation to selected maternal
and infant variables
Ear to shoulder .15u Jaw tilt .5u
Yes No Yes No
Variable (n = 16) (n = 86) p Value* (n = 13) (n = 86){ p Value*

Maternal age (years) 28.0 (6.5) 28.0 (6.9) 1.00 28.9 (6.8) 27.9 (6.9) 0.65
Non-white race/ethnicity 13 (81) 56 (65) 0.26 8 (62) 58 (67) 0.76
Primiparity 7 (44) 35 (41) 1.00 8 (62) 34 (40) 0.15
.6 weeks ‘‘stuck’’ 7 (44) 16 (19) 0.05 4 (31) 19 (22) 0.49
Delivery: caesarean 4/6 (67) 7/20 (35) 0.35 0/4 11/21 (52) 0.23
emergency or FTP{
Delivery: forceps" 0/9 11/66 (17) 0.34 3/12 (25) 8/61 (13) 0.13
.60 min pushing 2 (13) 22 (26) 0.35 6 (46) 17 (20) 0.07
Birth trauma 1 (6) 9 (11) 1.00 4 (31) 6 (7) 0.03
Male sex 8 (50) 48 (56) 0.79 7 (54) 47 (55) 1.00
Birth weight (g) 3600 (523) 3456 (474) 0.28 3577 (580) 3460 (475) 0.42
Birth length (cm) 51.9 (1.4) 50.8 (2.3) 0.02 51.2 (2.1) 51.0 (2.2) 0.80
Birth head (cm) 34.0 (1.6) 34.5 (1.4) 0.24 34.8 (1.4) 34.4 (1.4) 0.32
Values are n (%) or mean (SD).
*Unpaired t test or Fisher exact test.
{Missing values for three infants; percentages calculated using denominator excluding missing values.
{Emergency or failure to progress (FTP) caesarean vs elective caesarean delivery.
"Forceps-assisted vaginal delivery vs normal vaginal delivery.

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Original article

Table 5 Univariate analysis of measures of asymmetry in relation to selected maternal and infant variables
Moderate facial asymmetry Moderate vertex asymmetry
Yes No Yes No
Variable (n = 6) (n = 96) p Value* (n = 11) (n = 91) p Value*

Maternal age (years) 32.8 (4.8) 27.7 (6.8) 0.07 31.9 (6.5) 27.5 (6.7) 0.04
Non-white race/ethnicity 2 (33) 67 (70) 0.08 3 (27) 66 (73) 0.01
Primiparity 5 (83) 37 (39) 0.08 6 (55) 36 (40) 0.35
.6 weeks ‘‘stuck’’ 3 (50) 20 (21) 0.13 2 (18) 21 (23) 1.00
Delivery: caesarean 1/2 (50) 10/24 (42) 1.00 2/3 (67) 9/23 (39) 0.56
emergency or FTP{
Delivery: forceps{ 4/4 (100) 7/71 (10) ,0.001 4/8 (50) 7/67 (10) 0.01
.60 min pushing 4 (67) 20 (21) 0.03 5 (46) 19 (21) 0.12
Birth trauma 4 (67) 6 (6) 0.001 5 (46) 5 (6) 0.001
Male sex 2 (33) 54 (56) 0.41 4 (36) 52 (57) 0.22
Birth weight (g) 3903 (345) 3453 (478) 0.03 3534 (813) 3473 (433) 0.81
Birth length (cm) 53.0 (1.2) 50.9 (2.2) 0.02 51.8 (2.1) 50.9 (2.2) 0.19
Birth head (cm) 35.5 (1.1) 34.4 (1.4) 0.05 34.5 (2.1) 34.4 (1.3) 0.89
Values are n (%) or mean (SD).
*Unpaired t test or Fisher exact test.
{Emergency or failure to progress (FTP) caesarean vs elective caesarean delivery.
{Forceps-assisted vaginal delivery vs normal vaginal delivery.

subtle compared with the more impressive flattening of DPP stage of labour, and larger birth weight (table 5). These
that can develop in time (fig 1). newborns all had other asymmetries of the neck, head or
The constrained fetus with the head tipped and the jaw mandible. Such an infant may represent the more severely
pushed down on the shoulder can develop jaw tilt. We constrained fetus, occupying a fixed position that prevented
found that jaw tilt occurred in 13% of study babies, proper descent into the pelvis, or with a head that is not well
accompanied by torticollis in four cases, and facial and cranial aligned for vaginal delivery, thus leading to a more prolonged,
asymmetry in two cases. Of interest with regard to prognosis, traumatic or instrumented birth.
jaw tilt is thought to resolve spontaneously several months Ten percent of study newborns had more than one significant
after birth, but can interfere with breast feeding, especially in asymmetry. Infants who have multiple positional deformities
those with torticollis who resist turning the head away from the have been referred to by several names: the stuck baby, the
tight side.17 moulded baby syndrome, infantile postural asymmetry, and the
Six percent of study newborns had moderate facial asym- turned head-adducted hip–truncal curvature syndrome.9 18 19
metry, which correlated with birth trauma, a prolonged second The incidence of this syndrome is estimated at less than 1%

Figure 1 Representative infant

photographs: normal (A,B), mild facial
asymmetry (C), mild vertex asymmetry
(D), moderate facial asymmetry (E) and
moderate vertex asymmetry (F).

830 Arch Dis Child 2008;93:827–831. doi:10.1136/adc.2007.124123

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Original article

of newborns. However, milder forms of the stuck baby Competing interests: None.
syndrome are more common. Ethics approval: Ethics approval was obtained from the hospital human research
Newborns who have restricted neck ROM are at risk of protection committee.
developing cranial deformations that we suspect could be Patient consent: Obtained.
prevented with early identification and preventive treat-
ment.3 13 20 If given adequate prone time when awake, most of
REFERENCES
these children should resolve the minor asymmetries they have 1. American Academy of Pediatrics. AAP Task Force on Infant Positioning and SIDS:
at birth, as they did in the era of prone sleep.14 The prone, head Positioning and SIDS. Pediatrics 1992;89:1120–6.
up posture that the infant assumes during ‘‘tummy time’’ puts 2. Kane AA, Mitchell LE, Craven KP, et al. Observations on a recent increase in
plagiocephaly without synostosis. Pediatrics 1996;97:877–85.
the SCM on a maximal stretch, and may be adequate treatment 3. Graham JM. Smith’s recognizable patterns of human deformation. 3rd edn.
for mild torticollis. However, infants with very restricted neck Philadelphia: Saunders Elsevier, 2007.
ROM, low postural tone, or with inadequate ‘‘tummy time’’ 4. Rogers GF, Mulliken JB. The significance of torticollis in deformational posterior
may be at risk of developing DPP. Such infants may need to be plagiocephaly [abstract]. Proceedings of the Tenth International Congress of the
International Society of Craniofacial Surgery 2003;61.
referred for physical therapy or additional assessment. 5. Graham JM Jr, Gomez M, Halberg A, et al. Management of deformational
The limitations of this study relate to the difficulties in plagiocephaly: repositioning versus orthotic therapy. J Pediatr 2005;146:258–62.
accurate assessment of physical findings in newborns. Larger 6. Golden KA, Beals SP, Littlefield TR, et al. Sternocleidomastoid imbalance versus
congenital muscular torticollis: their relationship to positional plagiocephaly. Cleft
numbers of patients should allow us to further delineate risk Palate Craniofac J 1999;36:256–61.
factors for intrauterine constraint and to distinguish prenatal 7. Pivar SJ, Scheuerle A. Variable co-diagnosis of plagiocephaly and torticollis in Texas
influences from intrapartum events. Standardisation of neck health care facilities. J Craniofac Surg 2006;17:236–40.
ROM assessment and recommendations for initiation of 8. Dunn P. Congenital postural deformities: further perinatal associations. Proc R Soc
Med 1974;67:1174–8.
physical therapy would be useful for paediatric practitioners. 9. Hamanishi C, Tanaka S. Turned head–adducted hip–truncal curvature syndrome.
Further research is needed to define which newborns with Arch Dis Child 1994;70:515–19.
positional asymmetries are at risk of non-resolution of torticollis 10. Cheng JC, Tang SP, Chen TM, et al. The clinical presentation and outcome of
treatment of congenital muscular torticollis in infants: a study of 1,086 cases.
and development of DPP. J Pediatr Surg 2000;35:1091–6.
11. Cheng JC, Au AW. Infantile torticollis: a review of 624 cases. J Pediatr Orthop
1994;14:802–8.
CONCLUSIONS 12. Chen MM, Chang HC, Hsieh CF, et al. Predictive model for congenital muscular
That newborns can have positional deformities as a result of torticollis: analysis of 1021 infants with sonography. Arch Phys Med Rehabil
2005;86:2199–203.
their restricted intrauterine environment has long been recog- 13. Hutchison BL, Hutchison LA, Thompson JM, et al. Plagiocephaly and brachycephaly
nised. However, these deformities are more common than in the first two years of life: a prospective cohort study. Pediatrics 2004;114:970–80.
previously appreciated, and may lead to further cosmetic or 14. van Vlimmeren LA, van der Graaf Y, Boere-Boonekamp MM, et al. Risk factors for
postural problems if not addressed properly. Providers who care deformational plagiocephaly at birth and at 7 weeks of age: a prospective cohort
study. Pediatrics 2007;119:e408–18.
for newborns should carefully assess infants for these asymme- 15. Cheng JC, Tang SP, Chen TM. Sternocleidomastoid pseudotumor and congenital
tries and provide anticipatory guidance for the prevention of muscular torticollis in infants: a prospective study of 510 cases. J Pediatr
cranial deformation. Further research should test the effective- 1999;134:712–16.
16. Boere-Boonekamp MM, van der Linden-Kuiper LL. Positional preference:
ness of early interventions in newborns with torticollis or other prevalence in infants and follow-up after two years. Pediatrics 2001;107:339–43.
asymmetries. 17. Watson GH. Relation between side of plagiocephaly, dislocation of hip, scoliosis, bat
ears, and sternomastoid tumours. Arch Dis Child 1971;46:203–10.
Acknowledgements: We thank Cranial Technologies Inc for providing the camera, 18. Philippi H, Faldum A, Jung T, et al. Patterns of postural asymmetry in infants: a
photographic training, and study tool, Neil Finer, MD, and Marc Montminy, MD, PhD, standardized video-based analysis. Eur J Pediatr 2006;165:158–64.
for their thoughtful review, and Dina Campbell, RN PNP, Ali Wolf, MSN PNP, and all of 19. Stellwagen LM, Hubbard E, Vaux K. Look for the ‘‘stuck baby’’ to identify congenital
the baby-holders who helped with infant assessment. torticollis. Contemp Pediatr 2004;21:55–66.
20. Persing J, James H, Swanson J, et al. Prevention and management of positional
Funding: The study received assistance from Cranial Technologies, Inc, in the form of skull deformities in infants. American Academy of Pediatrics Committee on Practice
purchase of a camera, 2 h of photographic training, and assistance in the design and and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological
printing of the study tool. Surgery. Pediatrics 2003;112:199–202.

Arch Dis Child 2008;93:827–831. doi:10.1136/adc.2007.124123 831

 Downloaded from http://adc.bmj.com/ on September 11, 2016 - Published by group.bmj.com

Torticollis, facial asymmetry and

plagiocephaly in normal newborns
L Stellwagen, E Hubbard, C Chambers and K Lyons Jones

Arch Dis Child 2008 93: 827-831 originally published online April 1, 2008
doi: 10.1136/adc.2007.124123

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