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8 weeks baby diagnosed with asymmetric crying face. What are the complications?

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Pediatrician, Neonatology
Practicing since : 1970
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My daughter was diagnosed at the age of 8 weeks with Asymmetrical Crying Baby Facies. Other tests ruled out any other abnormalities of the heart, etc. I was wondering if there are any significant motor function problems with any cases such as this. She has never outgrown her startle reflex. Meaning, if she hears particular sounds, gets excited or over-stimulated, she freezes with her face distorted, and her hands are moving similar to children with autism. She will flap her hands by opening and closing them, and she stiffens completely straight, even when she's sitting. I've always felt there were problems causing this, but nothing major. All of these movements are completely involuntary. She is not aware that she is doing it. She was VBAC, and diagnosed in the hospital with a facial nerve palsy. When it didn't go away at her 8 week c/u, she was referred to a neurologist, who diagnosed the ACF. Has had ear tubes, 4 surgeries for removal of a cholesteotoma, but nothing related to motor function, etc. Any information that you could give regarding these involuntary movements would be great.
Posted Mon, 5 Nov 2012 in Child Health
Answered by Dr. Uma Rajah Ananth 6 hours later

Thanks for the query. I read through the details with diligence and my comments are as follows:

1. Asymmetric Crying Face (ACF) can be isolated defect or associated with other birth defects like cardiac problems. I am glad to know that she was screened and no cardiac problems were found.

2. The involuntary movements that you describe are definitely abnormal. However is the child otherwise developmentally normal?
I would be very concerned, if she her growth and development is restricted.

3. Based on your description, I am unable to classify the type of abnormal movements she has. Perhaps an EEG and MRI scan of the brain needs to be done to find the cause of these abnormal movements.

4. She needs to be followed up by a competent pediatric neurologist again with proper history and reports.

Hope this suffices. I will be available to address other concerns.

Good luck!!

Dr Uma
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