Heads-up on Positional Plagiocephaly and Whether It Can Affect aChild's Developmentby Lewis First MD, MS, Editor in Chief, Pediatrics
When a child has position plagiocephaly/brachycephaly (PPB) secondary to sleeping in the same position ontheir backs at night, we are usually asked two questions- (1)-will the flat head shape stay that way and (2) can itcause brain damage or developmental delay? We know the answer to the first question is no, based on priorstudies and perhaps personal experience with your own patients. As to the second question, Collett et al.(10.1542/peds.2018-2373) investigated this in a longitudinal cohort of infants with and without PPB who werefollowed until they were ages 7 to 11 years and then given a battery of developmental and academic tests. Inaddition, the children's head shapes were rated by two investigators blinded to the history of positioning using areliable and valid scoring system.
The good news is that those children who had only mild PPB showed no differences in development whencompared to controls without PPB, but those with moderate to severe changes in head shape did showstatistically significant differences although the magnitude of these differences did not appear to be substantial.Does that mean that PPB causes developmental abnormalities? This study cannot begin to prove causality butcan suggest that moderate to severe PPB might be a marker for developmental risk. In turn, detecting moderateto severe PPB warrants ongoing surveillance to make sure early intervention services (and not just a reshapinghelmet) are put into play as soon as developmental delays are noted. For the vast majority of infants with onlymild PPB, this study should keep you ahead of the families' concerns. There is a lot of good information aboutthe natural history of PPB and its association with a child's development, so shape up and give this study aread.
Systematic Review and Evidence-Based Guidelines for the Management of Patients with Positional
Plagiocephaly
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The Incidence of Positional Plagiocephaly: A Cohort Study●
Development at Age 36 Months in Children With Deformational Plagiocephaly●
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