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Updated: Jun 22, 2026
Midface Hypoplasia and Cranial Base Morphology in Syndromic Craniosynostosis: A Comparative Analysis Study Using a Predictive Regression Model
Published on: November 4, 2025
Characteristics, head shape measurements and developmental delay in 287 consecutive infants attending a plagiocephaly
B L Hutchison1, Alistair W Stewart, Edwin A Mitchell
1Department of Paediatrics, University of Auckland, Auckland, New Zealand. bl.hutchison@auckland.ac.nz
Insights
Infants with head shape deformities often have neck muscle dysfunction and developmental delays. Early physical examination is crucial to rule out serious conditions like craniosynostosis.
Area of Science:
- Pediatric neurology
- Developmental pediatrics
- Craniofacial abnormalities
Background:
- Head shape deformities, including deformational plagiocephaly, are common in infants.
- Neck muscle dysfunction is frequently observed in infants with plagiocephaly.
- Developmental delays can occur in infants with head shape deformities.
Purpose of the Study:
- To characterize infants presenting to a plagiocephaly clinic.
- To assess head shape deformation, developmental status, and neck function.
- To identify factors associated with head shape deformities and developmental delays.
Main Methods:
- 287 infants presenting to a plagiocephaly clinic were evaluated.
- Head shape was measured, and neck function was assessed.
- Infant development was assessed using the Ages and Stages Questionnaire (ASQ).
Main Results:
- Craniosynostosis was suspected in 2% of infants, with suture abnormalities found in five.
- 58% of cases had a history of limited neck function, more common in plagiocephalic infants.
- 36% of infants showed developmental delays on the ASQ.
Conclusions:
- Physical examination is vital to exclude craniosynostosis in infants with head shape deformities.
- Neck muscle dysfunction is prevalent in infants with deformational plagiocephaly.
- Developmental delays may be linked to supine sleep position, low muscle tone, and neck dysfunction.
Aim:
To describe the characteristics, developmental status and severity of head shape deformation in infants presenting to a plagiocephaly clinic.
Methods:
Head shape was measured and neck function assessed in 287 consecutive infants presenting to a plagiocephaly outpatient clinic. Information was obtained on demographic and obstetric factors, plagiocephaly history and current positioning strategies. Development was assessed by the Ages and Stages Questionnaire (ASQ).
Results:
After clinical examination, craniosynostosis was suspected in seven infants (2%) and a skull computed tomography (CT) scan was performed; five showed suture abnormalities. Fifty-eight percent of cases had a history of limitation of neck function; this was more likely in plagiocephalic infants than brachycephalic infants. Males, firstborn infants, instrument-delivered infants, supine sleep position and right-sided flattening were predominant. One or more delays on the ASQ were seen in 36% of infants.
Conclusion:
Physical examination of infants with head shape deformities is essential in order to rule out craniosynostosis. Infants with deformational plagiocephaly frequently have neck muscle dysfunction. We postulate that the higher than expected number of developmental delays may be related to the effects of supine sleep position, low or variable tone, lower activity levels, male gender and neck muscle dysfunction.
