Lasting Effects of Flat Head Syndrome

OVERVIEW

The first effect is the obvious cosmetic effect. The appearance of the child’s head with a flattened spot, if not corrected. This in turn can cause stress and anxiety for the parents and potentially lead to self image issues for the child as they grow older.

Parents tell me that once their precious baby’s head is recognised as ‘out of shape’, their attention is drawn to it constantly.

However, there are mixed opinions on the other effects of Flat Head Syndrome.

In January 2006, The Journal of Plastic Reconstruction Surgery published some research by Kordestani et al entitled ‘Neurodevelopmental delays in children with deformational plagiocephaly’.

The outcome, in summary, was that before intervention, infants showed significant delays in both mental and psychomotor development.

It was also it noted that not one child with positional plagiocephaly showed accelerated development.

Clinical Detail

At least 2 pieces of published research suggest that children with positional plagiocephaly (Flat Head Syndrome) do not do as well at school, both in the classroom as well as in the playground.

Links to each of these research papers are provided below, along with an Abstract and Summary.

Research Paper #1

https://pubmed.ncbi.nlm.nih.gov/11711916-neurodevelopment-in-children-with-single-suture-craniosynostosis-and-plagiocephaly-without-synostosis/

Plast Reconstr Surg. 2001 Nov;108(6):1492-8; discussion 1499-500.

Neurodevelopment in children with single-suture craniosynostosis and plagiocephaly without synostosis.

Panchal J1, Amirsheybani H, Gurwitch R, Cook V, Francel P, Neas B, Levine N.

Abstract

The objective of this study was to determine whether children with nonsyndromic craniosynostosis and plagiocephaly without synostosis demonstrated cognitive and psychomotor delays when compared with a standardized population sample.

This was the initial assessment of a larger prospective study, which involved 21 subjects with nonsyndromic craniosynostosis (mean age, 10.9 months) and 42 subjects with plagiocephaly without synostosis (mean age, 8.4 months).

Each child was assessed using the Bayley Scales of Infant Development-II (BSID-II) for cognitive and psychomotor development before therapeutic intervention (surgery for craniosynostosis and molding-helmet therapy for plagiocephaly without synostosis).

The distribution of the scores was divided into four groups: accelerated, normal, mild delay, and significant delay. The distributions of the mental developmental index (MDI) and the psychomotor developmental index (PDI) were then compared with a standardized Bayley’s age-matched population, using Fisher’s exact chi-square test. Within the craniosynostosis group, the PDI scores were significantly different from the standardized distribution (p < 0.001).

With regard to the PDI scores, 0 percent of the subjects in the craniosynostosis group were accelerated, 43 percent were normal, 48 percent had mild delay, and 9 percent had significant delay.

In contrast, the MDI scores were not statistically different (p = 0.08). Within the group with plagiocephaly without synostosis, both the PDI and MDI scores were significantly different from the normal curve distribution (p < 0.001).

With regard to the PDI scores, 0 percent of the subjects in the group with plagiocephaly without synostosis were accelerated, 67 percent were normal, 20 percent had mild delay, and 13 percent had significant delay.

With regard to the MDI scores, 0 percent of the subjects in this group were accelerated, 83 percent were normal, 8 percent had mild delay and 9 percent had significant delay.

This study indicates that before any intervention, subjects with single-suture syndromic craniosynostosis and plagiocephaly without synostosis demonstrate delays in cognitive and psychomotor development.

Continued postintervention assessments are needed to determine whether these developmental delays can be ameliorated with treatment.

Research Paper #2

https://pubmed.ncbi.nlm.nih.gov/16404269-neurodevelopmental-delays-in-children-with-deformational-plagiocephaly/

Plast Reconstr Surg. 2006 Jan;117(1):207-18; discussion 219-20.

Neurodevelopmental delays in children with deformational plagiocephaly.

Kordestani RK1, Patel S, Bard DE, Gurwitch R, Panchal J.

Abstract

BACKGROUND:

The purpose of this study was to determine whether, in fact, infants with deformational plagiocephaly, or plagiocephaly without synostosis, demonstrated cognitive and psychomotor developmental delays when compared with a standardized population. Through this study, we chose to expand upon our earlier findings from 2001 on patients with deformational plagiocephaly.

METHODS:

The study population includes a total of 110 consecutive patients, prospectively followed then retrospectively reviewed. Each infant was assessed using the Bayley Scales of Infant Development-II scoring system. The developmental analysis was categorized as either mental or psychomotor using the mental developmental index or the psychomotor developmental index, respectively. These infants were subcategorized into four groups: accelerated, normal, mild, or severely delayed. The groups were then compared with a standardized Bayley’s age-matched population, using chi-square test goodness-of-fit tests.

RESULTS:

Infants with deformational plagiocephaly were found to have significantly different psychomotor development indexes and mental developmental indexes when compared with the standardized population (p < 0.0001; p < 0.0001). With regards to the mental developmental index scores, none of the infants with deformational plagiocephaly were accelerated, 90 percent were normal, 7 percent were mildly delayed, and 3 percent were severely delayed. With regards to the psychomotor development index scores, none of infants were accelerated, 74 percent were normal, 19 percent were mildly delayed, and 7 percent were severely delayed.

CONCLUSIONS:

This study indicates that before any intervention, infants with deformational plagiocephaly show significant delays in both mental and psychomotor development. Also, of particular note is that no child with deformational plagiocephaly showed accelerated development.