title: Plagiocephaly and Developmental Delay: A Systematic Review.
abstract: Deformational plagiocephaly (includes plagiocephaly and brachycephaly) is a common pediatric condition. Infants who present with altered head shape often experience developmental delay. It is uncertain how common developmental delay is in infants with plagiocephaly and how sustained this is, when present. This review explores the association between plagiocephaly and developmental delay to guide clinical practice.
  
  
  
  A systematic review was conducted. MEDLINE, EMBASE, CINAHL, and PEDro databases were searched. Data from relevant studies were extracted regarding study: sample, follow-up, design, and findings. Methodological quality of each study was rated using a critical appraisal tool.
  
  
  
  The search recovered 1315 articles of which 19 met the inclusion criteria. In the included studies, the children's ages ranged from 3 months to 10 years. Study limitations included selection bias, nonblinding of assessors, and reuse of the same study population for multiple papers. Most papers (11/19) rated "moderate" on methodological quality. A positive association between plagiocephaly and developmental delay was reported in 13 of 19 studies, including 4 of 5 studies with "strong" methodological quality. Delay was more frequently in studies with children ≤24 months of age (9/12 studies) compared with >24 months of age (3/7 studies). Motor delay was the most commonly affected domain reported in high-quality papers (5/5 studies).
  
  
  
  This review suggests plagiocephaly is a marker of elevated risk of developmental delays. Clinicians should closely monitor infants with plagiocephaly for this. Prompt referral to early intervention services such as physiotherapy may ameliorate motor delays and identify infants with longer term developmental needs.
authors.affiliation: *School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia; †Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; ‡Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; §Built Environment, Industrial Design Research Collaboration, University of New South Wales, Sydney, New South Wales, Australia; ‖Gosford Hospital, Central Coast Local Health District, Gosford, New South Wales, Australia; ¶Physiotherapy Department, Royal North Shore Hospital, Sydney, New South Wales, Australia; **Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Alexandra L C
authors.initials: AL
authors.lastname: Martiniuk
authors.forename: Cassandra
authors.initials: C
authors.lastname: Vujovich-Dunn
authors.forename: Miles
authors.initials: M
authors.lastname: Park
authors.forename: William
authors.initials: W
authors.lastname: Yu
authors.forename: Barbara R
authors.initials: BR
authors.lastname: Lucas
mesh_terms: D002648:Child; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology; D006801:Humans; D007223:Infant; D059041:Plagiocephaly / Q000453:epidemiology