When a child has position plagiocephaly/brachycephaly (PPB) secondary to sleeping in the same position on their backs at night, we are usually asked two questions— (1)—will the flat head shape stay that way and (2) can it cause brain damage or developmental delay? We know the answer to the first question is no, based on prior studies and perhaps personal experience with your own patients. As to the second question, Collett et al. (10.1542/peds.2018-2373) investigated this in a longitudinal cohort of infants with and without PPB who were followed until they were ages 7 to 11 years and then given a battery of developmental and academic tests. In addition, the children’s head shapes were rated by two investigators blinded to the history of positioning using a reliable and valid scoring system.
The good news is that those children who had only mild PPB showed no differences in development when compared to controls without PPB, but those with moderate to severe changes in head shape did show statistically significant differences although the magnitude of these differences did not appear to be substantial. Does that mean that PPB causes developmental abnormalities? This study cannot begin to prove causality but can suggest that moderate to severe PPB might be a marker for developmental risk. In turn, detecting moderate to severe PPB warrants ongoing surveillance to make sure early intervention services (and not just a reshaping helmet) are put into play as soon as developmental delays are noted. For the vast majority of infants with only mild PPB, this study should keep you ahead of the families’ concerns. There is a lot of good information about the natural history of PPB and its association with a child’s development, so shape up and give this study a read.