KISS Syndrome
The term KISS translates to Kinematic Imbalance due to Suboccipital Strain. In layman terms this means that functional problems with the upper cervical spine can lead to an imbalance. It was coined by a German surgeon, Heiner Biedermann, who for many years had the opportunity to work with and observe different manual therapists. His focus later became manual therapy and he suggested that suboptimal inutero position and injuries during birth to the cervical spine can cause functional, reversible abnormalities which can lead to an array of symptoms and complaints in the infant. Left untreated, these are also observed in the child and adult. Biedermann is not alone in proposing that pre and post-natal trauma can result in spinal misalignments which affect not only the sympathetic nervous system, but the sensory-motor system as well. The upper cervical spine is adjacent to the brain stem and this area is particularly sensitive to strain. The infants with KISS demonstrate a specific asymmetry.
Common causative factors include a prolonged delivery, multiple gestation, and infants subjected to excessive force during labor (vacuum extraction, forceps delivery, pressure applied from above, or other forces applied to the fetus during delivery, including acute cesarean delivery).
The literature describing these infants and the much of the research available is in German which has made this syndrome somewhat of an enigma. Sacher, another German physician, also describes predisposing risk factors: pressure applied to the abdomen during delivery, birth weight greater than 4000 g, unfavorable fetal positioning, prolonged delivery, precipitate labor, and traumatic deliveries.
Some of the signs and symptoms of KISS are torticollis, problems with breastfeeding, irritability (colic), sleep disorders, C- scoliosis, hypersensitivity of the neck, extension posture, refusal to lay prone and reduced cervical range of motion, facial/cranial asymmetry.
Biederman and Sacher describe the consequences of children left untreated with KISS syndrome. They find that many children develop what they call KIDD syndrome (KISS induced dysgnosia and dyspraxia): which is a condition of senory- motor deficits leading to symptoms of attention deficit and impaired balance and coordination. The authors agree that dysfunction of the cervical spine are not the cause of attention deficit, but that it can be an aggravating factor in children with compromised concentration problems.
Studies of whiplash patients similarly demonstrate that injury to the cervical spine, affect the sensory-motor system, particularly proprioception. A study looking at re-positional skills of the neck concludes that improper functioning of the neck can influence the quality of movement affecting motor skills.
Common signs of KIDD:
Restlessness, slow motor development, poor coordination, asymmetric posture, functional scoliosis, difficulty concentrating, easily distracted and difficulty with balance and coordination and attention deficits.
Both KISS and KIDD are treated with manual therapy. Treatment is specifically to the upper cervical spine (when indicated).
IISMO: Irritable Infant Syndrome of Musculoskeletal Origin
IISMO translates into Irritable Infant Syndrome of Musculoskeletal Origin. This means that symptoms causing irritability and eventually asymmetry can arise from dysfunction in any area of the system of joints, ligaments and muscles. Some of the common symptoms include:
Restlessness, excessive crying, antalgic postures (child prefers an asymmetric posture of the head and/or body), asymmetric movements, hypertonicity (tightness unilaterally of musculature), sensitivity to touch particularly in the neck. Some infants bang their heads. Common areas of dysfunction besides the neck are the pelvis, ribcage and thoracic spine.
Treatment for these infants is to the areas that are not functioning properly which have been identified during examination. These children respond to gentle conservative treatment by practitioners with appropriate education and skills.
References:
Bein-Wirzbinski, B., Scheunenmann, R., and Sepke, C., 2008. Mögliche Zusammenhänge zwischen Kopfgelenkdysfunktionen und blickmotorischen Auffälligkeiten bei Grundschulkindern mit Schulschweirigkeiten. Manuelle Medizin, 46, 307-315.
Biedermann, H., 2004. Manual therapy in children. London: Churchill Livingstone.
Biedermann, H., 2007. Kiss-Kinder –Ursachen, (Spät-)Folgen und manualtherapeutische Behandlung frühkindlicher Asymmetrie. 3. Auflage, Stuttgart: Thieme.
Foreman, S. M., and Croft, A. C., 2002. Whiplash injuries- The cervical acceleration/deceleration syndrome. Third Edition, Philadelphia: Lippincott Williams & Wilkins.
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Hamanishi, C., and Tanaka, S., 1994. Turned head- adducted hip- truncal curvature syndrome. Archives of disease in childhood. 70, 515- 519.
Hawk, C., Schneider, M., Ferrance, R. J., Hewitt, E., Van Loon, M., and Tanis, L., 2009. Best practices recommendations for chiropractic care for infants, children and adolescents: result of a consensus process. Journal of Manipulative and Physiological Therapeutics, 32 (8), 639-647.
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Koch, L. E., and Graumann-Brunt, S., 1999. Kopfgelenk-induzierte Symmetriestörungen und deren Folgepathologien – Pilot Studie. Manuelle Medizin, 37, 67-78.
Miller, J. E., and Benfield, K., 2008. Adverse effects of spinal manipulative therapy in children younger than 3 years: A retrospective study in a chiropractic teaching clinic. Journal of Manipulative and Physiological Therapeutics, 31 (6), 419-423.
Miller, J. E., 2007. Cry babys: A framework for Chiropractic care. Clinical Chiropractic, 10, 139-146.
Owens, E. F., Henderson, C., Gudavalli, R. M., and Pickar, J. G., 2006. Head repositioning errors in normal student volunteers: a possible tool to assess the neck’s neuromuscular system. Chiropractic and Osteopathy, 14 (5) Available fom http://www.chiroandosteo.com [Accessed 10.11. 2010].
Sacher, R., 2007. Handbuch KISS KIDDs- Entwicklungsauffälligkeiten im Säuglings-Kleinkindsalter und bei Vorschul-/Schulkindern- Ein manualmedizinischer Behandlungsansatz. Dortmund: Verlag modernes lernen.
Stellwagen, L., Hubbard, E., Chambers, C., and Lyons Jones, K., 2008. Torticollis, facial asymmetries and plagiocephaly in normal newborns. Archives of disease in childhood, 93, 827-831.
Tsai S-W., Zhong, J-D., Chen, Y-W., Wu, S-K., and Lin, Y-W., 2009. Treatment of upper cervical subluxation in paediatric patients. Manual Therapy, 14, 448-451.