The upper cervical spine and atlanto-occipital junction have been identified in previous studies as being the cause of a diversity of clinical findings affecting the newborn infant. KISS syndrome is not a disease but a malfunction and blockage in the upper cervical in children. The definition of KISS in english is ‘Kinematic Imbalance due to Suboccipital Stress’. This means imbalance in motion due to stresses in the upper neck region. This can result in an asymmetric development in children that involves a disruption in the normal movement development or disturbances in the control as the child’s ability thrives.
A chiropractor looks for symptoms, for example by muscular torticollis, scoliosis and atlas blockage. The syndrome affects twice as many boys as girls. Many still choose not to use the KISS concept because it is not documented and recognized in medical environments. This means that there is too little research that supports the diagnosis. The doctor and manual coroner, Heiner Biedermann began using the term KISS in the early 90th century. He has over the years treated thousands of children with KISS issues.
KISS I and KISS II syndrome
KISS I is a disfunction in the neck that the child can not get out of byitself. They often have a favorite side, they keep their head turned to one side, and would prefer just one way. The child sees such right and tilts his head to the left. When the head is mostly turned to one side, the skull alters to this position. Beyond this, one can also see the asymmetry of the face where one facepiece may seem less than the other. Another characteristic of this type is that the child is like a C (a banana). This can happen in your bed, on your lap or in the car seat. The arm and leg on the ‘inside’ of the ‘C’ is less used and it can lead to a delayed motor development.
KISS II children are often hypermobile regardless of position (dorsal, lateral or upper arm). These children can usually rotate their head freely to both sides, but in this occasion with the extreme overstretch of the neck, the child may have difficulty bending the head forward and may have difficulties to lay down on their head. When lying on their stomach, they have a pronounced intolerance to lying on their stomach. The skull can be flat behind and the child may lose hair. There is also an increased tendency for a so-called 3-month child with infantile colic, increased gulping and drooling and delays in language development.
By getting your child tested and treated early by a chiropractor dysfunctions and pain in the neck could rapidly improve and your child will often resume normal movement. Our chiropractors have extensive experience treating children with these conditions.
Common symptoms in a child with KISS syndrome
• Misalignment of the head (favorite side)
• Difficulty keeping their head in the middle (after 3 months)
• Lying with their head in an extreme flexed position
• Unilateral sleeping position
• Moving arm and leg less on a page
• Unilateral facial features like a C banana
• Unilateral underdeveloped hip
• Faulty position in the foot
• Sleep disorders, child screams in their sleep
• The child has a tenderness in the neck to react negatively when one contacts the neck
• Asymmetrical head/facial shape
Who is at risk of getting KISS syndrome?
There are many known factors associated with KISS syndrome, which chiropractors often can link to neck dysfunction. Parents should be aware of these factors and contact a chiropractor for a thorough assessment and examination of the child. Below are the most common contributing factors.
• Redeemed with suction cups
• Delivered by forceps
• Head ‘squeezed out’ by external pressure on the stomach
• Deferred for manual drag (shoulder dystocia)
• Delivered by cesarean
• Born with face first
• More than 4,000 grams at birth
• Has been in a transverse lie, breech during pregnancy
• Twins, triplets
• Born prematurely
• Unusually long birth
Becomes a dysfunction in the upper cervical joints (KISS) when not treated and the consequences be disrupted or delayed psychomotor development, it is this one describes as KIDD syndrome. Below are the most common signs of possible KIDD syndrome.
• Concentration and learning difficulties
• Writing / reading difficulties
• Diffuse headache, heavy head
• Delayed motor development
• Difficult to ride and /or balance
• Phobia of heights
• Poor balance, coordination
• Unstable mood (frustration, anger, impatience or aggressiveness)
• ADHD like problems
• Maverick / intestinal disorders (constipation)
Chiropractic treatment for children with KISS and KIDD syndrome
Chiropractors at Plato Chiropractic Health Clinic will conduct a thorough examination of the child’s musculoskeletal system and initiate any treatment early. Children who have a developmental disorder should be examined in relation to the function of the vertebral column to rule ou that there is a dysfunction in the neck in relation to possible KISS or KIDD syndrome. If you find a dysfunction, treatment should be performed by an experienced chiropractor. The treatment of neck dysfunctions are painless and have a fairly high success rate, treatment should otherwise be implemented as quickly as possible.
Even with asymmetrical head shape, head shape improves way up until the child is 5 years. If one of our chiropractors find no reason to treat, he/she will refer the child for further follow-up to children physiotherapists or other therapies if needed. And remember that children respond much faster in most treatments than adults! Initiate an early action will result in quick results.
In a study by Dr Biedermann suboccipital strain was identified as causing a variety of signs and symptoms in a group of 114 young infants.
The study, published in the Journal of Manual Medicine, not only identifies the signs and symptoms of the suboccipital strain syndrome, but also highlights the effectiveness of spinal adjustments in correcting the problem.
From a group of 600 children, 114 were chosen for treatment and follow-up study. Their symptoms included restricted motion of the cervical spine, torticollis, cervical scoliosis, facial scoliosis, asymmetric muscle tone, retarded development of the hip joints, opisthotonos (retraction of the head and arching of the back, with infant unable to hold the head erect), deformities of the feet, restless sleep, and not eating or drinking well.
The most common findings were those of torticollis (head tilted to one side), scoliosis (sideways curve of the cervical spine), asymmetric muscle development, slow development of the hip joints and asymmetrical or slow development of motor skills.
The most common factors causing suboccipital strain were identified in the study as including intrauterine malposition of the fetus, the use of forceps or vacuum extraction during the birth process, prolonged labor and multiple fetuses (twins, triplets, etc.). The incidence of these risk factors in affected infants varied significantly from the established normal birth statistics.
According to the authors of this study, the pathogenic importance of asymmetric posture in infants and young children is often disregarded, with the condition either being dismissed as unimportant or not recognized at all.
All of the subjects in the study were treated by adjustments to either the atlanto-occipital or the atlanto-axial joints. According to the author, treating disturbances of the suboccipital joints and the cervical spine simplifies and shortens the course of the infant's problems, and significantly reduces the need for lengthy programs of physiotherapy. Furthermore, the indication for spinal manipulation in infants depends on first recognizing the clinical symptoms and then fitting them with the physical and radiological findings.
KISS syndrome was defined primarily because of the inability to consistently identify fixations, or "blockages" in the atlanto-occipital region, as had been previously described by Gutmann in the 1960s. In many cases, KISS syndrome can be dealt with effectively by correcting the alignment and restoring lost movement to spinal vertebrae.
Several case reports are presented in the paper, the first of a four month old female infant born by Cesarian section. The mother was concerned that her daughter had difficulty controlling her head position and always slept on her right side. The left arm was used less frequently than the right. Upon examination, painful palpation was identified on the right upper cervical spine, with cervical flexion on the left being half that on the right. Follow-up after manipulation showed symmetrical development and normal sleep patterns.
Another report details the case of a five month old twin who suffered hypoxia at birth. At six weeks of age examination showed cervical scoliosis, hypomobility of the left arm, poor head control and asymmetry of the facial structures. Following manipulation, posture and mobility were symmetrical and the cervical scoliosis straightened.
A third report gives details of the case of a six month old female with inability to turn her head to the left and with a pronounced facial scoliosis. Handling the child was described as difficult as she often cried, her motor development was retarded and she had recurrent fever of unknown origin. A few hours after the first treatment she moved her head to the left. One month later her facial scoliosis was much less pronounced and her motor development was improved. Twelve months later no abnormalities were detected.
In this study, 29 infants were identified with congenital torticollis. In this condition, spasm or trauma to the sternocleidomastoid muscle (SCM) causes the newborn infant's head to tilt to one side. Frequently, in persistent cases, surgery to lengthen the SCM is the elective option. All but one the 29 infants with torticollis responded to manipulation of the upper cervical spine.
Identification of Suboccipital Strain
Identification of suboccipital strain requires careful palpation by a doctor experienced in the art of spinal examination. Initial indications can be increased pain or sensitivity of the suboccipitaland upper cervical spinal regions and/or restricted movements of the head and neck.
Subluxation of the atlas to the right, relative to the occiput, was a more frequent finding than was left atlas subluxation. This finding correlates with the studies of Jirout who also found the most common direction for atlas subluxation to be to the right.2 In 19 cases the main spinal asymmetry was found at C1-C2. In these patients, treatment at C1-C2 proved to be as effective as adjusting C0-C1.
Suboccipital strain is a leading factor in the conditions described. It can be relieved quickly and effectively by adjusting the cervical spine, in most cases, with one or two treatments. A frequent comment by parents was that their child ate better and slept better after the treatment.
Biedermann H. Kinematic imbalances due to suboccipital strain in newborns. J. Manual Med (1992) 6:151-156.
Jirout J. (1990) Roentgenologische Bewegungsdiagnostik der Halswirbelsaule. Fischer, Stuttgart.