Objective: Since the Back to Sleep campaign in 1992, the incidence of positional plagiocephaly continues to increase substantially. A body of work is emerging linking positional plagiocephaly to neurodevelopmental delay, including data that reveals a physical shift in brain parenchyma in response to skull asymmetry. This review assesses the nature of the relationship between these neurodevelopmental delays and positional plagiocephaly.
Method: A literature search was required to answer the clinical question. Pubmed, Medline and The Cochrane Library were searched using the mesh terms: ‘plagiocephaly, nonsynostotic’ and ‘growth and development’ in conjunction with the terms: ‘neurodevelopmental delay’, development’ and ‘delay’. After the relevant inclusion and exclusion criteria were applied, 12 studies were reviewed.
Results: Positional plagiocephaly has shown a defined link to neurodevelopmental delay in infants. The effect is seen more prominently in motor skills during infancy and the delay has been noted to extend into preschool age children. Plagiocephaly patients are more likely to have altered muscle tone. No correlation was seen between the severity of the skull asymmetry and the level of neurodevelopmental delay experienced by the child.
Conclusion: The data suggest correlation but not necessarily causation. It is also possible that pre-existing neurodevelopmental delay may be the cause of positional plagiocephaly. In most cases it is likely to be a combination of the risk factors of supine sleep, lack of prone awake time, variable muscle tone, low activity levels, male gender and neck muscle dysfunction that attributes to the delays that have been recognized in these infants.
Author keywords: Positional Plagiocephaly, neurodevelopmental delay, Chiropractic, Pediatric
Author affiliation: AECC University College, Bournemouth England
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