Impact of Parent Practices of Infant Positioning on Head Orientation Profile and Development of Positional Plagiocephaly in Healthy Term Infants

Phys Occup Ther Pediatr. 2018 Feb;38(1):1-14. doi: 10.1080/01942638.2017.1287811. Epub 2017 Apr 4.


Aims: The influence of infant positioning on the development of head orientation and plagiocephaly is not clear. This study explored the relationship between infant body and head positioning, with the development of asymmetrical head orientation and/or positional plagiocephaly. Methods: Clinician measurement of head orientation profile and parent-reported infant positioning data were collected for 94 healthy term infants at 3, 6, and 9 weeks of age. Plagiocephaly was measured at 9 weeks with the modified Cranial Vault Asymmetry Index.

Results: More severe plagiocephaly was associated with longer supine-sleep-maximum (p = 0.001) and longer supine-lying-total (p = 0.014) at 6 weeks. Prone positioning was not associated with plagiocephaly. Parent-reported head asymmetry during awake and sleep time at 3 weeks identified infants with clinician-measured head asymmetry at 9 weeks. Better symmetry in head turning was associated with more side-lying-total time by 9 weeks (p = 0.013).

Conclusions: Our results showed that infant positioning is associated with early head orientation and plagiocephaly development. Early parent-reported asymmetry during awake and sleep time is an important indicator for the need for professional assessment and advice. A Plagiocephaly Prevention Strategy and Plagiocephaly Screening Pathway are provided for clinicians and parents.

Keywords: Community; head orientation; infant positioning; parent practice; plagiocephaly.

MeSH terms

  • Head / physiopathology*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Infant
  • Infant, Newborn
  • Parents
  • Plagiocephaly, Nonsynostotic / etiology*
  • Posture*
  • Prospective Studies
  • Surveys and Questionnaires
  • Term Birth