title: Cranial shape, size and cervical motion in normal newborns.
abstract: BACKGROUND
  Deformational plagiocephaly (DP) and torticollis are commonly seen in infants and they often co-occur, but little is known of the prevalence and relationship of these conditions in the immediate newborn period. No previous studies focusing on the relationship between cranial shape and cervical motion in newborns can be found.
  
  
  OBJECTIVE
  Determining the incidence rates and characteristics of DP and torticollis and examining the relationship between cervical range of motion (ROM), cranial size and cranial shape in neonates.
  
  
  METHODS
  A single-center, descriptive cross-sectional study including 155 healthy neonates was conducted. Participants were examined during their birth hospitalization. Oblique Cranial Length Ratio (OCLR) and Cephalic Index (CI), indicating cranial asymmetry and shape, were measured from standardized digital photographs with a computer-based cephalometric method. Cervical ROM was measured with goniometry.
  
  
  RESULTS
  7.7% of the newborns had DP and 3.9% had torticollis. 46.4% presented lesser cervical imbalances. DP was associated with gestational diabetes (adjusted OR 5.6; p<0.01) and vacuum assisted delivery (adjusted OR 6.8; p<0.01), but not at all with torticollis. CI correlated strongly with cervical ROM in all directions, while no definite association between cranial asymmetry and cervical motion could be found.
  
  
  CONCLUSIONS
  DP and torticollis are common and minor cervical imbalances very common in normal newborns. Our results support the theory that in most cases neither DP nor torticollis is congenital, but rather develops and worsens synergistically in early infancy. Still, although no direct association between DP and torticollis was found, cranial shape is linked to cervical motion at birth.
authors.affiliation: Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland; University of Oulu, Oulu, Finland. Electronic address: henri.aarnivala@student.oulu.fi.
authors.forename: Henri E I
authors.initials: HE
authors.lastname: Aarnivala
authors.affiliation: Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland.
authors.forename: A Marita
authors.initials: AM
authors.lastname: Valkama
authors.affiliation: Department of Orthodontics, Oulu University Hospital, Oulu, Finland.
authors.forename: Pertti M
authors.initials: PM
authors.lastname: Pirttiniemi
mesh_terms: D053587:Arthrometry, Articular / Q000379:methods; D002508:Cephalometry; D003430:Cross-Sectional Studies / Q000379:methods; D036861:Delivery, Obstetric / Q000379:methods; D016640:Diabetes, Gestational; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010781:Photography / Q000379:methods; D049068:Plagiocephaly, Nonsynostotic / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D012886:Skull / Q000033:anatomy & histology* / Q000502:physiology; D014103:Torticollis / Q000453:epidemiology / Q000209:etiology*; D014427:Twins
keywords: Cephalic Index; Cranial anthropometrics; Cranial molding; Deformational plagiocephaly; Nonsynostotic plagiocephaly; Torticollis