The course of positional cranial deformation from 3 to 12 months of age and associated risk factors: a follow-up with 3D imaging

Abstract

Deformational plagiocephaly is reported in up to 46.6 % of healthy infants, with the highest point prevalence at around 3 months of age. Few prospective studies on the natural course of skull deformation have been conducted, and we know of no studies using 3D imaging starting from the highest point prevalence period. In this prospective, population-based cohort study, we describe the course of cranial asymmetry and shape in an unselected population using 3D stereophotogrammetry and investigate factors associated with late cranial deformation and failure to recover from previous deformation. We evaluated 99 infants at 3, 6, and 12 months of age. We acquired 3D craniofacial images and performed structured clinical examinations and parental interviews at each visit. Eight outcome variables, representing different aspects of cranial shape, were calculated from a total of 288 3D images. Scores of asymmetry-related variables improved throughout the observation period. However, the rate of correction for cranial asymmetry decreased as the infants grew older, also in relation to the rate of head growth, and a significant amount of asymmetry was still present at 12 months. Positional preference at 3 months predicted an unfavorable course of cranial asymmetry after 3 months, increasing the risk for DP persisting. What is known: • The prevalence of deformational plagiocephaly spontaneously decreases after the first months of life. • Limited neck range of motion and infant positional preference increase the risk of deformational plagiocephaly during the first months of life. What is new: • Positional preference at 3 months predicts an unfavorable spontaneous course of deformation also from three to 12 months of age, presenting a potential target for screening and treatment. • The spontaneous rate of correction for cranial asymmetry decreases after 6 months of age, also in relation to the rate of head growth.

A 3D Follow-Up Study of Cranial Asymmetry from Early Infancy to Toddler Age after Preterm versus Term Birth

“…For this reason, the time interval to follow cranial molding from three months to three years was chosen, which might be considered a weakness. However, this period includes the peak prevalence of DP, and during this period, the majority of spontaneous resolving of cranial asymmetry is expected to happen [8,43]. Also, the differences in cranial shape and symmetry between preterm and full-term born children in TEA has been documented earlier [19].…”

“…There were 11 females and 23 (67.6%) males in each group. The control group was randomly selected from a previously collected nonintervention cohort [8] by computer-based random selection and matched to gender. All participants were born on preselected dates between the years 2012 and 2015 in Oulu University Hospital and entered into the study before their discharge home after birth.…”

“…After that, the reported prevalence of DP has risen as high as 46.6% in Canada [1,2,3]. However, the reported prevalence rates have a wide range, as the prevalence is affected by the evaluation age of the infants, the diagnostic methods used, the decade when the research was performed, and the prevention and follow-up aspects offered by local health professionals [4,5,6,7,8,9,10,11].…”

Craniosynostosis - Recognition, clinical characteristics, and treatment

“…The number of infants with this type of plagiocephaly has risen over the past several years, which has been associated with the "back to sleep" campaign to reduce the incidence of sudden infant death syndrome (SIDS). The presence of torticollis, prematurity, and gross motor delay can also predispose an infant to positional plagiocephaly [16,44,48,49].…”

Nonsynostotic plagiocephaly: a child health care intervention in Skaraborg, Sweden

“…In their follow-up of the RCT investigating head shape of infants from three to 12 months, all parents concerned about their infant’s head shape received advice on repositioning, regardless of previous group allocation. When sorted according to original group allocation, 13% of intervention group infants and 20% of control group infants had NSP at 12 months [27]. In our study, 13% of intervention group and 16% of control group infants had NSP at 12 months.…”