Objective: Deformational plagiocephaly (includes plagiocephaly and brachycephaly) is a common pediatric condition. Infants who present with altered head shape often experience developmental delay. It is uncertain how common developmental delay is in infants with plagiocephaly and how sustained this is, when present. This review explores the association between plagiocephaly and developmental delay to guide clinical practice.
Study Design: A systematic review was conducted. MEDLINE, EMBASE, CINAHL, and PEDro databases were searched. Data from relevant studies were extracted regarding study: sample, follow-up, design, and findings. Methodological quality of each study was rated using a critical appraisal tool.
Results: The search recovered 1315 articles of which 19 met the inclusion criteria. In the included studies, the children's ages ranged from 3 months to 10 years. Study limitations included selection bias, nonblinding of assessors, and reuse of the same study population for multiple papers. Most papers (11/19) rated “moderate” on methodological quality. A positive association between plagiocephaly and developmental delay was reported in 13 of 19 studies, including 4 of 5 studies with “strong” methodological quality. Delay was more frequently in studies with children ≤24 months of age (9/12 studies) compared with >24 months of age (3/7 studies). Motor delay was the most commonly affected domain reported in high-quality papers (5/5 studies).
Conclusion: This review suggests plagiocephaly is a marker of elevated risk of developmental delays. Clinicians should closely monitor infants with plagiocephaly for this. Prompt referral to early intervention services such as physiotherapy may ameliorate motor delays and identify infants with longer term developmental needs.
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*School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia;
†Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada;
‡Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia;
§Built Environment, Industrial Design Research Collaboration, University of New South Wales, Sydney, New South Wales, Australia;
‖Gosford Hospital, Central Coast Local Health District, Gosford, New South Wales, Australia;
¶Physiotherapy Department, Royal North Shore Hospital, Sydney, New South Wales, Australia;
**Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
Address for reprints: Alexandra L. C. Martiniuk, PhD, School of Public Health, Faculty of Medicine, The University of Sydney, Edward Ford Building, Sydney, New South Wales, Australia 2000; e-mail: firstname.lastname@example.org.
A. L. C. Martiniuk was funded by a University of Sydney Fellowship (2012–2015) and an NHMRC TRIP Fellowship (2016–2018).
Disclosure: The authors declare no conflict of interest.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jdbp.org).
A. L. C. Martiniuk conceptualized and designed the study, provided analysis and interpretation of the data, provided critical revision and intellectual content to subsequent versions of the manuscript and approved the final manuscript submitted. C. Vujovich-Dunn contributed to the study design, ran one of 2 independent searches for the acquisition of the data and reviewed each article, provided analysis and interpretation of the data, wrote the first draft of the manuscript and prepared the final manuscript. M. Park provided critical revision and intellectual content to the initial and subsequent versions of the manuscript. W. Yu contributed critical interpretation of study findings, contributed in particular to the results section and provided critical revision and intellectual content to subsequent versions of the manuscript. B. R. Lucas interpreted study findings and their implications, assisted with interpreting study methodological quality, and provided critical revision and intellectual content to subsequent versions of the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Received March , 2016
Accepted October , 2016