More developmental monitoring of children with skull deformation needed, researchers say

Top of head of child with deformational plagiocephaly (drawn by Huang MHS)

As many as 30 percent of all infants may have deformational plagiocephaly, also known as positional plagiocephaly, which is characterized by asymmetry and flattening of the head caused by external pressures. In previous studies, infants and toddlers with this condition have been shown to experience delays in development compared to unaffected children.

Researchers at Seattle Children’s Research Institute wanted to find out if these developmental delays persisted as children grew older. The researchers studied the development of 224 children with deformational plagiocephaly from infancy ( months, on average) through 36 months of age, comparing them to 231 unaffected children. This is the first scientifically rigorous study to examine development in preschool-age children with deformational plagiocephaly compared to a control group of kids without the condition.

Results of the study were published today in the journal Pediatrics. The findings indicate that children with deformational plagiocephaly continued to score lower on development measures than unaffected children at age 36 months.  Differences between children with and without deformational plagiocephaly were largest on measures of language and cognition, and smallest on measures of motor skills such as balance, jumping and running.

The researchers emphasize that their findings do not imply that skull deformational causes developmental delays. In fact, it may be the opposite: infants with even fairly mild developmental delays may be more likely to get deformational plagiocephaly.   Regardless of which comes first, developmental concerns or skull flattening, deformational plagiocephaly should serve as a prompt for clinicians to screen kids for possible developmental issues, said Brent R. Collett, PhD, of Seattle Children’s Research Institute and lead author of the study.

“Parents who are concerned about their baby’s head shape should talk to their doctors about the child’s development to find out whether further assessment is needed,’’  Collett said. The child’s doctor can also offer suggestions for repositioning and ensuring that the baby has adequate “tummy time” (i.e., time spent on his or her belly while awake), which may help to reduce skull flattening and foster early development.

Tips for preventing problems with plagiocephaly – for parents and caregivers

  • Flat spots in a young baby’s head can be quite common and by itself are not a cause for alarm. Ask your children’s doctor about it.
  • If your baby is diagnosed with plagiocephaly, ask the doctor to also screen for developmental delays in both motor and cognitive skills, and then talk to them about the results.
  • Babies develop at different times and different rates. What is  “normal” for your baby may be ahead of or behind what is normal for another child. Babies who start out slower often catch up in the future.
  • Always place babies to sleep on their backs as this remains the safest way to sleep. Place your baby’s head at one end of the crib and then switch to the other end the following night.
  • Encourage active “tummy time” when your baby is awake and find ways for baby to play, move and engage while on their tummy. Do this several times each day and watch your baby during tummy time.
  • Choose different positions and ways for babies to play and be held as a variety of stimulation is very important. Switch the arm you use to cradle your baby during feedings – left one time, the right the next.
  • Use car seats, strollers, infant seats, cribs, bassinets and play pens when necessary. However,remember that babies also need frequent cuddling, lap time, active play times and opportunities to move that are not limited to being in only stationary positions.
  • Develop motor skills – play with babies to get them moving. Encourage rolling, crawling, pushing, reaching, pulling, holding and grasping.
  • Develop cognitive skills – play with your baby to get them talking and thinking. Encourage interactions with their environment, listening, looking, babbling, imitating, reading, singing and talking.

If you’re a member of the media and would like to arrange an interview with Dr. Collett, please contact Children’s PR team at 206-987-4500 or at

Co-authors of the study include Carrie Heike, MD, Michael Cunningham, MD, PhD, and Matthew L. Speltz, PhD (Seattle Children’s/University of Washington); Kristen Gray, MS (University of Washington); and Jacqueline Starr, PhD (University of Washington/The Forsyth Institute/Harvard School of Dental Medicine).

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