Deformational plagiocephaly: a follow-up of head shape, parental concern and neurodevelopment at ages 3 and 4 years

Abstract

Objectives To compare head shape measurements, parental concern about head shape and developmental delays in infancy with measurements obtained at follow-up at ages 3 and 4 years. Design Longitudinal cohort study. Setting Initial assessments were conducted at a plagiocephaly clinic; follow-up assessments were conducted in the children's homes. Participants 129 children with a mean age of 4 years (range 3 years 3 months to 4 years 9 months), all of whom were diagnosed in infancy with deformational plagiocephaly or brachycephaly. Main outcome measures Head shape measurements of cephalic index and oblique cranial length ratio; level of parental concern about head shape; and delays on parent-completed age-appropriate Ages and Stages Questionnaires. Results 61% of head shape measurements reverted to the normal range; 4% remained severe at follow-up. Brachycephaly improved more than plagiocephaly. Facial and frontal asymmetry reduced to almost nil. Most had good improvement, but 13% were categorised as having 'poor improvement'. Initially, 85% of parents reported being 'somewhat' or 'very' concerned; this decreased to 13% at follow-up. The percentage of children with ≥1 delay decreased from 41% initially to 11% at follow-up. Conclusions Overall, head shape measurements, parental concern and developmental delays in infancy showed a dramatic improvement when re-measured at 3 and 4 years of age.

Cosmetic and Cognitive Outcomes of Positional Plagiocephaly Treatment

“…[12] Among patients with PP followed from infancy to three to four years of age, Ages and Stages uestionnaire (ASQ) testing revealed improvement among early developmental delay that was primarily gross motor in quality. [5] ose patients with most severe initial deformity were least likely to demonstrate short-term cognitive improvement. e remarkable ndings from this analysis begin with identifying possible associations between PP and cognitive development persisting into school-aged populations, with a three-to four-fold increase in language and motor di culties than the general population.…”

“…Similarly, only 10% of children raised any concern about their head shape. Followup work by Hutchinson and coworkers [5] among patients aged three to four years also reveals 61% normalization of head shape and only 4% residual severe deformity.…”

“…ese ndings are consistent with similar retrospective reviews of plagiocephaly with regards to both short and medium-term outcomes. [5,7,8] is may be related to positional preference among infants, with population studies revealing 68% preference for right-sided position, particularly among males and among supine-sleeping patients. [9] Cosmetic outcomes a er helmeting in this series of patients were acceptable, with 85% of parents noticing improvement in head shape and only 4% having residual signi cant deformity.…”

“…In more severe cases, orthotic molding can provide for more complete and rapid resolution of PP than with repositioning alone, with more favorable cosmetic outcomes observed when such treatment is applied earlier in the disease course between 6 and 12 months [4]. Mulliken and coworkers [5] describe the natural history of plagiocephaly without intervention to yield residual deformity among 45% of patients at 24 months of age. e literature surrounding the cognitive outcomes among patients treated for positional plagiocephaly remains scarce and ill-de ned.…”

Efficacy of passive helmet therapy for deformational plagiocephaly: report of 1050 cases

“…Greater numbers of studies are confirming the correlation between positional plagiocephaly and neurodevelopmental delay seen in fine motor skills. 7,9,12,19 Whether the developmental delay or the plagiocephaly is the causative factor remains unanswered. The importance of regular repositioning and observed tummy time cannot be overstated.…”