gms | German Medical Science

Objective: Deformational plagiocephaly in infants is a common and increasing problem. The objective of this study was to identify risk factors influencing the development of nonsynostotic plagiocephaly.

Methods: We conducted a case-control study and included infants with nonsynostotic plagiocephaly of our outpatient clinic during the period from 2003 to 2006 (n=109). Healthy controls were randomly selected by referring centers (n=50). Information concerning obstetric factors, infant factors and infant care practice was obtained by a parental answered standardized questionnaire containing 27 items. Data was statistically analysed including univariate and multivariate logistic regression analyses.

Results: Case and control groups were comparable with regard to age (mean 13 months) and gender with a slight but non-significant male predominance in the case group. Infants with deformational plagiocephaly were more likely to have been firstborn than healthy controls (OR:1.4; 95% CI:0.66–2.86), premature (<37 weeks) or to have had an unusual intrauterine position (OR:8.4; 95% CI:1.09–65.46) and headshape (OR:4.4; 95% CI:1.26–15.47) during delivery. However, the type of delivery including forceps- or ventouse-assisted deliveries was not predictive for the development of plagiocephaly as has been suggested in previous studies. Cases were more likely to have been limited in their ability to rotate the head (OR:35.4; 95% CI:8.16–153.74) while also having a preferential head orientation during sleep (OR:9.8; 95% CI:4.49–21.25). Tummy time in the first weeks after birth were significantly lower in the case group (mean 34 min/d versus 143 min/d) while variables of the composition of mattress and pillow had no influence on the development of plagiocephaly. More parents of cases reported a developmental delay (p<0.05) and their children as less active (p<0.01). Analyses at a multivariate level revealed that factors influencing the head mobility such as time at supine position (aOR:1.2; 95% CI:1.07–1.26) or neck muscle dysfunction (aOR:16.1; 95% CI:3.01–85.89) are significantly correlated with the development of plagiocephaly.

Conclusions: Our study reinforces the hypothesis that specific nursing habits and positional preferences in combination with impaired head motility are highly associated with the development of deformational plagiocephaly. Therefore, early identification of these risk factors may help to prevent and guide the management of infants with deformational plagiocephaly.