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Epidemiology

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Positional Plagiocephaly

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Abstract

Cranial deformities have always existed, but it is only until recently that they provoked a greater interest. Several reports have demonstrated an increasing tendency for occipital plagiocephaly since 1992. The incidence of positional plagiocephaly varies according to the diagnostic criteria used. The increased incidence of positional occipital plagiocephaly is most likely related to the recommendations given by the American Pediatrics Association to put the infants to sleep on their backs. In 1992 it had, in fact, started the campaign “Back to Sleep” which provided that all healthy children born at term were placed to sleep on their backs to prevent sudden infant death syndrome. The simultaneous diffusion of principal multifunction devices for the transport of infants did increase the time that the child spends with the occipital region under constant pressure also when awake.

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Notes

  1. 1.

    The American Academy of Pediatrics’ policy statement acknowledges, in the absence of any published population-based epidemiological studies for plagiocephaly, that “it seems likely that both [a real increase and increased awareness] have arisen since the ‘Back to Sleep’ campaign began in 1992” [15]. The statement was based upon 17 articles published between 1996 and 2004, although emphasis was placed on the work of a New Zealand group [16, 17]. No scoring system was used to grade the design methodology. The statement refers to a case–control study [16] demonstrating an association between PPP and supine slee** position (odds ratio (OR), 2.51; 95 % CI, 1.23–5.16) and a subsequent prospective cohort study [18] of 200 consecutively enrolled neonates followed for 2 years that showed spontaneous decrease in the incidence from 20 % at 8 months to 3 % at 24 months of age. The spontaneous resolution was, nevertheless, highly biased, given that these children’s mothers were alerted to the problem and given recommendations for conservative care. The study is further confounded by the failure to state inclusion or exclusion criteria and by the nonvalidated method of assessment. Despite the use of population-based anthropometric comparison data, the authors admitted to the use of arbitrary delineation measures to designate case and control allocation, based upon subjective visual assessment methods. Loss-to-follow-up figures were low (9.5 %) over 2 years, but no discussion of statistical treatment of these data was made. Considerable sociodemographic, obstetric, and perinatal baseline data were collected; however, it was unclear if these were used in the statistical analysis or if logistic regression analysis was necessary [19].

  2. 2.

    There are varying estimates of the new incidence of plagiocephaly. Persing [9] notes a sixfold increase in the incidence since 1992, when back to sleep was introduced in the United States. Graham suggests an incidence of 1 in 60. A prospective study in the Netherlands [17] of over 7,000 newborns found the incidence of positional preference to be 8.2 %. Of these children, 45 % demonstrated asymmetric flattening of the occiput, 21 % of the forehead at the second assessment between age 2 and 3 (2.4 % of all children). It has been suggested by Hutchison [23] that the actual prevalence is unknown but that, as a result of increased awareness, it is being recognized more frequently.

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Authors and Affiliations

  1. Department of Preventive Medicine, ASL Milano, Via Statuto, 5, Milan, 20122, Italy

    Maria Vittoria Meraviglia

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  1. Maria Vittoria Meraviglia
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Correspondence to Maria Vittoria Meraviglia .

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  1. Child and Adolescent Neuropsychiatry Department, Ospedale Niguarda Ca’ Granda, Milan, Italy

    Donata Villani

  2. Department of Preventive Medicine, ASL Milano, Milan, Italy

    Maria Vittoria Meraviglia

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Meraviglia, M.V. (2014). Epidemiology. In: Villani, D., Meraviglia, M. (eds) Positional Plagiocephaly. Springer, Cham. https://doi.org/10.1007/978-3-319-06118-4_3

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  • DOI: https://doi.org/10.1007/978-3-319-06118-4_3

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