‘Flat head’ associated with developmental delay in systematic review

By Bianca Nogrady
Positional plagiocephaly, or ‘flat head’, may be a marker for developmental delay, according to a recent systematic review. 

Referrals for treatment for plagiocephaly, characterised by occipital flattening and asymmetric cranial vaults, have been increasing noticeably since the advent of campaigns encouraging parents to place infants on their backs to sleep to reduce the risk of SIDS. 

Writing in the Journal of Developmental & Behavioral Pediatrics, researchers noted that several studies have previously suggested a link between plagiocephaly and developmental delay. In their study, they reviewed 19 trials conducted in children aged 3 months to 10 years, most of which were rated ‘moderate’ on methodological quality.

Overall, they found a positive association between plagiocephaly and developmental delay in 13 of the 19 studies, including four of the five studies with strong methodological quality.

The researchers noted that most of the studies reporting an association with developmental delay involved infants 2 years of age or under, and that the associations were weaker in older children. The developmental delay most often affected motor skills, followed by language.

Lead author Associate Professor Alexandra Martiniuk, from The University of Sydney and The George Institute for Global Health, said the study had arisen because their previous research pointed to considerable confusion among parents and medical practitioners about the implications of plagiocephaly, with some saying it was a benign cosmetic problem and others concerned about development consequences.

Although the review found clear evidence of a link between plagiocephaly and developmental delay, Professor Martiniuk told Medicine Today the challenge was knowing which way the relationship ran.

‘We sought to determine whether flat head causes developmental delay or whether developmental delay causes flat head but at this point it could go either way because none of the existing research designs are able to answer this chicken and egg question,’ she said.

Professor Martiniuk said the only way to answer this would be to undertake a prospective cohort study in a group of unselected children. In the meantime, she suggested clinicians assess for developmental delay in any children presenting with plagiocephaly, and similarly, in children with developmental delay that they look for plagiocephaly, and refer accordingly.
J Dev Behav Pediatr 2017; 38: 67-78.