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Charalambous L, Hadders-Algra M, Yamasaki EN, Lampropoulou S. Comorbidities of deformational plagiocephaly in infancy: A scoping review. Acta Paediatr 2024; 113:871-880. [PMID: 38226538 DOI: 10.1111/apa.17103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024]
Abstract
AIM While deformational plagiocephaly (DP) is suspected to be associated with comorbidities, their nature and prevalence are unclear. This scoping review aims to report DP comorbidities occurring until the age of 2 years, their prevalence and whether they depend on the child's age and sex. METHODS Relevant studies were identified by searching the Cochrane, MEDLINE, EMBASE, PubMed and EBSCO databases from 1992 to 30 April 2021. Data on study characteristics, comorbidities and assessment instruments were extracted and qualitatively synthesised. Risk of bias was assessed and studies with high risk of bias were excluded. RESULTS Studies meeting selection criteria (n = 27) often evaluated groups from tertiary clinics, implying selection bias. Studies reported on developmental delay (n = 16), limited speech production (n = 1), auditory (n = 3), visual (n = 3), mandibular (n = 3) and neurological impairments (n = 1). The data did not allow prevalence calculation or modifying effect of sex. Due to biased data, the review provided no evidence on DP comorbidities. Weak evidence suggested that in the selective samples, DP was associated with motor and language delays in the first year. CONCLUSION Due to biased data, no evidence on comorbidity in infants with DP was available. Our study underlined the need of risk of bias assessment in scoping reviews.
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Affiliation(s)
- Lia Charalambous
- Department of Health Sciences, School of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Mijna Hadders-Algra
- University of Groningen, Department of Pediatrics, Division of Developmental Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Edna N Yamasaki
- Department of Life Sciences, School of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Sofia Lampropoulou
- Department of Health Sciences, School of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
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Huang T, Li W, Wang C, Qu F, Yang Q, Pan Q, Pu X, Xiao C, Cai Y, Xia M, Zhang Y. Research into the correlation between positional skull deformation and motor performance of infants aged under 4 months. BMC Pediatr 2023; 23:212. [PMID: 37143034 PMCID: PMC10157931 DOI: 10.1186/s12887-023-03959-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 03/20/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE To investigate the correlation between positional skull deformation (PD) and motor performance of infants under 4 months of age. METHODS Infants aged under 4 months were enrolled in the children's healthcare and the premature infants follow-up Clinic of the Second Affiliated Hospital of Army Military Medical University. The cranial vault asymmetry (CVA) and cephalic index (CI) were calculated in all infants, and the infant motor performance test (TIMP) was used to evaluate the infant motor performance. The motor performances of infants with different types and degrees of PD were compared, so were the incidences of PD in infants with different motor performance levels. RESULTS Overall, 2118 infants were recruited and divided according to the types of PD and TIMP scores. The comparison of TIMP scores within different types of PD at different months of age showed that, regardless of the types of PD, TIMP scores of infants with PD were lower than those of normal infants. In particular, the difference in TIMP scores was statistically significant (P < 0.05) in infants with dolichocephaly, plagiocephaly,dolicho-plagiocephaly and brachy-plagiocephy. In addition, the comparison of CVA values of infants with different TIMP score levels at different months of age showed that the CVA values of the extremely low-level group were significantly higher than those of the medium-level and high-level group, especially in the 3-month-old and 4-month-old groups, which showed significant statistical differences (P < 0.05). CONCLUSIONS PD and motor performance of infants aged under 4 months seem to interact and influenc each other. The more serious the severity of PD were,the worse the motor performance of infants. Conversely, the incidence of PD increased in infants with poor motor performance.
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Affiliation(s)
- Tianqi Huang
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Wenzao Li
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Chengju Wang
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Fuxiang Qu
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Qiuxia Yang
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Qiuming Pan
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Xiaoqin Pu
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Can Xiao
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Yi Cai
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Meifeng Xia
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Yuping Zhang
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China.
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Williams E, Galea M. Another look at “tummy time” for primary plagiocephaly prevention and motor development. Infant Behav Dev 2023; 71:101839. [PMID: 37030250 DOI: 10.1016/j.infbeh.2023.101839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/27/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
It is three decades since it was recommended that infants sleep on the back to reduce risk of sudden unexpected infant death (SUID). The SUID prevention program is known as "back to sleep" or "safe sleeping", and this initiative is not questioned. Sleeping on the back is associated with, but not the cause of, the development of infant positional plagiocephaly, also known as deformational or a non-synostotic misshapen head when the skull sutures are open, not fused. This paper provides a synthesis of the history and impact of positional plagiocephaly. It includes a scoping review of plagiocephaly prevention facilitating motor development and reveals few articles on primary prevention which aims to prevent it developing in the first place. It is concerning that preschool-aged children with a history of infant plagiocephaly continued to receive lower developmental scores, particularly in motor development, than unaffected controls, and this may be a marker of developmental delay. Tummy-time (prone) for play is the mainstay of plagiocephaly prevention advice to minimize development of plagiocephaly and to facilitate infant motor development, particularly head control. While tummy-time has shown benefit for infant development, there is limited evidence of its effectiveness in preventing plagiocephaly and some evidence that it promotes only prone-specific motor skills. Most of the published literature is concerned with treatment post-diagnosis, in the form of reviews, or clinical notes. There is a plethora of opinion articles reinforcing tummy-time from birth for plagiocephaly prevention. The review shows that there are gaps in advice for early infant development of head control. An accepted test of head control in infants is "pull to sit" from supine which demonstrates antigravity strength of the neck flexors and coordination of the head and neck when the infant is drawn to sit from supine. This motor skill was cited as achievable by 4 months in the earliest paper on plagiocephaly in 1996. Physical therapists and others should revisit the mechanism of early infant head control development against gravity, particularly antigravity head, neck and trunk coordinated flexion movement in supine, as there has been little attention to early facilitation of this motor skill as a plagiocephaly prevention strategy. This may be achieved by considering "face time" as well as tummy time for primary prevention of plagiocephaly.
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Affiliation(s)
- Elizabeth Williams
- The University of Melbourne, Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, VIC 3010, Australia.
| | - Mary Galea
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne.Academic Director, Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Parkville, VIC 3010, Australia
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Pan WW, Liao JJ, Tong XM. [Follow-up and prognostic study of infants with positional plagiocephaly]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:368-373. [PMID: 37073841 PMCID: PMC10120334 DOI: 10.7499/j.issn.1008-8830.2210031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVES To study the effects of infantile positional plagiocephaly on the growth and neural development. METHODS A retrospective study was conducted on the medical data of 467 children who underwent craniographic examination and were followed up to 3 years of age in Peking University Third Hospital from June 2018 to May 2022. They were divided into four groups: mild positional plagiocephaly (n=108), moderate positional plagiocephaly (n=49), severe positional plagiocephaly (n=12), and normal cranial shape (n=298). The general information of the four groups and the weight, length, head circumference, visual acuity screening results, hearing test results, and the scores of Pediatric Neuropsychological Developmental Scales/Gesell Developmental Schedules of the four groups from 6 to 36 months old were compared. RESULTS The rates of adverse perinatal factors, congenital muscular torticollis, and supine fixed sleeping posture in the mild, moderate, and severe positional plagiocephaly groups were higher than the normal cranial group (P<0.05). There was no significant difference in weight, length, and head circumference among the four groups at 6, 12, 24 and 36 months of age (P>0.05). The incidence rate of abnormal vision in the severe positional plagiocephaly group was higher than that in the mild positional plagiocephaly, moderate positional plagiocephaly and normal cranial shape groups at 24 and 36 months of age (P<0.05). The scores of the Pediatric Neuropsychological Developmental Scales at 12 and 24 months of age and the scores of the Gesell Developmental Schedules at 36 months of age in the severe positional plagiocephaly group were lower than those in the mild positional plagiocephaly, moderate positional plagiocephaly and normal cranial shape groups, but the difference was not statistically significant (P>0.05). CONCLUSIONS Adverse perinatal factors, congenital muscular torticollis, and supine fixed sleeping position may be associated with infantile positional plagiocephaly. Mild or moderate positional plagiocephaly has no significant impact on the growth and neural development of children. Severe positional plagiocephaly have adverse effects on the visual acuity. However, it is not considered that severe positional plagiocephaly can affect the neurological development.
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Affiliation(s)
- Wei-Wei Pan
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
| | | | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
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Collett BR, Wallace ER, Ola C, Kartin D, Cunningham ML, Speltz ML. Do Infant Motor Skills Mediate the Association Between Positional Plagiocephaly/Brachycephaly and Cognition in School-Aged Children? Phys Ther 2020; 101:6041454. [PMID: 33340327 PMCID: PMC8525193 DOI: 10.1093/ptj/pzaa214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/26/2020] [Accepted: 11/02/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Positional plagiocephaly/brachycephaly (PPB) is associated with lower cognitive scores in school-aged children. This study tested the hypothesis that infant motor skills mediate this association. METHODS Children with a history of PPB (cases, n = 187) and without PPB (controls, n = 149) were followed from infancy through approximately 9 years of age. Infant motor skills were assessed using the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-3), and cognition was assessed using the Differential Ability Scales, 2nd edition (DAS-2). The Bayley-3 motor composite was examined as a mediator of the association between PPB and DAS-2 general cognitive ability (GCA) scores. In secondary analyses, mediation models were examined for the DAS-2 verbal ability, nonverbal ability, and working memory scores; models using the Bayley-3 fine versus gross motor scores also were examined. RESULTS Cases scored lower than controls on the DAS-GCA (β = -4.6; 95% CI = -7.2 to -2.0), with an indirect (mediated) effect of β = -1.5 (95% CI = -2.6 to -0.4) and direct effect of β = -3.1 (95% CI = -5.7 to -0.5). Infant motor skills accounted for approximately 33% of the case-control difference in DAS-2 GCA scores. Results were similar for other DAS-2 outcomes. Evidence of mediation was greater for Bayley-3 gross motor versus fine motor scores. CONCLUSION Infant motor skills partially mediate the association between PPB and cognition in school-aged children. Monitoring motor development and providing intervention as needed may help offset associated developmental concerns for children with PPB. IMPACT To our knowledge, this study is the first longitudinal investigation of the development of children with and without PPB from infancy through the early school years and the first to examine motor skills as a mediator of cognitive outcomes in this population. The findings highlight the importance of early motor skills for other developmental outcomes. LAY SUMMARY Infants' motor skills are related to the development of PPB and its association with later cognition. If your child has PPB, physical therapists may have an important role in assessing and providing treatment to promote motor development.
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Affiliation(s)
- Brent R Collett
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA,Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA 98101, USA,Address all correspondence to Dr Collett at:
| | - Erin R Wallace
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA 98101, USA
| | - Cindy Ola
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA,Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA 98101, USA
| | - Deborah Kartin
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Michael L Cunningham
- Department of Pediatrics, University of Washington, Seattle Children’s Craniofacial Center, Seattle, Washington, USA
| | - Matthew L Speltz
- Department of Pediatrics, University of Washington, Seattle Children’s Craniofacial Center, Seattle, Washington, USA
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武 燕, 吴 至, 张 雨, 赵 聪, 余 秀, 杨 望, 陈 再, 潘 秋. [Efficacy of sleep position correction for treating infants with positional plagiocephaly]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:688-692. [PMID: 28606238 PMCID: PMC7390297 DOI: 10.7499/j.issn.1008-8830.2017.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the efficacy of 2-month course of sleeping position correction in the treatment of positional plagiocephaly in infants aged <8 months. METHODS A total of 73 infants with positional plagiocephaly between January 2015 and June 2016 were divided into treatment group (n=46) and control group (n=27) according to parents' wishes. The treatment group received sleeping position correction, while the control group received sleep curve mattress. The oblique diameters A and B in the two groups were measured and the cranial vault asymmetry (CVA) was calculated before and after treatment. The severity of positional plagiocephaly based on CVA was compared between the two groups before and after treatment. The Gesell Developmental Scale was used to determine the developmental quotients (DQs) in the motor, adaptive, language, and social domains in the two groups before and after treatment. RESULTS Before treatment, there were no significant differences in oblique diameters A and B, CVA, and DQs in the four specific domains between the two groups (P>0.05). After 2 months of treatment, the treatment group had a significantly greater oblique diameter B and a significantly smaller CVA than the control group (P<0.05); there were no significant differences in DQs in the four specific domains between the two groups (P>0.05). After treatment, both groups had significant improvements in oblique diameters A and B, CVA, and DQs in the motor and adaptive domains (P<0.01); moreover, the treatment group showed a significant improvement in the DQs in the social domain (P<0.01). There was no significant difference in the severity of positional plagiocephaly between the two groups before and after treatment (P>0.05). CONCLUSIONS For infants with positional plagiocephaly, sleeping position correction has better efficacy and is more convenient and economical than the sleep curve mattress, so it holds promise for clinical application.
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Affiliation(s)
- 燕 武
- />第三军医大学新桥医院儿科, 重庆 400037Department of Pediatrics, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - 至凤 吴
- />第三军医大学新桥医院儿科, 重庆 400037Department of Pediatrics, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - 雨平 张
- />第三军医大学新桥医院儿科, 重庆 400037Department of Pediatrics, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - 聪敏 赵
- />第三军医大学新桥医院儿科, 重庆 400037Department of Pediatrics, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - 秀梅 余
- />第三军医大学新桥医院儿科, 重庆 400037Department of Pediatrics, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - 望 杨
- />第三军医大学新桥医院儿科, 重庆 400037Department of Pediatrics, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - 再新 陈
- />第三军医大学新桥医院儿科, 重庆 400037Department of Pediatrics, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - 秋名 潘
- />第三军医大学新桥医院儿科, 重庆 400037Department of Pediatrics, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
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