The course of skull deformation from birth to 5 years of age: a prospective cohort study

Abstract

In a continuation of a prospective longitudinal cohort study in a healthy population on the course of skull shape from birth to 24 months, at 5 years of age, 248 children participated in a follow-up assessment using plagiocephalometry (ODDI—oblique diameter difference index, CPI—cranio proportional index). Data from the original study sampled at birth, 7 weeks, 6, 12, and 24 months were used in two linear mixed models. Main findings: (1) if deformational plagiocephaly (ODDI <104%) and/or positional preference at 7 weeks of age are absent, normal skull shape can be predicted at 5 years of age; (2) if positional preference occurs, ODDI is the highest at 7 weeks and decreases to a stable lowest value at 2 and 5 years of age; and (3) regarding brachycephaly, all children showed the highest CPI at 6 months of age with a gradual decrease over time. Conclusion: The course of skull deformation is favourable in most of the children in The Netherlands; at 5 years of age, brachycephaly is within the normal range for all children, whereas the severity of plagiocephaly is within the normal range in 80%, within the mild range in 19%, and within the moderate/severe range in 1%. Medical consumption may be reduced by providing early tailored counselling. What is Known: • Skull deformation prevalence increased after recommendations against Sudden Infant Death Syndrome, little is known about the longitudinal course. • Paediatric physical therapy intervention between 2 and 6 months of age reduces deformational plagiocephaly at 6 and 12 months of age. What is New: • The course of skull deformation is favourable in most of the children in The Netherlands; at 5 years of age, deformational brachycephaly is within the normal range for all children, whereas the severity of deformational plagiocephaly is within the normal range in 80%, within the mild range in 19%, and within the moderate to severe range in only 1%. • Paediatric physical therapy intervention does not influence the long-term outcome; it only influences the earlier decrease of the severity of deformational plagiocephaly. Electronic supplementary materialThe online version of this article (doi:10.1007/s00431-016-2800-0) contains supplementary material, which is available to authorized users.

Infant/toddler motor skills as predictors of cognition and language in children with and without positional skull deformation

“…Findings from this study suggest that motor skills assessed at age 18 months were consistently and significantly associated with language and cognitive outcomes among children with PPB when they reached preschool age. A holistic developmental approach to physical therapy and occupational therapy for children with PPB intervention is warranted, [19,13] as such interventions might lay the developmental foundation for the later acquisition of cognitive and language skills. Early motor deficits are among the first developmental issues observed in this population and targeted intervention or prevention efforts may help to improve these and other developmental outcomes.…”

Craniofacial Asymmetry from One to Three Years of Age: A Prospective Cohort Study with 3D Imaging

“…Even though DP decreases throughout childhood, either spontaneously or with treatment, a notable amount of cranial asymmetry in the cases of DP can still be seen at the age of three to five years old [20]. Moreover, the growth potential of the upper and lower jaws is most significant during the first years of life [21,22].…”

Normal Head Shape Parameters in the First 2 Years of Life and Effect of Helmet Therapy

“…1e, f). Spontaneous improvement of nonsynostoticisolated brachycephaly was described by many authors to date, 11,33 and some might tend to discourage the use of molding helmets to correct this rather scarce condition. However, since the CI improved faster and in a significant manner in a substantial number of children orthotically treated for positional brachycephaly, we stick to recommend treatment of severe cases of central-occipital flattening with individual molding orthoses, although other authors might advise differently.…”

“…However, since the CI improved faster and in a significant manner in a substantial number of children orthotically treated for positional brachycephaly, we stick to recommend treatment of severe cases of central-occipital flattening with individual molding orthoses, although other authors might advise differently. 33 But caregivers should be informed that brachycephaly improves to some extent with 25,34 or without 10,16,35 molding devices, and that it might not be normalized fully by any nonsurgical means. Collectively, the findings of this study support the idea that positional cranial deformation once being classified as moderate or severe should be treated 36 in the crucial period of time.…”