Acta Neurochirurgica

, Volume 161, Issue 6, pp 1095–1098 | Cite as

Prevalence and severity of positional plagiocephaly in children and adolescents

  • Federico Di RoccoEmail author
  • Valeria Ble
  • Pierre-Aurelien Beuriat
  • Alexandru Szathmari
  • Laura Nanna Lohkamp
  • Carmine Mottolese
Original Article - Pediatric Neurosurgery
Part of the following topical collections:
  1. Pediatric Neurosurgery



Though positional posterior plagiocephaly (PPP) is considered common in infants since the pediatric recommendations of “Back to Sleep”, several aspects of its natural history still remain unclear. The aim of this study is to understand the actual prevalence and severity of PPP in children and adolescents.


Head CT scans performed for head trauma during the period September 2016–September 2017 were retrospectively analyzed in a total of 165 children ranging from 0 to 18 years of age (101 boys).

Cranial vault asymmetry index (CVAI) was calculated at the level of the superior orbital rim. CVAI values greater 3.5% was considered index of asymmetry.

The results were analyzed according to different age groups: group I: 1 month to 1 year of age (37 children), group II: 2 to 4 years (32 children), group III: 5 to 8 years (36 children), group IV: 9 to 12 years (27 children), and group V: 13 to 18 years (33 children) and the severity of asymmetry according to CVAI values: mild group (CVAI range 3.5–7%), moderate group (CVAI range 7–12%), and severe group (CVAI > 12%).


The total prevalence of PPP in the 165 children was 25%. While the prevalence in infants of group I was estimated to be 40.5%, it was 15.6% in group II, 30.5% in group III, 18.5% in group IV, and 12% in group V.

The mean and maximum degrees of deformation were 3.5% and 15.1%, respectively. Most children had a mild asymmetry. One child (group II) presented a severe asymmetry. The degree of the asymmetry varied according to the groups but moderate asymmetry could be found at all ages even in groups IV and V.


This study analyzing PPP in an unselected unbiased pediatric population shows that PPP has a high prevalence in adolescents. It confirms that the prevalence of deformational plagiocephaly is more common than usually reported and that PPP may persist at a late age.


Positional posterior plagiocephaly Deformational plagiocephaly Nonsynostotic plagiocephaly Pediatric population 


Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee of HFME of Lyon and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Federico Di Rocco
    • 1
    Email author
  • Valeria Ble
    • 1
  • Pierre-Aurelien Beuriat
    • 1
  • Alexandru Szathmari
    • 1
  • Laura Nanna Lohkamp
    • 1
  • Carmine Mottolese
    • 1
  1. 1.Department of Pediatric Neurosurgery, French Referral Center for CraniosynostosisHôpital Femme Mère Enfant, Hospices Civils de Lyon, Université de LyonLyonFrance

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