A growing clarity!

I have struggled for a few years to come to some broad perspective on the symmetry of the head shape in early childhood.

I confess that I ignored asymmetry in the skull shape for many years till about fifteen years ago. Since then, I have taken note of the shape of the head in children. Since I started feeling the sutures on the skull, size of the sternomastoid muscle in the neck on both sides, measuring the ears, face, etc. I have enough evidence to conclude that the shape of the head is determined by some identifiable factors in childhood. 

They are: the premature closure of the sutures of the skull, asymmetry  in the tone of the sternomastoid muscles, the positional effect of the head on the skull,  injury to the brain during intra-uterine life or thereafter, etc.

The shape of the skull has a bearing on vision and causation of squint, position of the head, spinal curvature, etc.

Along with the shape of the skull, I have given considerable importance to measuring the anterior fontanelle, which is one sign to know indirectly the brain growth. An early closure of the anterior fontanelle before one year is an indication of the reduced brain growth.  

Now that the measurement of the head size of the parents, their height and weight have become a regular feature in our clinical examination protocol, this information is adding insights to study the significance in the alteration of head sizes in children. Families are happy to share with us family photographs which contribute information about the hereditary factor in the head size profile of the family. 

It is now thirty years, since I have been measuring the skin fold thickness of children routinely, which has also helped me to know the subtle fat accumulation in children who were born preterm or with low bird weight, who have a risk of overweight in pre-adolescent years. Now that measuring the lipid profile has become regular in children who show a sudden increase in their skin fold thickness, there is an evidence based approach to reduce the risk of obesity in late childhood. The use of peek flow meter to measure the expiratory volume has become another tool to know which children are at risk for obstructive apnoea when they become obese. 

Now that I have enough evidence about the size of the thumb being an early indication of the dominant hand, it has become easier to identify the natural left handedness form the acquired left handedness in children. If the left thumb is mild later than the right and the right sided muscle tone and deep tendon reflexes are normal, then the left hand might be the domain hand. There might be other members in the family who too might be left handers. 

I have been on a campaign to let left handed children be left handers even for eating and writing. I have shared this information with some schools to create chairs with moving table to be fitted on the left side of he chair for the advantage a few in the class who might be habitual left handers. 

For me this journey in to the domains of child development has been a journey of discoveries and insights. 

Thank you children and parents, for being my teachers and pathfinders!My former colleagues at Chennai, Nagpur, Vellore, Pondicherry and now at Kolenchery have provided me the guidance to think differently and originally. 

I look back the last forty years in gratitude. Many observations were not mine. Others raised them as questions because of which I was alerted to observe even more. 

The ten medical students who did research with me or Anna while at MOSC Medial college have been co-travellers who should showed us the way on some critical issues in childhood such as sleep behaviour, overweight, peek respiratory flow, role of vitamins D, craniosynostosis etc. 

M.C.Mathew(text and photo)