Before "Back to Sleep": Deformational plagiocephaly and pediatric insights from Iron Age Italy
Michael Allen Beck De Lotto1, Alberto Zanatta2, Albert Zink3
1Department of Odontostomatological and Maxillofacial Sciences, Sapienza University of Rome, via Caserta, 6, Rome 00161, Italy; Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, via Giustiniani, 2, Padua 35128, Italy.
Insights
Deformational plagiocephaly, a condition linked to infant head immobility, was found in ancient Italian crania. This suggests the condition has deep historical roots and may be a cultural marker, not just a modern pediatric issue.
Area of Science:
- Paleopathology
- Bioarchaeology
- Pediatric Health
Background:
- Deformational plagiocephaly is a common pediatric cranial condition often associated with limited infant head mobility.
- Its presence in ancient populations can offer insights into historical infant care practices.
Purpose of the Study:
- To investigate the occurrence of deformational plagiocephaly in an ancient Italian population.
- To explore the implications of its presence for understanding past infant care.
Main Methods:
- Macroscopic assessment of 26 Early Iron Age crania from Matelica, Italy.
- Computed tomography (CT) on 11 crania with posterior cranial asymmetry for differential diagnosis.
- Classification of severity using the oblique cranial length ratio and CT-derived measurements.
Main Results:
- Posterior cranial asymmetry was identified in 42.3% of the crania, with a male predominance and right-sided flattening.
- CT scans revealed occipital base flattening and mastoid displacement, suggesting the oblique cranial length ratio may underestimate deformity.
- Postcranial markers potentially linked to congenital muscular torticollis were observed in seven individuals.
Conclusions:
- The findings are consistent with prolonged infant head immobility, likely influenced by caregiving behaviors.
- These represent the earliest Italian examples of deformational plagiocephaly, indicating it is not solely a modern condition.
- The study highlights deformational plagiocephaly as a potential pediatric condition and a cultural marker with deep historical context.
Objective:
Investigate whether deformational plagiocephaly, a common pediatric cranial condition, often linked to limited infant head mobility, occurred in an ancient population and its implications for infant care practices.
Materials:
Twenty-six Early Iron Age adult crania from Matelica, Italy (mid-9th-8th c. BCE).
Methods:
All crania underwent macroscopic assessment. Computed tomography was performed on those with posterior cranial asymmetry (n = 11) to support differential diagnosis. Severity was classified using the oblique cranial length ratio from standardized vertex images.
Results:
Eleven crania (42.3%) showed posterior asymmetry, with a male predominance (63.6%) and more common right-sided flattening (72.7%). Differential diagnosis excluded post-depositional changes, intentional modification, and craniosynostosis. In several cases, CT revealed occipital base flattening with ipsilateral mastoid anterior displacement - features vertex-based oblique cranial length ratio may underestimate. Seven individuals exhibited postcranial markers possibly consistent with congenital muscular torticollis, a condition clinically correlated with deformational plagiocephaly.
Conclusions:
The pattern is consistent with prolonged infant head immobility, plausibly linked to caregiving behaviors.
Significance:
These represent the earliest known Italian examples of deformational plagiocephaly, placing the condition in deep historical and evolutionary context. These findings suggest that deformational plagiocephaly may not be solely modern, supporting its interpretation as both a pediatric condition and cultural marker.
Limitations:
The small sample size and preservation-dependent skeletal markers limit interpretations. Infant care practices are inferred indirectly; oblique cranial length ratio may underestimate basal deformity.
Suggestions For Further Research:
Future comparative studies are needed to determine whether the high deformational plagiocephaly prevalence at Matelica is localized or represents a broader Iron Age pattern in central Italy.
