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Efficacy of Parent Education for Reducing Positional Plagiocephaly in Infants: Interim Results
Jessica J. Farzan
*, Lisa Nguyen, Yvonne Nguyen, Anna Bogursky, Yiming (Ace) Zhang, Janice F. Lalikos
UMass Chan Medical School, Andover, MA
Introduction: The Back-to-Sleep Campaign (1994) led to increased positional plagiocephaly, affecting 16-22.1% of infants by six weeks. This condition may result from prolonged pressure on the developing skull due to excessive supine positioning, unilateral feeding, and insufficient tummy time. Beyond cosmetic concerns, skull deformation may impair vision, hearing, and speech development. In Massachusetts, 4.3% of infants require helmet therapy at approximately $1,600 per case. Despite its significant impact, caregiver awareness remains inadequate, emphasizing the need for better prevention strategies.
Methods: In this ongoing two-arm, partially blinded randomized controlled trial (June 2022-April 2025) at University of Massachusetts Memorial Hospital, we compare standard care with an educational intervention for plagiocephaly prevention. Primary outcomes include measurement of cephalic index (CI)"”a validated metric for cranial asymmetry"”measured at 2, 4, and 6 months, with higher CI values indicating greater deformity severity. Secondary outcomes assess parental self-reported behaviors regarding compliance with recommendations. Unpaired t-tests and difference-in-difference models were used to compare CI trajectories and survey responses between groups.
Results: Currently 110 subjects (control: 47; intervention: 63) are enrolled. Baseline CI was similar between groups (control: 87.74 [SD 8.82]; intervention: 86.64 [SD 6.50]; p=0.0.89). The intervention group showed consistently lower CI values at all timepoints, reaching statistical significance by 4 months (p=0.04 (Table 1). Parental compliance scores were significantly higher in the intervention group (15.87 vs. 13.75) (p = 0.028).
Conclusion: The intervention was associated with reduced cranial deformation, reaching statistical significance by 4 months. This correlated with better parental compliance, suggesting the education program's effectiveness. With continued enrollment, 6-month data will provide definitive confirmation, but current findings support early education as an effective preventive strategy.
| Average CI | Intervention Group | Control Group | P-value |
| Mean (SD) Baseline CI | 86.64 (6.50) | 87.74 (8.82) | 0.89 |
| Mean (SD) CI at 2 months | 86.20 (4.51) | 86.76 (7.95) | 0.72 |
| Mean (SD) CI at 4 months | 86.57 (6.02) | 89.81 (4.99) | 0.04 |
| Mean (SD) CI at 6 months | 83.85 (5.42) | 85.48 (4.15) | 0.12 |
Table 1 - Average CI of the intervention and control groups at the 2-, 4-, and 6-month time points.
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