Heads-up on positional plagiocephaly and whether it can affect a child’s development

When a child has positional plagiocephaly/brachycephaly (PPB) secondary to sleeping in the same position on their backs at night, we are usually asked two questions:

1. Will the flat head shape stay that way? and
2. Can it cause brain damage or developmental delay?

We know the answer to the first question is no, based on prior studies and perhaps personal experience with your own patients.

As to the second question, Collett et al.^[1] investigated this in a longitudinal cohort of infants with and without PPB who were followed until they were ages 7 to 11 years and then given a battery of developmental and academic tests. In addition, the children’s head shapes were rated by two investigators blinded to the history of positioning using a reliable and valid scoring system.

Lewis First MD MS, Editor in Chief, Pediatrics, American Academy of Pediatrics AAP January 11, 2019

The good news is that those children who had only mild PPB showed no differences in development when compared to controls without PPB, but those with moderate to severe changes in head shape did show statistically significant differences although the magnitude of these differences did not appear to be substantial.

Does that mean that PPB causes developmental abnormalities? This study ^[1] cannot begin to prove causality but can suggest that moderate to severe PPB might be a marker for developmental risk. In turn, detecting moderate to severe PPB warrants ongoing surveillance to make sure early intervention services (and not just a reshaping helmet) are put into play as soon as developmental delays are noted.

For the vast majority of infants with only mild PPB, this study should keep you ahead of the families’ concerns. There is a lot of good information about the natural history of PPB and its association with a child’s development, so shape up and give this study a read.

Source American Academy of Pediatrics AAP

References

1. Cognitive Outcomes and Positional Plagiocephaly, Collett BR, Wallace ER, Kartin D, Cunningham ML, Speltz ML. Pediatrics. 2019 Feb;143(2). pii: e20182373. doi: 10.1542/peds.2018-2373. Epub 2019 Jan 11.
2. Development at age 36 months in children with deformational plagiocephaly, Collett BR, Gray KE, Starr JR, Heike CL, Cunningham ML, Speltz ML. Pediatrics. 2013 Jan;131(1):e109-15. doi: 10.1542/peds.2012-1779. Epub 2012 Dec 24. Full text
3. Prevalence and characteristics of positional plagiocephaly in healthy full-term infants at 8-12 weeks of life, Ballardini E, Sisti M, Basaglia N, Benedetto M, Baldan A, Borgna-Pignatti C, Garani G. Eur J Pediatr. 2018 Oct;177(10):1547-1554. doi: 10.1007/s00431-018-3212-0. Epub 2018 Jul 20.
4. Correlative vs. Causative Relationship between Neonatal Cranial Head Shape Anomalies and Early Developmental Delays, Andrews BT, Fontana SC. Front Neurosci. 2017 Dec 19;11:708. doi: 10.3389/fnins.2017.00708. eCollection 2017. Review. Full text
5. Long-term developmental outcomes in patients with deformational plagiocephaly, Miller RI, Clarren SK. Pediatrics. 2000 Feb;105(2):E26.
6. Systematic Review and Evidence-Based Guidelines for the Management of Patients with Positional Plagiocephaly, [No authors listed] Pediatrics. 2016 Nov;138(5). pii: e20162802. No abstract available. Full text

Also see
My Baby Has a Flat Head – What Next? Technology in Motion
A Quick and Easy Guide to the Different Types of Flat Head Syndrome Technology in Motion