Another look at “tummy time” for primary plagiocephaly prevention and motor development

Guidance strategies for infantile asymmetry prevention: a systematic review

BACKGROUND

Infantile asymmetries of posture, movement and/or shape are common. Coincidence in the presentation of asymmetrical features can lead to a broad spectrum of descriptors. Published guidelines on prevention strategies are not currently available. The objective of this systematic review was to find, evaluate, and synthesise the available evidence regarding the effectiveness of prevention strategies for infantile asymmetries, specifically strategies involving paediatric screening and/or guidance to parents.

METHODS

This review has been reported based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the review protocol was prospectively registered on the Open Science Framework, ( https://osf.io/rgzev/ ). Searches were conducted on Ovid Medline, Ovid AMED, and PEDro. Inclusion criteria of articles were infants < 28 weeks old who had received either an early musculoskeletal screen and/or education to parents on home care guidance/exercises to prevent asymmetry development. Any primary research was included. There was no limit placed upon date of publication. Data were screened, extracted and appraised in duplicate by at least two blinded reviewers. The Cochrane Collaboration's tool for assessing risk of bias available as part of Covidence was used by two reviewers independently.

RESULTS

Of the 878 papers retrieved, 19 studies were included: 9 randomised controlled trials, 6 cohort studies and 4 non-randomised experimental studies. The presenting conditions included head shape asymmetry in 16/19 studies, cervical range of motion in 10 studies and positional preference in 3. Due to a lack of homogeneity between all the studies, it was not possible to pool the data and conduct meta-analysis. Guidance strategies show better outcomes in asymmetry prevention when provided early (< 3 months) and under supervision of a healthcare professional. The overall risk of bias for cohort and non-randomised experimental studies was considered to be 'low', and 'adequate' or 'low' for randomised controlled trials. The GRADE level of evidence was found to be 'very low'.

CONCLUSION

Early parental guidance may prevent infantile asymmetry when supervised by a trained healthcare professional and with good adherence from parents. Further studies with a higher methodological rigour are needed to identify and perform comparative interventions.

CLINICAL TRIAL NUMBER

Not applicable. OSF NUMBER: https://doi.org/10.17605/OSF.IO/RGZEV .

Positional Skull Deformities and Neurodevelopmental Delay: Study on 449 Infants

OBJECTIVE

Provide data on a cross-sectional study of neurodevelopmental delays (NDD) in patients with positional skull deformities (PSD), based on severity and gender, in early childhood.

METHODS

Neurodevelopment of 449 patients with PSD, with an age range of 3 to 59 months, was assessed with Battelle Developmental Inventory (BDI) tests during and after their cranial orthotic treatment. Data obtained were compared with the anthropometric measurements taken the same day the test was made, and results were grouped by diagnosis and severity, segmented by age group, and split by gender.

RESULTS

From 3983 patients with PSD and simple craniosynostosis, 526 accepted to participate and took a total of 1261 BDI tests. Premature patients, patients with neurological diseases or congenital malformations, and tests taken when PSD had been corrected were excluded. The resulting study group was 449 children (123 girls and 326 boys) and 972 BDI tests. Ninety-five percent of tests presented significant NDD (median value, expressed in months) in one or more BDI domains; male patients present larger NDD than do female patients; largest delays were found in brachycephaly and plagiocephaly combined (-7 mo at age range 48-59 mo), scaphocephaly (-3.5 mo at age range 12-17 mo), plagiocephaly (-3.2 mo at age range 12-17 mo). No significant NDD were found in the receptive or cognitive domains.

CONCLUSION

When evaluating PSD, BDI tests, or similar, as well as mixed PSD classification should be considered. Patients with PSD should be monitored by a coordinated set of medical specialists.