Seeking advice.
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3.5yo female, born at term by normal vaginal delivery, no neonatal complications. Has reached all developmetal milestones at age appropriate rate. No illnesses or regular medications, has recieved all recommended immunisations. No significant materanal Hx generally, but mother does have bilateral HAV. Physically very active & has never complained of any foot pain or discomfort.
For past 18 months has been regularly sitting in W position and when she sits in this position she frequently rocks backwards & forwards. Parents try hard to stop her sitting this way and encourage her constantly to sit with legs out in front or to the side. Recently she has developed bruising & blistering to the medial aspect of the dorsum of both feet from the sitting position & rocking. The issue has been brought up on visits to to the GP and paediatrician as the parents were concerned that she may be autistic (purely based on the sitting & rocking) however this has been discarded by both the GP and paediatrician.
I observed her sitting in the W position & rocking however she seems to rock backwards & forwards intemittently i.e. she will rock for a few seconds then stop for up to a couple of minutes then rock again for a few seconds. When I would get her to sit with her legs out in front she would plantarflex & evert both feet (almost like a decerebrate posturing). When I got her to watch a "Wiggles" video she initially sat in W position doing the intermittent rocking. I then got her to sit with her legs out in front while she was watching the video which she was very absorbed in. When sitting with legs in front she would intermittently arch her back and her feet would plantarflex & invert (decerebrate like posturing again) like when I first got her to straighten her legs. This posturing would only last a few seconds then she would relax but it recurred every 30seconds or so while she was sitting straight legged. When I got her to sit in a chair with her legs out in front I didn't notice any of the posturing but she wouldn't sit in the chair for long and would sit back on the floor in the W position.
All her muscles groups have good strength, ankle & patellar reflexes appeared normal (however she was a bit unco-operative with this test),gastrocs are a bit tight, rearfoot valgus, pronates throughout gait, although her parents said this has improved significantly in past 6 months. Has MLA in heel raises & 'Jack's test'. Wears good quality, supportive shoes. Psychologically her parents say she is a bit 'shyer' than most of her peers but otherwise interacts well with her peers & adults.
Can anybody provide any advice on children sitting in the W position in terms of pathological processes that might be causing this or is it more likely psychological and to be something she will 'grow out of'. My feeling is that there may be a neurological cause due to the posturing she displays but would be keen to hear from anybody with experience / knowledge in this area.
Regards,
David Kelly
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