European Journal of Pediatrics

, Volume 174, Issue 9, pp 1197–1208 | Cite as

Preventing deformational plagiocephaly through parent guidance: a randomized, controlled trial

  • Henri AarnivalaEmail author
  • Ville Vuollo
  • Virpi Harila
  • Tuomo Heikkinen
  • Pertti Pirttiniemi
  • A. Marita Valkama
Original Article


Deformational plagiocephaly (DP) occurs frequently in otherwise healthy infants. Many infants with DP undergo physiotherapy or helmet therapy, and ample treatment-related research is available. However, the possibility of preventing DP has been left with little attention. We sought to evaluate the effectiveness of intervention in the newborn’s environment, positioning, and handling on the prevalence of DP at 3 months and to investigate the causal relationship between DP and cervical imbalance. We carried out a randomized controlled trial, with healthy newborns randomized into two groups at birth. All families received standard positioning instructions to prevent SIDS. Additionally, the intervention group received detailed instructions regarding the infant’s environment, positioning, and handling, with the goal of creating a nonrestrictive environment that promotes spontaneous physical movement and symmetrical motor development. Two- and three-dimensional photogrammetry served to assess cranial shape and goniometry to measure cervical motion. At 3 months, the prevalence of DP was lower in the intervention group in both 2D (11 vs 31 %) and 3D analyses (15 vs 33 %), and the asymmetry was milder in the intervention group. Infants with DP at follow-up had also developed more torticollis.

Conclusion: An early educational intervention reduces the prevalence and severity of DP at 3 months.

What is Known:

Deformational plagiocephaly, often with associated torticollis, is common in healthy infants.

Parental education is frequently recommended for preventing deformational plagiocephaly, although information regarding the effectiveness of preventive strategies is scarce.

What is New:

Early parent guidance effectively reduces the prevalence and severity of DP and improves the cervical range of motion at three months.

Educating both parents and professionals about proper infant positioning on a national scale could help minimize public healthcare costs.


Plagiocephaly Nonsynostotic plagiocephaly Cranial deformations Torticollis Prevention Motor development 



Anterior cranial asymmetry index


Cephalic index


Congenital muscular torticollis


Deformational plagiocephaly


Endocanthion left


Endocanthion right




Oblique cranial length ratio from 2D image


Oblique cranial length ratio from 3D image


Posterior cranial asymmetry index


Tragion left


Tragion right



The authors are grateful to all the families who participated in the study. The research was funded by a grant from the Alma and K. A. Snellman Foundation.

Author contributions

HA wrote the first draft of the manuscript and performed the data analysis. HA and AMV were responsible for the recruitment, background data collection, physical examination, and the management and development of the trial. AMV, VH, TH, and PP designed the study and obtained funding. AMV and PP supervised the study. HA and VV processed and analyzed the images. VV wrote the software used to align and analyze the 3D images. All authors interpreted the data, contributed to writing and revising the manuscript, and take full responsibility for the integrity of the data and the accuracy of the data analysis.

Conflicts of interest

The authors declare no conflicts of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Henri Aarnivala
    • 1
    • 3
    • 4
    Email author
  • Ville Vuollo
    • 2
    • 4
  • Virpi Harila
    • 2
    • 4
  • Tuomo Heikkinen
    • 2
    • 4
  • Pertti Pirttiniemi
    • 2
    • 4
  • A. Marita Valkama
    • 1
    • 3
    • 4
  1. 1.Department of Children and AdolescenceOulu University HospitalOuluFinland
  2. 2.Department of Oral Development and OrthodonticsOulu University HospitalOuluFinland
  3. 3.PEDEGO Research GroupUniversity of OuluOuluFinland
  4. 4.Medical Research Center OuluUniversity of OuluOuluFinland

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