Prevalence and characteristics of abnormal head posture in children with down syndrome: A 20-year retrospective, descriptive review

Alina V. Dumitrescu, Daniela C. Moga, Susannah Q. Longmuir, Richard J. Olson, Arlene V. Drack

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Purpose: To characterize the abnormal head posture (AHP) in children with Down syndrome (DS). The study had 3 aims: to estimate the prevalence of AHP, to describe the distribution of different causes for AHP, and to evaluate the long-term outcomes of AHP in children with DS evaluated at the University of Iowa Hospitals and Clinics between 1989 and 2009. Design: Retrospective chart review. Participants: Two hundred fifty-nine patient records. Methods: The study data were analyzed using chi-square tests (the Fisher exact test when appropriate) to describe the relationship between the outcome of interest and each study covariate. A predictive logistic regression model for AHP was constructed including all the significant covariates. Main Outcome Measures: Abnormal head posture. Results: Over the study period, 259 records of patients with DS were identified. Of these, 64 (24.7%) patients had AHP. The most frequent cause of AHP was incomitant strabismus in 17 (26.6%) of 64 patients. The second most frequent cause of AHP was nystagmus, in 14 (21.8%) of 64 patients. For a substantial number of patients with AHP, the cause could not be determined. They represented 12 (18.8%) of all the patients with AHP in this study and 12 (4.6%) of all patients with DS examined. When compared with patients with AHP from a determined cause, this subgroup has a statistically significantly (P = 0.027, Fisher exact test) higher percentage of atlantoaxial instability. In the study population, 9 (14.1%) of 64 patients with AHP had more than 1 cause for AHP. Refractive errors, ptosis, unilateral hearing loss, and neck and spine musculoskeletal abnormalities were responsible for AHP in a small percentage of patients. Of all the patients with AHP, 23 (35.9%) improved their head posture with treatment (glasses or surgery). An additional 6 (9.4%) patients improved their posture spontaneously, over time and without treatment. Conclusions: The prevalence of AHP in the children with DS evaluated was 24.7%. From this analysis, having strabismus of any kind and particularly incomitant strabismus, nystagmus, or both is highly correlated with the development of an AHP. Almost 19% of DS patients with AHP had no definitive cause that could be determined. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Original languageEnglish
Pages (from-to)1859-1864
Number of pages6
Issue number9
StatePublished - Sep 2011

Bibliographical note

Funding Information:
Supported by a Marjorie Carr Adams Career Development Award from the Foundation Fighting Blindness and a Hope for Vision award (Dr. Drack); the National Center for Research Resources, National Institutes of Health , Bethesda, Maryland (grant no.: UL1RR024979 ). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the Clinical and Translational Science Award (CTSA) or the National Institutes of Health.

ASJC Scopus subject areas

  • Ophthalmology


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