Delayed Motor Development and Infant Obesity as Risk Factors for Severe Deformational Plagiocephaly: A Matched Case–Control Study

Eun-Hee Kim,Ki Eun Kim,Kyoung Min Choi,So Young Yoon,Hyun-Seung Lee,Youn Ho Sheen,Jihyun Jeon,Nam Hyo Kim

doi:10.3389/fped.2020.582360

Abstract

The prevalence of deformational plagiocephaly (DP) has increased since the recommendation of positioning infants to their back during sleeping and is affected by various biological and environmental factors. This study aimed to investigate associations between DP and perinatal or infant characteristics, including obesity. This case–control study included 135 infants (81 males) aged 2–12 months who were diagnosed with DP using calculated cranial vault asymmetric index and cranial index and 135 age- and sex-matched controls. Motor development was evaluated using the Alberta Infant Motor Scale, and obesity was defined by body mass index. Univariate and multivariate logistic regression models were used to assess potential risk factors for DP and its severity. One hundred thirty-five infants with DP were divided into the following three subgroups according to severity indicated by the cranial vault asymmetry index: mild to moderate group (n = 87, 64.4%), severe group (n = 48, 35.6%), and a combined plagiocephaly and brachycephaly group (n = 79, 58.5%). Independent risk factors significantly associated with development of DP were bottle-only feeding (adjusted odds ratio (aOR) = 4.65; 95% CI: 2.70–8.00), little tummy time when awake (aOR = 3.51, 95% CI: 1.71–7.21), delay of motor development (aOR = 2.85, 95% CI: 1.08–7.49), and obesity at diagnosis (aOR = 2.45, 95% CI: 1.02–5.90). Among these risk factors, delay of motor development (aOR = 4.91, 95% CI: 1.46–16.51) and obesity at diagnosis (aOR = 4.10, 95% CI: 1.42–11.90) were particularly related to severe DP. In conclusion, this study confirms that DP risk is positively associated with bottle-only feeding, infrequent tummy time, and delayed development of motor milestones. Notably, this study demonstrates infant obesity as a new risk factor for DP. Our findings suggest that obesity should be identified early and managed comprehensively in infants with DP.

Highlights

Deformational plagiocephaly (DP) is an asymmetry of the skull caused by external pressure on an infant’s head in the absence of premature craniosynostosis [1,2,3]
We found that only bottle feeding, little tummy time when awake, delay of motor development, and obesity (BMI > 97th percentile) at diagnosis were significantly associated with increased risk of deformational plagiocephaly (DP)
Little tummy time, and delay of motor development have been identified as risk factors in previous studies, and this study is the first to identify infant obesity as an additional risk factor for DP

Summary

Introduction

Deformational plagiocephaly (DP) is an asymmetry of the skull caused by external pressure on an infant’s head in the absence of premature craniosynostosis [1,2,3]. Deformational plagiocephaly develops in infants aged 6– 8 weeks, whose heads grow rapidly while lying down, and this is analogous to how a pumpkin flattens as it grows on the ground (“Pumpkin Analogy”) [1]. Some infants with severe DP are known to have facial asymmetry, ear misalignment, positional torticollis, or neurodevelopment problems, such as delayed motor development and cognitive learning disorder [3, 12,13,14], suggesting that DP is not just a cosmetic issue but may be associated with increased risk of neurodevelopment problems [15,16,17].

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