Developmental plagiocephaly (DP) has been an increasing problem since the successful “back to sleep campaign”. The referrals for DP have increased by more than 400% during the years 2004 to 2008. Many infants spend less time in the prone position nowadays and some of the risk factors for DP are: tummy time less than 3 times per day, torticollis and slow achievement of motor milestones. Improved information for the parents is needed but also other strategies to prevent DP. This study is a continuum of an earlier pilot study; the aim was to investigate the effect of a pillow, designed to reduce pressure on the infant head. Method: Infants aged zero to two months were included in the study. They were randomized to either intervention group or control group. Head shape was investigated on two occasions, on the second occasion motor development, mobility and muscle function of the neck were also investigated. The parents were asked about tummy time and sleep position. All infants were investigated by the same physical therapist, blinded to group belonging. Result: Fishers exact test showed that it was more common with decreased CVAI among infants in the intervention group (P 0.001). Paired t test showed significant decrease in CVAI for the intervention group (P 0.002), but not for the control group (P 0.96). Conclusion: This study shows that a specially designed pillow can decrease DP in young infants.
KeywordsDevelopmental PlagiocephalyInfantPillowMotor DevelopmentTummy Time
Clarren, S.K. (1981) Plagiocephaly and Torticollis: Etiology, Natural History and Helm Treatment. Journal of Pediatrics, 98, 92-95. http://dx.doi.org/10.1016/S0022-3476(81)80549-5
Littlefield, T.R., Kelly, K.M., Pomatto, J.K. and Beals, S.P. (2002) Multiple-Birth Infants at Higher Risk for Development of Deformational Plagiocephaly: II. Is One Twin at Greater Risk? Pediatrics, 109, 19-25. http://dx.doi.org/10.1542/peds.109.1.19
McKinney, C.M., Cunningham, M.L., Holt, V.L., Leroux, B. and Starr, J.R. (2009) Case-Control Study of Infant, Maternal and Perinatal Characteristics Associated with Deformational Plagiocephaly. Paediatric and Perinatal Epidemiology, 23, 332-345. http://dx.doi.org/10.1111/j.1365-3016.2009.01038.x
Hutchison, B.L., Thompson, J.M. and Mitchell, E.A. (2003) Determinants of Nonsynostotic Plagiocephaly: A Case-Control Study. Pediatrics, 112, e316. http://dx.doi.org/10.1542/peds.112.4.e316
Hutchison, B.L., Hutchison, L.A.D., Thompson, J.M.D. and Mitchell, E.A. (2004) Plagiocephaly and Brachycephaly in the First Two Years of Life: A Prospective Cohort Study. Pediatrics, 114, 970-980. http://dx.doi.org/10.1542/peds.2003-0668-F
Van Vlimmeren, L.A., van der Graaf, Y., Boere-Boonekamp, M.M., L’Hoir, M.P., Helders, P.J. and Engelbert, R.H.H. (2007) Risk Factors for Deformational Plagiocephaly at Birth and at Seven Weeks of Age: A Prospective Cohort Study. Pediatrics, 119, e408-e418. http://dx.doi.org/10.1542/peds.2006-2012
Oh, A.K., Hoy, E.A. and Rogers, G.F. (2009) Predictors of Severity in Deformational Plagiocephaly. Journal of Craniofacial Surgery, 20, 685-689. http://dx.doi.org/10.1097/SCS.0b013e318193d6e5
Brofin, D.R. (2001) Misshapen Heads in Babies: Position or Pathology? The Ochsner Journal, 3, 191-199.
Robinson, S. and Proctor, M. (2009) Diagnosis and Management of Deformational Plagiocephaly. A Review. Journal of Neurosurgery, 3, 284-295.
Peitsch, W.K., Keefer, C.H., LaBrie, R.A. and Mulliken, J.B. (2002) Incidence of Cranial Asymmetry in Healthy Newborns. Pediatrics, 110, e72. http://dx.doi.org/10.1542/peds.110.6.e72
Joganic, J.L., Lynch, J.M., Littlefield, T.R. and Verrelli, B.C. (2009) Risk Factors Associated with Deformational Plagiocephaly. Pediatrics, 124, e1126-e1133. http://dx.doi.org/10.1542/peds.2008-2969
Hutchison, B.L., Stewart, A.W. and Mitchell, E.A. (2009) Characteristics, Head Shape Measurements and Developmental Delay in 287 Consecutive Infants Attending a Plagiocephaly Clinic. Acta Pædiatrica, 98, 1494-1499. http://dx.doi.org/10.1111/j.1651-2227.2009.01356.x
Golden, K.A., Beals, S.P., Littlefield, T.R. and Pomatto, J.K. (1999) Sternocleidomastoid Imbalance versus Congenital Muscular Torticollis: Their Relationship to Positional Plagiocephaly. Cleft Palate-Craniofacial Journal, 36, 256-261. http://dx.doi.org/10.1597/1545-1569(1999)036 2.3.CO;2
Rogers, G.F., Oh, A.K. and Mulliken, J.B. (2009) The Role of Congenital Muscular Torticollis in the Development of Deformational Plagiocephaly. Plastic and Reconstructive Surgery, 123, 643-652. http://dx.doi.org/10.1097/PRS.0b013e318196b9be
Bialocerkowski, A.E., Vladusic, S.L. and Wei, C. (2008) Prevalence, Risk Factors and Natural History of Positional Plagiocephaly: A Systematic Review. Developmental Medicine & Child Neurology, 50, 577-586. http://dx.doi.org/10.1111/j.1469-8749.2008.03029.x
Persing, J., James, H., Swanson, J., Kattwinkel, J. and American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery (2003) Prevention and Management of Positional Skull Deformities in Infants. Pediatrics, 112, 199-202. http://dx.doi.org/10.1542/peds.112.1.199
Argenta, L.C., David, L.R., Wilson, J.A. and Bell, W.O. (1996) An Increase in Infant Cranial Deformity with Supine Sleeping Position. Journal of Craniofacial Surgery, 7, 5-11. http://dx.doi.org/10.1097/00001665-199601000-00005
Kane, A.A., Mitchell, L.E., Craven, K.P. and Marsch, J.L. (1996) Observations on a Recent Increase in Plagiocephaly without Synostosis. Pediatrics, 97, 877-885.
White, N., Warner, R.M., Noons, P., McAlister, E.M, Solanki, G., Nishikawa, H. and Dover, M.S. (2010) Changing Referral Patterns to a Designated Craniofacial Centre over a Four-Year Period. Journal of Plastic, Reconstructive & Aesthetic Surgery, 63, 921-925. http://dx.doi.org/10.1016/j.bjps.2009.05.007
Wennergren, G. (2004) Prevention of Sudden Infant Death Syndrome. Pediatric Pulmonology, 26, 110-111. http://dx.doi.org/10.1002/ppul.70072
Majnemer, A. and Barr, R.G. (2005) Influence of Supine Sleep Positioning on Early Motor Milestones Acquisition. Developmental Medicine & Child Neurology, 47, 370-376.
Mildered, J., Beard, K., Dallwitz, Z. and Unwin, J. (1995) Play Position Is Influenced by Knowledge of SIDS Sleep Position Recommendations. Journal of Paediatrics and Child Health, 31, 499-502. http://dx.doi.org/10.1111/j.1440-1754.1995.tb00871.x
Öhman, A., Nilsson, S., Lagerkvist, A.L. and Beckung, E. (2009) Are Infants with Torticollis at Risk for a Delay in Early Motor Milestones Compared with a Control Group of Healthy Infants? Developmental Medicine & Child Neurology, 51, 545-550. http://dx.doi.org/10.1111/j.1469-8749.2008.03195.x
Lauritzen, C. and Tarnow, P. (1999) Assymetric Skull? Early Correct Diagnosis Is a Must! Positional Skull Deformities Can Be Avoided. Lakartidningen, 96, 1447-1453.
Hauck, F.R., Herman, S.M., Donovan, M., Ivasu, S., Moore, C.M., Donoghue, E., Kirschner, R.H. and Willinger, M. (2003) Sleep Environment and the Risk of Sudden Infant Death Syndrome in an Urban Population: The Chicago Infant Mortality Study. Pediatrics, 111, 1207-1214.
van Sleuwen, B.E., L’Hoir, M.P., Engelberts, A.C., Westers, P. and Schulpen, T.W. (2003) Infant Care Practise Related to Cot Death in Turkish and Moroccan Families in the Netherlands. Archives of Disease in Childhood, 88, 784-788. http://dx.doi.org/10.1136/adc.88.9.784
Scheers, N.J., Dayton, C.M. and Kemp, J.S. (1998) Sudden Infant Death with External Airways Covered Case-Comparision Study of 206 Deaths in the Untied States. Archives of Pediatrics and Adolescent Medicine, 152, 540-547. http://dx.doi.org/10.1001/archpedi.152.6.540
Carpenter, R.G. and Shaddick, C.W. (1965) Role of Infection, Suffocation and Bottle-Feeding in Cot Death. Ananalysis of Some Factors in the Histories of 110 Cases and Their Controls. British Journal of Preventive and Social Medicine, 19, 1-7.
McGarvey, C., McDonnell, M., Chong, A., O’Regan, M. and Matthews, T. (2003) Factors Relating to the Infant’s Last Sleep Environment in Sudden Infant Death Syndrome in the Republic of Ireland. Archives of Disease in Childhood, 88, 1058-1064.
Thompson, J.M., Thach, B.T., Becroft, D.M. and Mitchell, E.A. (2006) New Zealand Cot Death Study Group. Sudden Infant Death Syndrome: Risk Factors for Infants Found Face Down Differ from Other SIDS Cases. The Journal of Pediatrics, 149, 630-633. http://dx.doi.org/10.1016/j.jpeds.2006.07.041
Öhman, A. (2103) A Specially Designed Pillow May Be Used as Treatment for Young Infants with Developmental Plagiocephaly. Health, 5, 2064-2067.
Persson, K. and Strömberg, B. (1995) Structured Observation of Motor Performance (SOMP-I) Applied to Neonatally Healthy Fullterm Infants at the Ages of 0 - 10 Months. Early Human Development, 40, 127-143. http://dx.doi.org/10.1016/0378-3782(94)01598-J
Öhman, A. and Beckung, E. (2008) Reference Values for Range of Motion and Muscle Function in the Neck in Infants. Pediatric Physical Therapy, 20, 53-58. http://dx.doi.org/10.1097/PEP.0b013e31815ebb27
Öhman, A., Nilsson, S. and Beckung, E. (2009) Validity and Reliability of the Muscle Function Scale, Aimed to Assess the Lateral Flexors of the Neck in Infants. Physiotherapy Theory and Practice, 25, 129-137. http://dx.doi.org/10.1080/09593980802686904
Loveday, B.P. and de Chalain, T.B. (2001) Active Counterpositioning or Orthotic Device to Treat Positional Plagiocephaly? Journal of Craniofacial Surgery, 12, 308-313. http://dx.doi.org/10.1097/00001665-200107000-00003
Jonsell, R. (1999) Infants Should Sleep in Supine Position. The Risk of Skull Deformities Can Be Prevented. Läkartidningen, 96, 1404-1405.
Cavalier, A., Picot, M.C., Artiaga, C., Mazurier, E., Amilhau, M.O., Froye, E., Captier, G. and Picaud, J.C. (2011) Prevention of Deformational Plagiocephaly in Neonates. Early Human Development, 87, 537-543. http://dx.doi.org/10.1016/j.earlhumdev.2011.04.007
Knudsen, B., Christensen, K., Baagøe, S., Hoppe, P., Juhl, C., Buus, L. and Jakobsen, T.L. (2011) Positional Plagiocephaly in Infants Can Be Prevented. Ugeskr for Laeger, 173, 644-648.
American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome (2005) The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk. Pediatrics, 116, 1245-1255. http://dx.doi.org/10.1542/peds.2005-1499
Nield, L.S., Brunner, M.D. and Kamat, D. (2007) The Infant with a Misshapen Head. Pediatrics, 46, 292-298.
Robertson, R. (2011) Supine Infant Positioning—Yes, but There’s More to It. Journal of Family Practice, 60, 605-608.