Deformational plagiocephaly: a follow-up of head shape, parental concern and neurodevelopment at ages 3 and 4 years
B L Hutchison1, A W Stewart, E A Mitchell
1Department of Paediatrics: Child and Youth Health, The University of Auckland, New Zealand. bl.hutchison@auckland.ac.nz
Insights
Infants diagnosed with deformational plagiocephaly or brachycephaly showed significant improvements in head shape and developmental delays by age 4. Parental concern also dramatically decreased, indicating positive long-term outcomes.
Area of Science:
- Pediatric medicine
- Developmental pediatrics
- Craniofacial abnormalities
Background:
- Deformational plagiocephaly and brachycephaly are common infant head shape conditions.
- Early assessment and intervention are crucial for managing these conditions.
- Longitudinal data on the long-term outcomes of head shape abnormalities are valuable.
Purpose of the Study:
- To compare infant head shape measurements, parental concerns, and developmental delays with outcomes at 3 and 4 years of age.
- To evaluate the natural progression and resolution of deformational plagiocephaly and brachycephaly.
- To assess the impact of these conditions on child development and parental perception over time.
Main Methods:
- A longitudinal cohort study design was employed.
- 129 children diagnosed with deformational plagiocephaly or brachycephaly in infancy were assessed.
- Head shape (cephalic index, oblique cranial length ratio), parental concern, and developmental delays (Ages and Stages Questionnaires) were measured at initial assessment and follow-up (ages 3-4 years).
Main Results:
- 61% of head shape measurements normalized, with brachycephaly showing more improvement than plagiocephaly.
- Parental concern decreased from 85% to 13%, and developmental delays reduced from 41% to 11%.
- Facial and frontal asymmetry significantly reduced, though 13% had 'poor improvement' in head shape.
Conclusions:
- Infant head shape measurements, parental concern, and developmental delays demonstrate significant improvement by ages 3-4 years.
- The findings support the positive natural history of many cases of deformational plagiocephaly and brachycephaly.
- Early diagnosis and monitoring contribute to favorable long-term outcomes for affected children.
Objectives:
To compare head shape measurements, parental concern about head shape and developmental delays in infancy with measurements obtained at follow-up at ages 3 and 4 years.
Design:
Longitudinal cohort study.
Setting:
Initial assessments were conducted at a plagiocephaly clinic; follow-up assessments were conducted in the children's homes.
Participants:
129 children with a mean age of 4 years (range 3 years 3 months to 4 years 9 months), all of whom were diagnosed in infancy with deformational plagiocephaly or brachycephaly.
Main Outcome Measures:
Head shape measurements of cephalic index and oblique cranial length ratio; level of parental concern about head shape; and delays on parent-completed age-appropriate Ages and Stages Questionnaires.
Results:
61% of head shape measurements reverted to the normal range; 4% remained severe at follow-up. Brachycephaly improved more than plagiocephaly. Facial and frontal asymmetry reduced to almost nil. Most had good improvement, but 13% were categorised as having 'poor improvement'. Initially, 85% of parents reported being 'somewhat' or 'very' concerned; this decreased to 13% at follow-up. The percentage of children with ≥1 delay decreased from 41% initially to 11% at follow-up.
Conclusions:
Overall, head shape measurements, parental concern and developmental delays in infancy showed a dramatic improvement when re-measured at 3 and 4 years of age.
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