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7 year old, twins, has an indented area on the skull, curved spine, impulse control issues. Risk of brain injury?

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Pediatrician, Infectious Diseases
Practicing since : 2005
Answered : 1528 Questions
My 7- y.o. daughter has an indented area on the top of her skull. she is a twin. When born by c-section at 38 weeks, she had great difficulty with latching and nursing which resolved at 7 months with a frenuloplasty. However, she had torticullis secondary to untrauterine positioning problems (she was transverse and her head was shoved up under my ribs and her brother was breach). At 32 weeks, a substitute OB-Gyn punched (yes) her head through my stomach quite hard twice to show his excitement at seeing her head clearly outlined through my stomach. This was very hard and I was prone and shocked and helpless to move or respond or anticipate it. He said she was perfectly safe in there when I verbally responded--cushioned in amniotic fluid. However, she still has this indention (remarkably, the size of a fist).After birth we had to see a phys therapist to straighten her neck out (still not totally straight) and later noticed gait difficulty and some unusual curving of spine this way and that. A helmet was considered, but we were advised that that might cause severe emotional problems for her so we didn't get the referral for the specialist at that time. She had one ear ahead of the other and one eye noticably bigger and the PT helped that alot but didn't resolve it totally. She just completed 1st grade and did well, but has always struggled more than her brother with spacial reasoning (builds insane senseless things) and does weird sorting of her toys, moving them constantly into irrational groups. She also has some impulse control issues and is likely to flail her arms about and bop her brother. She draws like a 3 year old (her brother draws like a 9 yr old). She has less fine motor control than him, is loud, has never slept well at night (wakes up constantly--3 or 4 times a night until she was 5 y.o., and has difficulty moderating her appetite. She is very physically gifted in strength and coordination (athletic) and reads at almost a 3rd grade level. She struggles to get math but on extreme repetition can produce the right answer. I worry that there is brain injury from either what the OB-GYN did or because she spent a few months crushed into a small place with her brother. Pregnancy was healthy--I did aerobics till wk 32, ate salmon and blueberries, etc. She was a very "colicky" baby and had both breast milk and formula. Breast feeding continued until age 2. She was given omeprazole for her first year--but, I don't think it helped. We had alot of yeast and thrush. i don't know if I should take her to the Amen (Daniel Amen, MD) clinic up in Seattle to get her a CAT scan to see if she has some brain injury and needs treatment.
Posted Tue, 31 Jul 2012 in Brain and Spine
Answered by Dr. Hema Yadav 2 hours later
Thanks for posting your query .
I understand your concern and appreciate your efforts as a vigilant parent .
First and foremost , according to the information provided by you there definitely seems to be a physical and possibly a neurological anomaly in your child . The cause can be anything from a twin pregnancy causing inadequate fetal development , a genetic or a intrauterine growth retardation . However considering that the blow you received was after 32 weeks by which most organs are fully developed its less likely to be the cause or the only cause , I would say . Yes it's true that the fetus is protected by the amniotic fluid but in twins the cushioning effect might be reduced as compared to a single fetus .
Now that your daughter is 7 yrs old if you want to get a confirmation the best approach would be to get her thoroughly evaluated by a neurologist and get a MRI brain done which can show even minor changes or effects of birth related injuries to the brain.
Please do not correlate the size of the indentation as that does not correlate with the severity of damage as even perfectly closed skull can show XXXXXXX brain damage .
Please do not worry as whatever be the result the treatment more or less depends on the present neurological status .With proper physiotherapy and occupation therapy much progress can be achieved .
Hope I have answered your query.
I'll be available for any follow up queries.
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