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The course of positional cranial deformation from 3 to 12 months of age and associated risk factors: a follow-up with 3D imaging

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Abstract

Deformational plagiocephaly is reported in up to 46.6 % of healthy infants, with the highest point prevalence at around 3 months of age. Few prospective studies on the natural course of skull deformation have been conducted, and we know of no studies using 3D imaging starting from the highest point prevalence period. In this prospective, population-based cohort study, we describe the course of cranial asymmetry and shape in an unselected population using 3D stereophotogrammetry and investigate factors associated with late cranial deformation and failure to recover from previous deformation. We evaluated 99 infants at 3, 6, and 12 months of age. We acquired 3D craniofacial images and performed structured clinical examinations and parental interviews at each visit. Eight outcome variables, representing different aspects of cranial shape, were calculated from a total of 288 3D images. Scores of asymmetry-related variables improved throughout the observation period. However, the rate of correction for cranial asymmetry decreased as the infants grew older, also in relation to the rate of head growth, and a significant amount of asymmetry was still present at 12 months. Positional preference at 3 months predicted an unfavorable course of cranial asymmetry after 3 months, increasing the risk for DP persisting.

What is known:

• The prevalence of deformational plagiocephaly spontaneously decreases after the first months of life.

• Limited neck range of motion and infant positional preference increase the risk of deformational plagiocephaly during the first months of life.

What is new:

• Positional preference at 3 months predicts an unfavorable spontaneous course of deformation also from three to 12 months of age, presenting a potential target for screening and treatment.

• The spontaneous rate of correction for cranial asymmetry decreases after 6 months of age, also in relation to the rate of head growth.

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Abbreviations

ACAI:

Anterior cranial asymmetry index

AS:

Asymmetry score

CI:

Cephalic index

DP:

Deformational plagiocephaly

EO:

Ear offset

FS:

Flatness score

KDE:

Kernel density estimate

LMM:

Linear mixed model

OCLR:

Oblique cranial length ratio

PCAI:

Posterior cranial asymmetry index

RCT:

Randomized, controlled trial

ROM:

Range of motion

wAS:

Weighted asymmetry score

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Acknowledgments

The authors are grateful to all the families who participated in the study. The research was funded with a grant from the Alma and K. A. Snellman foundation.

Authors’ Contributions

HA wrote the first draft of the manuscript. HA and VV performed the data analysis. HA and AMV were responsible for recruitment, background data collection, physical examination, and the management and development of the study. 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 and LH wrote the software used to align and analyze the 3D images, and developed the method using kernel density estimation to describe cranial asymmetry and flattening. 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.

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Authors and Affiliations

  1. Department of Children and Adolescence, Oulu University Hospital, Oulu, Finland

    Henri Aarnivala & A. Marita Valkama

  2. Medical Research Center Oulu, University of Oulu, Oulu, Finland

    Henri Aarnivala, Ville Vuollo, Virpi Harila, Tuomo Heikkinen, Pertti Pirttiniemi, Lasse Holmström & A. Marita Valkama

  3. PEDEGO Research Group, University of Oulu, Oulu, Finland

    Henri Aarnivala & A. Marita Valkama

  4. Department of Orthodontics, Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland

    Ville Vuollo, Virpi Harila, Tuomo Heikkinen & Pertti Pirttiniemi

  5. Department of Mathematical Sciences, University of Oulu, Oulu, Finland

    Ville Vuollo & Lasse Holmström

Authors
  1. Henri Aarnivala
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  2. Ville Vuollo
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  3. Virpi Harila
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  4. Tuomo Heikkinen
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  5. Pertti Pirttiniemi
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  6. Lasse Holmström
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  7. A. Marita Valkama
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Corresponding author

Correspondence to Henri Aarnivala.

Ethics declarations

The study was approved by the Ethics Committee of the Northern Ostrobothnia Hospital District, and it was carried out according to the Declaration of Helsinki. Written, informed consent was obtained from all of the parents, prospectively. The authors declare no conflicts of interest.

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Communicated by Beat Steinmann

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Aarnivala, H., Vuollo, V., Harila, V. et al. The course of positional cranial deformation from 3 to 12 months of age and associated risk factors: a follow-up with 3D imaging. Eur J Pediatr 175, 1893–1903 (2016). https://doi.org/10.1007/s00431-016-2773-z

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  • DOI: https://doi.org/10.1007/s00431-016-2773-z

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