QuestionDear Dr. McNiece, My nephew is 10 months old and I've noticed that he seems to hang his head down and to the right all the time. He can pick his head up and look directly ahead of himself but usually dosen't do it very often. He does not have any signs of an ear infection. Along with him hanging his head the right side of his face seems to be either partially of fully paralyzed. When he smiles he only smiles with the left side of his face, or squints with his left eye. His mother does have a history of drug use and I cannot seem to convince her to take him to a doctor. Is there anything you can tell me to convince her to do so? Thank you. Lori.
AnswerHello Lori,
Thank you for question. I apologize for the delay, but I appreciate your patience.
Any child that is under one year of age with a suspected neurologic problem or developmental delay should be evaluated. This is true despite any reluctance on the part of biological parents. We have a responsibility to serve the children, who cannot speak for themselves. If CPS needs to be involved to establish an appointment, then that has to happen. Additionally, occasionally the reluctance of biological parents to take the child to the doctor extends beyond the symptoms of the child. Parents that are struggling do not want any extra attention focused upon them.
This is one of the reasons why it is critical that the baby be evaluated.
What you're describing regarding his head positioning and squinting suggests to me that he may have a condition called diplopia, or double vision. Often children will compensate for double vision by changing their head position, squinting or closing and eye (often with her hand or another object, because they are unable to close the lid physiologically themselves yet). If in fact, this child does have diplopia, he needs to be seen right away. To have normal vision with both lies as an adolescent or adult, a child must develop their vision. The neurological pathways from the eye to the back of the brain, where site is processed are developed during childhood. If the signals that are required to develop those pathways are distorted, such as during diplopia (double vision), the neural pathways on that side of the brain will not develop and the affected eye will never developed adequate sight.
Furthermore, the other symptoms that you described regarding facial droop maybe concerning as well. It sounds as if the boy needs an ophthalmologic and a neurologic exam.
If your sister is unwilling to have the boy evaluated somebody has to step up to do it. I'm not suggesting challenging his mother in any fashion, and I understand that she may have some issues that might make her reluctance to go to the doctor.
However, a 10-month-old boy can not speak for himself and needs someone to help him. Clearly, you have identified a problem, perhaps you can make arrangements to have him seen where his mother would endorse it. If not, and I don't mean to exert pressure on you, but you might find that you have an obligation to help him.
Best of luck. I admire your courage in this situation.
Dr. T
