{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T20:37:17Z","timestamp":1790109437326,"version":"4.0.1"},"reference-count":44,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2007,2,1]]},"abstract":"<jats:p>OBJECTIVE. The purpose of this work was to identify risk factors for deformational plagiocephaly within 48 hours of birth and at 7 weeks of age.<\/jats:p>\n                  <jats:p>PATIENTS AND METHODS. This was a prospective cohort study in which 380 healthy neonates born at term in Bernhoven Hospital in Veghel were followed at birth and at 7 weeks of age. Data regarding obstetrics, sociodemographics, asymmetry of the skull, anthropometrics, motor development, positioning, and care factors related to potentially provoking deformational plagiocephaly were gathered, with special interest for putative risk factors. The main outcome measure at birth and at 7 weeks of age was deformational plagiocephaly, assessed using the plagiocephalometry parameter oblique diameter difference index, a ratio variable, calculated as the longest divided by the shortest oblique diameter of the skull \u00d7 100%. A cutoff point of \u2265104% was used to indicate severe deformational plagiocephaly.<\/jats:p>\n                  <jats:p>RESULTS. Only in 9 of 23 children who presented deformational plagiocephaly at birth was deformational plagiocephaly present at follow-up, whereas in 75 other children, deformational plagiocephaly developed between birth and follow-up. At birth, 3 of 14 putative risk factors were associated with severe flattening of the skull: gender, birth rank, and brachycephaly. At 7 weeks of age, 8 of 28 putative risk factors were associated with severe flattening: gender, birth rank, head position when sleeping, position on chest of drawers, method of feeding, positioning during bottle-feeding, and tummy time when awake. Early achievement of motor milestones was a protective factor for developing deformational plagiocephaly. Deformational plagiocephaly at birth was not a predictor for deformational plagiocephaly at 7 weeks of age. There was no significant relation between supine sleeping and deformational plagiocephaly.<\/jats:p>\n                  <jats:p>CONCLUSIONS. Three determinants were associated with an increased risk of deformational plagiocephaly at birth: male gender, first-born birth rank, and brachycephaly. Eight factors were associated with an increased risk of deformational plagiocephaly at 7 weeks of age: male gender, first-born birth rank, positional preference when sleeping, head to the same side on chest of drawers, only bottle feeding, positioning to the same side during bottle feeding, tummy time when awake &amp;lt;3 times per day, and slow achievement of motor milestones. This study supports the hypothesis that specific nursing habits, as well as motor development and positional preference, are primarily associated with the development of deformational plagiocephaly. Earlier achievement of motor milestones probably protects the child from developing deformational plagiocephaly. Implementation of practices based on this new evidence of preventing and diminishing deformational plagiocephaly in child health care centers is very important.<\/jats:p>","DOI":"10.1542\/peds.2006-2012","type":"journal-article","created":{"date-parts":[[2007,2,3]],"date-time":"2007-02-03T01:46:57Z","timestamp":1170467217000},"page":"e408-e418","source":"Crossref","is-referenced-by-count":200,"title":["Risk Factors for Deformational Plagiocephaly at Birth and at 7 Weeks of Age: A Prospective Cohort Study"],"prefix":"10.1542","volume":"119","author":[{"given":"Leo A.","family":"van Vlimmeren","sequence":"first","affiliation":[{"name":"Department of Physical Therapy, Bernhoven Hospital, Veghel, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yolanda","family":"van der Graaf","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, Clinical Epidemiology, University Medical Center Utrecht, Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magda M.","family":"Boere-Boonekamp","sequence":"additional","affiliation":[{"name":"Organization for Home Care, Hengelo, Science, Technology, Health and Policy Studies, University of Twente, Enschede, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique P.","family":"L'Hoir","sequence":"additional","affiliation":[{"name":"Medical Psychology Department"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J.M.","family":"Helders","sequence":"additional","affiliation":[{"name":"Department of Pediatric Physical Therapy and Exercise Physiology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raoul H.H.","family":"Engelbert","sequence":"additional","affiliation":[{"name":"Department of Pediatric Physical Therapy and Exercise Physiology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2007,2,1]]},"reference":[{"key":"2021120901475086300_R1","doi-asserted-by":"crossref","unstructured":"Littlefield TR, Beals SP, Manwaring KH, et al. Treatment of craniofacial asymmetry with dynamic orthotic cranioplasty. J Craniofac Surg.\u20081998;9:11\u201317","DOI":"10.1097\/00001665-199801000-00004"},{"key":"2021120901475086300_R2","doi-asserted-by":"crossref","unstructured":"Clarren SK, Smith DW, Hanson JW. Helmet treatment for plagiocephaly and congenital muscular torticollis. J Pediatrics.\u20081979;94:43\u201346","DOI":"10.1016\/S0022-3476(79)80347-9"},{"key":"2021120901475086300_R3","doi-asserted-by":"crossref","unstructured":"Littlefield TR, Kelly KM, Pomatto JK, Beals SP. Multiple-birth infants at higher risk for development of deformational plagiocephaly: II. Is one twin at greater risk?Pediatrics.\u20082002;109:19\u201325","DOI":"10.1542\/peds.109.1.19"},{"key":"2021120901475086300_R4","doi-asserted-by":"crossref","unstructured":"Bredenkamp JK, Hoover LA, Berke GS, Shaw A. Congenital muscular torticollis. Arch Otolaryngol Head Neck Surg.\u20081990;16:212\u2013216","DOI":"10.1001\/archotol.1990.01870020088024"},{"key":"2021120901475086300_R5","doi-asserted-by":"crossref","unstructured":"Mulliken JB, Vander Woude DL, Hansen M, LaBrie RA, Scott RM. Analysis of posterior plagiocephaly: deformational versus synostotic. Plast Reconstr Surg.\u20081999;103:371\u2013380","DOI":"10.1097\/00006534-199902000-00003"},{"key":"2021120901475086300_R6","doi-asserted-by":"crossref","unstructured":"Peitsch WK, Keefer CH, LaBrie RA, Mulliken JB. Incidence of cranial asymmetry in healthy newborns. Pediatrics.\u20082002;110(6). Available at: www.pediatrics.org\/cgi\/content\/full\/110\/6\/e72","DOI":"10.1542\/peds.110.6.e72"},{"key":"2021120901475086300_R7","doi-asserted-by":"crossref","unstructured":"Hutchison BL, Hutchison LA, Thompson JM, Mitchell EA. Plagiocephaly and brachycephaly in the first two years of life: a prospective cohort study. Pediatrics.\u20082004;114:970\u2013980","DOI":"10.1542\/peds.2003-0668-F"},{"key":"2021120901475086300_R8","doi-asserted-by":"crossref","unstructured":"Bridges SJ, Chambers TL, Pople IK. Plagiocephaly and head binding. Arch Dis Child.\u20082002;86:144\u2013145","DOI":"10.1136\/adc.86.3.144"},{"key":"2021120901475086300_R9","doi-asserted-by":"crossref","unstructured":"Kane AA, Mitchell LE, Craven KP, Marsh JL. Observations on a recent increase in plagiocephaly without synostosis. Pediatrics.\u20081996;97:877\u2013885","DOI":"10.1542\/peds.97.6.877"},{"key":"2021120901475086300_R10","doi-asserted-by":"crossref","unstructured":"Argenta LC, Davis LR, Wilson JA, Bell WO. An increase in infant cranial deformity with supine sleeping position. J Craniofacial Surg.\u20081996;7:5\u201311","DOI":"10.1097\/00001665-199601000-00005"},{"key":"2021120901475086300_R11","doi-asserted-by":"crossref","unstructured":"Golden KA, Beals SP, Littlefield TR, Pomatto JK. Sternomastoid imbalance versus congenital muscular torticollis: Their relationship to positional plagiocephaly. Cleft Palate-Craniofacial J.\u20081999;36:256\u2013261","DOI":"10.1597\/1545-1569(1999)036<0256:SIVCMT>2.3.CO;2"},{"key":"2021120901475086300_R12","doi-asserted-by":"crossref","unstructured":"Hutchison BL, Thompson JM, Mitchell EA. Determinants of nonsynostotic plagiocephaly: a case-control study. Pediatrics.\u20082003;112(4). Available at: www.pediatrics.org\/cgi\/content\/full\/112\/4\/e316","DOI":"10.1542\/peds.112.4.e316"},{"key":"2021120901475086300_R13","doi-asserted-by":"crossref","unstructured":"Graham JM, Gomez M, Halberg A, Earl DL, Kreutzman JT, Cui J, Guo X. Management of deformational plagiocephaly; repositioning versus orthotic therapy. J Pediatr.\u20082005;146:258\u2013262","DOI":"10.1016\/j.jpeds.2004.10.016"},{"key":"2021120901475086300_R14","doi-asserted-by":"crossref","unstructured":"Collett B, Breiger D, King D, Cunningham M, Speltz M. Neurodevelopmental implications of deformational plagiocephaly. J Dev Behav Pediatr.\u20082005;26:379\u2013389","DOI":"10.1097\/00004703-200510000-00008"},{"key":"2021120901475086300_R15","doi-asserted-by":"crossref","unstructured":"Balan P, Kushnerenko E, Sahlin P, Huotilainen M, Naatanen R, Hukki J Auditory ER. Ps reveal brain dysfunction in infants with plagiocephaly. J Craniofac Surg.\u20082002;13:520\u2013525","DOI":"10.1097\/00001665-200207000-00008"},{"key":"2021120901475086300_R16","doi-asserted-by":"crossref","unstructured":"St John D, Mulliken JB, Kaban LB, Padwa BL. Anthropometric analysis of mandibular asymmetry in infants with deformational posterior plagiocephaly. J Oral Maxillofac Surg.\u20082002;60:873\u2013877","DOI":"10.1053\/joms.2002.33855"},{"key":"2021120901475086300_R17","doi-asserted-by":"crossref","unstructured":"Rekate HL. Occipital plagiocephaly: a critical review of the literature. J Neurosurg.\u20081998;89:24\u201330","DOI":"10.3171\/jns.1998.89.1.0024"},{"key":"2021120901475086300_R18","doi-asserted-by":"crossref","unstructured":"Bialocerkowski AE, Vladusic SL, Howell SM. Conservative interventions for positional plagiocephaly: a systematic review. Dev Med Child Neurol.\u20082005;47:563\u2013570","DOI":"10.1017\/S0012162205001118"},{"key":"2021120901475086300_R19","doi-asserted-by":"crossref","unstructured":"Persing JA. Discussion on: neurodevelopment in children with single-suture craniosynostosis and plagiocephaly without synostosis. Plast Reconstr Surg.\u20082001;108:1499\u20131500","DOI":"10.1097\/00006534-200111000-00008"},{"key":"2021120901475086300_R20","doi-asserted-by":"crossref","unstructured":"Miller RI, Clarren SK. Long-term developmental outcomes in patients with deformational plagiocephaly. Pediatrics.\u20082000;105(2). Available at: www.pediatrics.org\/cgi\/content\/full\/105\/2\/e26","DOI":"10.1542\/peds.105.2.e26"},{"key":"2021120901475086300_R21","doi-asserted-by":"crossref","unstructured":"Panchal J, Amirsheybani H, Gurwitch R, Cook V, Francel P, Neas B, Levine N. Neurodevelopment in children with single-suture craniosynostosis and plagiocephaly without synostosis. Plast Reconstr Surg.\u20082001;108:1492\u20131500","DOI":"10.1097\/00006534-200111000-00008"},{"key":"2021120901475086300_R22","doi-asserted-by":"crossref","unstructured":"Engelberts AC, de Jonge GA. Choice of sleeping position for infants: possible association with cot death. Arch Dis Child.\u20081990;65:462\u2013467","DOI":"10.1136\/adc.65.4.462"},{"key":"2021120901475086300_R23","doi-asserted-by":"crossref","unstructured":"Fleming PJ, Gilbert R, Azaz Y. Interaction between bedding and sleeping position in the sudden infant death syndrome; a population based case-control study. BMJ.\u20081990;301:85\u201389","DOI":"10.1136\/bmj.301.6743.85"},{"key":"2021120901475086300_R24","doi-asserted-by":"crossref","unstructured":"Kattwinkel J, Brooks J, Keenan MJ, Malloy M, Willinger M, Scheers NJ. Changing concepts of sudden infant death syndrome: implications for the sleeping environment and sleep position. Pediatrics.\u20082000;105:650\u2013656","DOI":"10.1542\/peds.105.3.650"},{"key":"2021120901475086300_R25","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics. Task force on positioning and SIDS. Pediatrics.\u20081992;89:1120\u20131126","DOI":"10.1542\/peds.89.6.1120"},{"key":"2021120901475086300_R26","doi-asserted-by":"crossref","unstructured":"Kattwinkel J, Brooks J, Keenan MJ, Malloy M. Positioning and sudden infant death syndrome (SIDS): update. Pediatrics.\u20081996;98:1216\u20131218","DOI":"10.1542\/peds.98.1.165"},{"key":"2021120901475086300_R27","doi-asserted-by":"crossref","unstructured":"Boere-Boonekamp MM, Linden-Kuiper AT van der. Positional preference: prevalence in infants and follow-up after two years. Pediatrics.\u20082001;107:339\u2013343","DOI":"10.1542\/peds.107.2.339"},{"key":"2021120901475086300_R28","unstructured":"Boere-Boonekamp MM, Bunge van Lent FCGM, Roovers EA, Haasnoot-Smallegange ME. Voorkeurshouding bij zuigelingen: prevalentie, preventie en aanpak [in Dutch]. Tijdschr Jeugdgezondheidszorg\u20082005;5:92\u201397"},{"key":"2021120901475086300_R29","doi-asserted-by":"crossref","unstructured":"van Vlimmeren LA, Helders PJ, van Adrichem LN, Engelbert RH. Diagnostic strategies for the evaluation of asymmetry in infancy: a review. Eur J Pediatr.\u20082004;163:185\u2013191","DOI":"10.1007\/s00431-004-1412-2"},{"key":"2021120901475086300_R30","doi-asserted-by":"crossref","unstructured":"van Vlimmeren LA, Helders PJ, van Adrichem LN, Engelbert RH. Torticollis and plagiocephaly in infancy: therapeutic strategies. Pediatr Rehabil.\u20082006;9:40\u201346","DOI":"10.1080\/13638490500037904"},{"key":"2021120901475086300_R31","doi-asserted-by":"crossref","unstructured":"van Vlimmeren LA, Takken T, van Adrichem LN, van der Graaf Y, Helders PJ, Engelbert RH. Plagiocephalometry: a non-invasive method to quantify asymmetry of the skull; a reliability study. Eur J Pediatr.\u20082006;165:149\u2013157","DOI":"10.1007\/s00431-005-0011-1"},{"key":"2021120901475086300_R32","unstructured":"Piper M, Darrah J. Motor Assessment of the Developing Infant. Vol 1. 1st ed. Philadelphia, PA: WB Saunders; 1994"},{"key":"2021120901475086300_R33","unstructured":"Piper M, Pinnell LE, Darrah J, Maguire T, Byrne PJ. Construction and validation of the Alberta Infant Motor Scale (AIMS). Can J Public Health1992;83:46\u201350"},{"key":"2021120901475086300_R34","unstructured":"Bayley N. Bayley Scales of Infant Development. 2nd ed. San Antonio, TX: The Psychological Corporation Harcourt Brace and Company; 1993"},{"key":"2021120901475086300_R35","unstructured":"Bernbeck R, Dahmen G. Kinderorthopedie. Stuttgart, Germany: Thieme Verlag; 1983"},{"key":"2021120901475086300_R36","doi-asserted-by":"crossref","unstructured":"Coster W. Critique of the Alberta Infant Motor Scale (AIMS). Phys Occup Ther Pediatr.1995;5:53\u201364","DOI":"10.1080\/J006v15n03_04"},{"key":"2021120901475086300_R37","doi-asserted-by":"crossref","unstructured":"Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med.\u20081996;15:361\u2013387","DOI":"10.1002\/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4"},{"key":"2021120901475086300_R38","doi-asserted-by":"crossref","unstructured":"Kelly KM, Littlefield TR, Pomatto JK, Manwaring KH, Beals SP. Cranial growth unrestricted during treatment of deformational plagiocephaly. Pediatr Neurosurg.\u20081999;30:193\u2013199","DOI":"10.1159\/000028794"},{"key":"2021120901475086300_R39","doi-asserted-by":"crossref","unstructured":"Hansen M, Mulliken JB. Frontal plagiocephaly. Diagnosis and treatment. Clin Plast Surg.\u20081994;21:543\u2013553","DOI":"10.1016\/S0094-1298(20)30722-7"},{"key":"2021120901475086300_R40","doi-asserted-by":"crossref","unstructured":"Bruneteau RJ, Mulliken JB. Frontal plagiocephaly: synostotic, compensational or deformational. Plast Reconstr Surg.\u20081992;89:21\u201333","DOI":"10.1097\/00006534-199289010-00005"},{"key":"2021120901475086300_R41","doi-asserted-by":"crossref","unstructured":"Clarren SK. Plagiocephaly and torticollis: etiology, natural history and helmet treatment. J Pediatr.\u20081981;98:92\u201395","DOI":"10.1016\/S0022-3476(81)80549-5"},{"key":"2021120901475086300_R42","doi-asserted-by":"crossref","unstructured":"Pollack IF, Losken HW, Fasick P. Diagnosis and management of posterior plagiocephaly. Pediatrics.\u20081997;99:180\u2013185","DOI":"10.1542\/peds.99.2.180"},{"key":"2021120901475086300_R43","doi-asserted-by":"crossref","unstructured":"Biedermann H. Manual therapy in children: proposals for an etiologic model. J Manipulative Physiol Ther.\u20082005;28:211.e1\u201315","DOI":"10.1016\/j.jmpt.2005.02.011"},{"key":"2021120901475086300_R44","doi-asserted-by":"crossref","unstructured":"Majnemer A, Barn RG. Influence of supine sleep positioning on the early motor milestone acquisition. Dev Med Child Neurol.\u20082005;47:370\u2013376","DOI":"10.1017\/S0012162205000733"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/119\/2\/e408\/1118421\/zpe0020700e408.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/119\/2\/e408\/1118421\/zpe0020700e408.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T12:17:35Z","timestamp":1683721055000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/119\/2\/e408\/70294\/Risk-Factors-for-Deformational-Plagiocephaly-at"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,2,1]]},"references-count":44,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2007,2,1]]},"published-print":{"date-parts":[[2007,2,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2006-2012","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,2,1]]}}}