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Determinants of nonsynostotic plagiocephaly: a case-control study
B Lynne Hutchison1, John M D Thompson, Ed A Mitchell
1Department of Paediatrics, University of Auckland, Auckland, New Zealand. bl.hutchison@auckland.ac.nz
Insights
Nonsynostotic plagiocephaly in infants is linked to male gender, prematurity, and specific sleep practices like consistent supine positioning and limited "tummy time." Early detection of preferred head orientation is key for prevention.
Area of Science:
- Pediatrics
- Developmental Biology
- Public Health
Background:
- Nonsynostotic plagiocephaly cases have increased following supine sleeping recommendations for SIDS prevention.
- Understanding the factors contributing to infant positional skull deformities is crucial for public health initiatives.
Purpose of the Study:
- To identify and quantify the key determinants of nonsynostotic plagiocephaly in infants.
- To investigate the association between infant characteristics, parental factors, and infant care practices with plagiocephaly development.
Main Methods:
- A case-control study comparing 100 infants with nonsynostotic plagiocephaly to 94 control infants aged 2-12 months.
- Data collected via parental interviews covering sociodemographic, obstetric, infant, and caregiving factors.
Main Results:
- Infants with plagiocephaly were more likely to be male, firstborn, and premature.
- Risk factors included supine sleeping in the first 6 weeks, lack of head position variation, and limited supervised 'tummy time'.
- Maternal perception of infant activity, developmental delay, preferred head orientation, and lower educational attainment were also associated with increased risk.
Conclusions:
- Early identification of preferred head orientation may signal neck muscle dysfunction and aid in preventing nonsynostotic plagiocephaly.
- Preventive strategies include alternating head position during sleep and incorporating supervised 'tummy time'.
Objective:
There has been a large increase in reported cases of nonsynostotic plagiocephaly in infants since the adoption of supine sleeping recommendations to prevent sudden infant death syndrome. The objective of this study was to identify and quantify the determinants of nonsynostotic plagiocephaly in infants.
Methods:
One hundred infants who received a diagnosis of having nonsynostotic plagiocephaly were recruited as case patients and compared with 94 control subjects who were selected from a citywide database of infants. The infants all were aged between 2 and 12 months. Information concerning sociodemographic variables, obstetric factors, infant factors, and infant care practices was obtained by parental interview.
Results:
Case patients were significantly more likely to be male (adjusted odds ratio [aOR]: 2.51; 95% confidence interval [CI]: 1.23-5.16), to be a firstborn (aOR: 2.94; 95% CI: 1.46-5.96), and to have been premature (aOR: 3.26; 95% CI: 1.02-10.47). In the first 6 weeks, they were more likely to have been sleeping in the supine position (aOR: 7.02; 95% CI: 2.98-16.53), not to have had the head position varied when put down to sleep (aOR: 7.11; 95% CI: 2.75-18.37), and to have had <5 minutes a day of tummy time (OR: 2.26; 95% CI: 1.03-5.00). Mothers of case patients were more likely to perceive their infants as less active (aOR: 3.23; 95% CI: 1.38-7.56), to have a developmental delay (aOR: 3.32; 95% CI: 1.01-10.85), and to have had a definite preferred head orientation at 6 weeks (aOR: 37.46; 95% CI: 8.44-166.32). Case mothers were more likely to have no or low educational qualifications (aOR: 5.61; 95% CI: 2.02-15.56), although they were more likely to have attended antenatal classes (aOR: 6.61; 95% CI: 1.59-27.47).
Conclusions:
Early identification of a preferred head orientation, which may indicate the presence of neck muscle dysfunction, may help prevent the development or further development of nonsynostotic plagiocephaly in infants. Plagiocephaly might also be prevented by varying the head position when putting the very young infant down to sleep and by giving supervised tummy time when awake.
