Plagiocephaly – more than just a skull issue?
Plagiocephaly, a condition characterised by asymmetrical flattening of an infant’s skull, has seen a significant increase in prevalence over the past few decades. Prior to the 1990s, the estimated prevalence was about 1 in 300 infants. However, following the introduction of the “Back to Sleep” campaign in 1992, there has been a dramatic rise in cases, with current estimates suggesting that positional plagiocephaly may affect up to 46.6% of infants at 3 months of age [1].
This condition is typically diagnosed in the first 4 months of life and is less likely to be detected after 2 years of age. Risk factors include being a firstborn, maternal age over 35, breech position (not laying head down), prolonged labour, assisted vaginal delivery, and multiple births [2].
Plagiocephaly is often associated with torticollis, occurring in approximately 1 in 6 cases [3], with more recent research by Dr Christian showing over 90% of infants with plagiocephaly having reduced range of motion in their neck – highlighting the importance of considering neck involvement in its development and management [4].
Recent studies have found associations between moderate to severe plagiocephaly and developmental delays that can persist into adolescence. Research has shown increased odds of developmental delays, particularly in motor, language, and social domains, in children diagnosed with plagiocephaly by 12 months of age [5]. These findings suggest that plagiocephaly, especially in its more severe forms, may be linked to developmental challenges that can impact academic performance into the school-age years [6]. But this needs to be taken with a pinch of interpretation; the plagiocephaly is not the CAUSE of any developmental delay, it is an indicator for RISK of developing.
[1] Mawji A, et al. Paediatr Child Health. 2014;19(8):423-7.
[2] Di Rocco C, et al. Childs Nerv Syst. 2012;28(9):1413-22.
[3] Looman WS, Flannery AB. J Pediatr Health Care. 2012;26(5):372-80.
[4] Fludder CJ & Keil BG. Alt Ther Health Med. 2021;27(6):26-32
[5] Collett BR, et al. Pediatrics. 2019;143(1):e20182373.
[6] Speltz ML, et al. Pediatrics. 2010;125(3):e537-42.