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Deformational plagiocephaly in normal infants: a systematic review of causes and hypotheses
Freia De Bock1,2, Volker Braun3, Herbert Renz-Polster1
1Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany.
Insights
Deformational plagiocephaly (DP) is common in infants. Evidence on its causes is limited and inconsistent, with few studies examining risk factors in typical infant populations.
Area of Science:
- Pediatric Health
- Developmental Biology
- Public Health
Background:
- Deformational plagiocephaly (DP) is a prevalent condition in infants.
- It is a common reason for parents to seek pediatric medical advice.
Purpose of the Study:
- Systematically review existing literature.
- Identify evidence and hypotheses regarding the etiology and determinants of DP in healthy infants.
Main Methods:
- Conducted a systematic keyword search across major biomedical databases.
- Screened 3150 studies published between 1985 and 2016.
- Analyzed empirical research (22 studies) and hypotheses (110 articles) separately.
Main Results:
- Few high-quality empirical studies exist on DP risk factors.
- Commonly reported risk factors include male gender, supine sleep, limited neck rotation, first-born status, low activity, and lack of tummy time.
- Agreement among studies on risk factors like sleep position and tummy time was poor.
Conclusions:
- The evidence on the etiology of DP is fragmented and heterogeneous.
- Potential contributing factors, particularly from the infant's care environment, require further investigation.
Background:
Deformational plagiocephaly (DP) is one of the most prevalent abnormal findings in infants and a frequent reason for parents to seek paediatric advice.
Objective:
To systematically review the literature and identify evidence and hypotheses on the aetiology and determinants of DP in otherwise healthy infants.
Design:
Systematic keyword search in all major biomedical databases to identify peer-reviewed publications reporting (a) empirical research or (b) hypotheses on the aetiology of DP in healthy, term infants. 3150 studies published between 1985 and 2016 and containing relevant keywords were screened. In a two-pronged approach, results were summarised separately for the body of empirical work (22 studies) and the body of hypotheses (110 articles).
Review Findings:
Only a few empirical studies have examined risk factors in non-selected patient populations on a higher grade methodological level. The most commonly reported risk factors were: male gender, supine sleep position, limited neck rotation or preference in head position, first-born child, lower level of activity and lack of tummy time. Agreement between empirical studies was poor for most exposures, including supine sleep position, tummy time and use of car seats. The articles reporting hypotheses on the aetiology of DP cover a wide field of environmental and biological factors, but include little suggestions as to the potential influence of the everyday care environment of the baby.
Conclusions And Relevance:
The evidence on the aetiology of DP is fragmentary and heterogeneous. In addition, factors possibly relevant to the development of DP have not been appreciated in the scientific discussion.
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