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Incidence of Nonsynostotic Plagiocephaly and Developmental Disorders
Mary E Lynch1,2, Melanie J White1, Amy E Rabatin1,2
1Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota.
Insights
Positional head deformity (PPB) affects 5.8% of infants. A small percentage of these infants develop a childhood developmental disorder, with 7.5% diagnosed by age 7.
Area of Science:
- Pediatric Epidemiology
- Developmental Pediatrics
- Craniofacial Abnormalities
Background:
- Nonsynostotic positional plagiocephaly and/or brachycephaly (PPB) is a common infant condition.
- Understanding the incidence of PPB and its association with developmental disorders is crucial for clinical practice.
Purpose of the Study:
- To determine the population-based incidence of PPB in infants under one year of age.
- To report the incidence of craniosynostosis.
- To assess the percentage of children with PPB diagnosed with a developmental disorder by age seven.
Main Methods:
- Retrospective, population-based cohort study using the Rochester Epidemiology Project (REP).
- Inclusion of infants born in Olmsted County, Minnesota, between 2008 and 2012, with follow-up through age 7.
- Analysis of data from March 2021 to April 2024.
Main Results:
- The incidence of PPB was 5.8% overall, with higher rates in preterm infants (11.8%) compared to term infants (5.3%).
- The incidence of craniosynostosis was 0.16%.
- By age 7, 7.5% of infants with PPB were diagnosed with a developmental disorder, including 2.2% with autism spectrum disorder (ASD).
Conclusions:
- The majority of infants with positional head deformity do not develop significant developmental disorders.
- This data aids in counseling families regarding the developmental risks associated with PPB.
- The findings highlight the importance of early identification and monitoring for developmental concerns in infants with PPB.
Importance:
This is the first population-based study quantifying the incidence of nonsynostotic positional plagiocephaly and/or brachycephaly (PPB) in infancy and its association with developmental disorders.
Objective:
To report the incidence of PPB before age 1 year, the incidence of craniosynostosis, and the percentage of children with PPB diagnosed with a developmental disorder by age 7 years.
Design, Setting, And Participants:
This was a retrospective, population-based cohort study of children in the Rochester Epidemiology Project (REP) born in Olmsted County, Minnesota, from January 1, 2008, through December 31, 2012, with follow-up through age 7 years. Data were analyzed from March 2021 to April 2024.
Exposure:
Physical examination detecting cranial deformity.
Main Outcomes And Measures:
The primary outcome was the incidence of PPB. Secondary outcomes were the incidence of craniosynostosis and the percentage of children with PPB diagnosed with a developmental disorder by age 7 years.
Results:
Of 9909 infants (5084 [51.3%] male; 9205 [92.9%] born at term and 704 [7.1%] born preterm) included in the study, 575 had PPB, for a PPB incidence of 5.8% (95% CI, 5.3%-6.3%). The incidence of PPB was 5.3% (95% CI, 4.8%-5.8%) in term infants vs 11.8% (95% CI, 9.4%-14.6%) in preterm infants. The incidence of craniosynostosis was 0.16% (95% CI, 0.09%-0.26%). A developmental disorder was known or suspected in 4.2% (95% CI, 2.7%-6.2%) of infants at the time of PPB diagnosis; among 402 infants with PPB and follow-up through age 7 years, 30 (7.5%; 95% CI, 5.0%-10.7%) had a confirmed developmental disorder by 7 years of age. The prevalence of autism spectrum disorder (ASD) in children with a history of PPB who were followed up to age 7 years was 2.2% (9 of 402 children).
Conclusions And Relevance:
This study found that only a small percentage of the infants had positional head deformity significant enough to be documented and/or referred for subspecialty evaluation, and only a small subset of these children went on to have a developmental disorder in childhood. This information is helpful for counseling families about their child's developmental risk at time of PPB diagnosis.
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