title: Deformational plagiocephaly in normal infants: a systematic review of causes and hypotheses.
abstract: Deformational plagiocephaly (DP) is one of the most prevalent abnormal findings in infants and a frequent reason for parents to seek paediatric advice.
  
  
  
  To systematically review the literature and identify evidence and hypotheses on the aetiology and determinants of DP in otherwise healthy infants.
  
  
  
  Systematic keyword search in all major biomedical databases to identify peer-reviewed publications reporting (a) empirical research or (b) hypotheses on the aetiology of DP in healthy, term infants. 3150 studies published between 1985 and 2016 and containing relevant keywords were screened. In a two-pronged approach, results were summarised separately for the body of empirical work (22 studies) and the body of hypotheses (110 articles).
  
  
  
  Only a few empirical studies have examined risk factors in non-selected patient populations on a higher grade methodological level. The most commonly reported risk factors were: male gender, supine sleep position, limited neck rotation or preference in head position, first-born child, lower level of activity and lack of tummy time. Agreement between empirical studies was poor for most exposures, including supine sleep position, tummy time and use of car seats. The articles reporting hypotheses on the aetiology of DP cover a wide field of environmental and biological factors, but include little suggestions as to the potential influence of the everyday care environment of the baby.
  
  
  
  The evidence on the aetiology of DP is fragmentary and heterogeneous. In addition, factors possibly relevant to the development of DP have not been appreciated in the scientific discussion.
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany.|Centre for Child Neurology, Frankfurt am., Germany.
authors.forename: Freia
authors.initials: F
authors.lastname: De Bock
authors.affiliation: University Library, University Medicine Mannheim, Medical faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Braun
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Herbert
authors.initials: H
authors.lastname: Renz-Polster
mesh_terms: D015444:Exercise / Q000502:physiology; D005260:Female; D019416:Head Movements / Q000502:physiology; D006801:Humans; D007223:Infant; D008297:Male; D049068:Plagiocephaly, Nonsynostotic / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors; D012737:Sex Factors; D016683:Supine Position / Q000502:physiology
keywords: deformational plagiocephaly; etiology; positional plagiocephaly; supine sleep position; systematic review