Heads-up on Positional Plagiocephaly and Whether It Can Affect a Child’s Development
LewisFirst, MD, MS, Editor in Chief, Pediatrics
When a child has position 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. (10.1542/peds.2018-2373) 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.
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 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.