The course of skull deformation from birth to 5 years of age: a prospective cohort study

Abstract

In a continuation of a prospective longitudinal cohort study in a healthy population on the course of skull shape from birth to 24 months, at 5 years of age, 248 children participated in a follow-up assessment using plagiocephalometry (ODDI-oblique diameter difference index, CPI-cranio proportional index). Data from the original study sampled at birth, 7 weeks, 6, 12, and 24 months were used in two linear mixed models.

Main findings: (1) if deformational plagiocephaly (ODDI <104%) and/or positional preference at 7 weeks of age are absent, normal skull shape can be predicted at 5 years of age; (2) if positional preference occurs, ODDI is the highest at 7 weeks and decreases to a stable lowest value at 2 and 5 years of age; and (3) regarding brachycephaly, all children showed the highest CPI at 6 months of age with a gradual decrease over time.

Conclusion: The course of skull deformation is favourable in most of the children in The Netherlands; at 5 years of age, brachycephaly is within the normal range for all children, whereas the severity of plagiocephaly is within the normal range in 80%, within the mild range in 19%, and within the moderate/severe range in 1%. Medical consumption may be reduced by providing early tailored counselling. What is Known: • Skull deformation prevalence increased after recommendations against Sudden Infant Death Syndrome, little is known about the longitudinal course. • Paediatric physical therapy intervention between 2 and 6 months of age reduces deformational plagiocephaly at 6 and 12 months of age. What is New: • The course of skull deformation is favourable in most of the children in The Netherlands; at 5 years of age, deformational brachycephaly is within the normal range for all children, whereas the severity of deformational plagiocephaly is within the normal range in 80%, within the mild range in 19%, and within the moderate to severe range in only 1%. • Paediatric physical therapy intervention does not influence the long-term outcome; it only influences the earlier decrease of the severity of deformational plagiocephaly.

Keywords: Deformational brachycephaly; Deformational plagiocephaly; Newborns; Skull deformation.

Conflict of interest statement

Compliance with ethical standards All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Medical Ethics Committees of the University Medical Center Utrecht, The Netherlands (initial part of the study 0–24 months), of the Radboud University Medical Center Nijmegen, The Netherlands (5-year assessments) and of the Bernhoven Hospital Veghel (all assessments), The Netherlands, gave ethical approval. Written informed consent was obtained from all parents of the children in the cohort. Funding This study was made possible by a grant BU002/10 from the Scientific Committee of The Royal Dutch Association for Physiotherapy, Amersfoort, The Netherlands. There was independence of researchers from funders. Conflict of interest The authors declare that they have no conflicts of interest. The authors have indicated they have no financial relationships relevant to this article to disclose.

Figures

Fig. 1

Flowchart of the children assessed six times from birth to 5.5 years of age

Fig. 2

Patterns of the predicted mean ODDI and its 95% confidence interval for the three subgroups

Fig. 3

Patterns of the predicted mean CPI and its 95% confidence interval for the three subgroups