Comparison of Developmental Milestones Between Pediatric Populations with and Without Cranial Deformities
Meghan Hancock
Kennesaw State University, Department of Prosthetics and Orthotics
Clinical Question
In infants diagnosed with cranial deformities, does the application of clinical developmental scales identify differences in motor development compared to a normative population?
Background
Since the introduction of the “Back to Sleep” program in 1992, a large increase in cranial deformities, such as plagiocephaly and brachycephaly, has been noted among the pediatric population.1 Infants with plagiocephaly have an elevated risk for hearing issues,2 deficiency in language,3 as well as psychological issues regarding self-confidence.4 A prevailing concern among the parents of these children is the potential for delayed development. This CAT aims to examine the literature regarding cranial deformities, focusing on plagiocephaly, and potential correlations to developmental delay.
Search Strategy
Synthesis of Results
Five studies were identified (see evidence table). All articles reviewed included participants with plagiocephaly and the number of subjects ranged from 20 to about 77,000 infants.5–9 The collected data provide evidence comparing infants with a cranial deformity diagnosis to control populations without a diagnosis6 and children with a plagiocephaly diagnosis to children ages 0–5 without plagiocephaly,7 all of which included the progression of deformity over set periods of time, ranging from 6 months to 5 years.5–9 One study examined mental development based on cognition, language and social abilities.5 The results showed that infants with plagiocephaly displayed significantly weaker motor skills, but cognitive skills were not significantly different.
Another study examined individual education plans, enrollment in special education practices, ADHD diagnoses, and any form of special help.8 The results showed that infants with plagiocephaly showed a higher risk for developmental difficulties that began to present during school aged years when compared to siblings without plagiocephaly. Potential limitations presented from the studies included are the number of participants, reliance on EMR for plagiocephaly and development delay diagnoses; potential for misdiagnoses, use of observation in the studies, biased results from the surveys provided and the lack of a control group for comparison.5–9
Clinical Message
The results of these studies indicate that positional cranial deformities in infants are associated with an increased risk of developmental motor delays compared to normative pediatric populations. Future research should emphasize understanding the potential influence of a CRO on motor development to allow clinicians to better educate caregivers on what changes, if any, may occur during treatment. Additionally, these findings may help clinicians monitor patients more effectively by identifying deviations from typical developmental scales during CRO use that may warrant further evaluation.