Preventing deformational plagiocephaly through parent guidance: a randomized, controlled trial
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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.
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.
KeywordsPlagiocephaly Nonsynostotic plagiocephaly Cranial deformations Torticollis Prevention Motor development
Anterior cranial asymmetry index
Congenital muscular torticollis
Oblique cranial length ratio from 2D image
Oblique cranial length ratio from 3D image
Posterior cranial asymmetry index
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.
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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