A case-control study of infant, maternal and perinatal characteristics associated with deformational plagiocephaly

Deformational plagiocephaly, an abnormal asymmetric flattening of infants' heads, is diagnosed in approximately 10% of infants. The prevalence of plagiocephaly has increased dramatically since 1992 when it was first recommended that infants be placed to sleep in a non-prone position to reduce the risk of sudden infant death syndrome. The authors conducted a case-control study to evaluate associations between plagiocephaly and perinatal characteristics. The authors assessed whether risk factors for plagiocephaly have changed since 1992. Cases were born 1987-2002 in Washington State and diagnosed with plagiocephaly at the Craniofacial Center at Seattle Children's Hospital. Risk factor information was abstracted from birth certificate and hospital discharge data and unconditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Cases (n = 2764) were more likely than controls (n = 13 817) to have been injured at birth (OR 1.4; 95% CI 1.2, 1.7) or diagnosed with a congenital anomaly (OR 2.0; 95% CI 1.8, 2.3). Cases were more likely to have been male, a twin, or small-for-gestational-age. This first large-scale, case-control study of risk factors for plagiocephaly in a U.S. population provides new evidence that birth injuries and congenital anomalies are associated with plagiocephaly risk.