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Prevalence and characteristics of positional plagiocephaly in healthy full-term infants at 8–12 weeks of life

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Positional plagiocephaly (PP) denotes flattening of the skull that occurs frequently in healthy infants. Aim of this study was to estimate the prevalence of positional plagiocephaly and to identify the risk factors in a cohort of healthy infants in order to help prevention of PP. In a prospective design, all healthy full-term infants, ranging from 8 to 12 weeks of age, who presented at the public immunization clinic in Ferrara, were eligible for the study. After obtaining informed consent, we interviewed the parents and examined the infants using the Argenta’s assessment tool. Of 283 infants examined, 107 (37.8%) were found to have PP at 8–12 weeks of age. In 64.5%, PP was on the right side, 50.5% were male and 15% presented also with brachycephaly. Risk factors significantly associated were lower head circumference, advanced maternal age, Italian compared to African, and supine sleep position, in particular for infants born at 37 weeks, preference for one side of the head. In logistic regression, risk factors significantly associated were lower birth weight, advanced maternal age, and supine sleep position.

Conclusions: Positional plagiocephaly is a common issue faced by pediatricians; our results reinforce the need of improving prevention both of sudden infant death and positional plagiocephaly, through uniform messages provided prenatally and postnatally by different health professionals.

“What is Known:”

The incidence of positional plagiocephaly varies due to population studied and measuring methods.

•Different factors are considered in the literature as being associated to positional plagiocephaly (infant factors, obstetric factors, infant care practices, sociodemographic factors).

“What is New:”

•This is one of the few European studies quantifying positional plagiocephaly prevalence in a population of unselected healthy infants.

•In this study, positional plagiocephaly is confirmed as a common issue, related to some factor (as supine sleep position and positional head prevalence) that should be addressed in pre and postnatal counseling.

•The prone sleepers rate in our population highlight the need to improve parental awareness regarding SIDS prevention, in particular in borderline gestational age.

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Positional plagiocephaly


Sudden infant death syndrome


Standard deviation


Confidence interval


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The authors would like to thank The Public Health Immunization clinic of the AUSL (Azienda Unità Sanitaria Locale) of Ferrara and Mr. Manuel Higginbotham for editing the manuscript.


We do not have a sponsor, and costs necessary to collect data were covered by funds from the Pediatric Department at the University of Ferrara.

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Authors and Affiliations



EB and GG performed the physical examinations; MB helped with the data collection. MS was the referral physiotherapist for the severe forms of plagiocephaly. NB was the physiotherapist who supervised the study. CBP had the idea of performing the study and contributed to its design. AB performed the statistical analysis. EB, AB, CBP, MS, and GG wrote the article.

Corresponding author

Correspondence to Elisa Ballardini.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

This project was approved by the Ethics Committee of Ferrara University Hospital, on September 2014. All parents received an informative letter together with the vaccine invitation and an informative report at the visit day. Then who accepted signed a consent form.

Additional information

Communicated by Mario Bianchetti

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Ballardini, E., Sisti, M., Basaglia, N. et al. Prevalence and characteristics of positional plagiocephaly in healthy full-term infants at 8–12 weeks of life. Eur J Pediatr 177, 1547–1554 (2018).

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