Children with deformational plagiocephaly (DP), or “flat-head syndrome,” have been more commonly seen ever since pediatricians recommended placing infants on their backs during sleep. It’s an accepted consequence of a maneuver that has been found to lower crib death (sudden infant death syndrome, or SIDS) by about 40 to 50%. So far it’s been thought of as merely a cosmetic problem, and various conservative repositioning measures are generally recommended.
However, in a recent study, children with DP at 36 months were found to be around 2 to 8 times more likely to receive “at-risk” scores compared to children without DP. Differences were largest in cognition, cognition and parent-reported maladaptive behavior, and smallest in motor development. As you may see, there can be a significant overlap in these developmental problems and common conditions like ADHD and autism.
In the conclusion, the authors point out that this study doesn’t prove that having DP leads to developmental problems. One possible explanation proposed was that children with developmental delays may be less likely to reposition themselves, thus leading to DP.
Here’s another possible explanation: It’s been shown that back sleep lowers sleep quality in infants. One study from 1993 showed that prone body position was associated with a significant increase in sleep duration (+ 6%) and in non-REM sleep (+25%) and a significant decrease in number of arousals (–40%) and in their duration (-43%).
This is one possible way that being placed on backs during sleep can lower the rate of SIDS. By keeping children in a lighter stage of sleep, they are more easily arousable, if they obstruct. One obvious consequence of poor quality sleep is that it can negatively affect young children’s brain development. Proper amounts of REM and deep sleep is important for memory consolidation and optimal brain development.
Perhaps having poor sleep and slower brain development can lead to less optimal motor reflexes that allows the infant to roll over. In some infants that naturally want to roll over onto their tummies, parents are told to turn their infants on to their backs, or to use positioning devices to promote back sleep.
I’m not recommending that parents ignore pediatrician’s back sleep recommendation. This can be a very sensitive issue that needs further research and discussion. With advances in technology and current know-how, it would be relatively easy to do a study to answer these questions.
Did your child have flat-head syndrome? If so, did he or she have any developmental issues later in life?