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Randomized Trial of Plagiocephaly Education: Comparable Outcomes Suggest a Broad Awareness Effect
Yvonne Nguyen
*, Anna Bogursky, Andrea R. Buendia, Courtney Heitmiller, Ashley Roes, Elissa Daniel, Seohyun Hong, Yiming Zhang, Jessica J. Farzan, Lisa Nguyen, Janice F. Lalikos
University of Massachusetts Medical School, Worcester, MA
Background:
Positional plagiocephaly, a common cranial asymmetry in infants, has increased since the Back-to-Sleep campaign, which reduced Sudden Infant Death Syndrome but led to higher plagiocephaly rates. While not life-threatening, it may lead to cosmetic deformities, psychosocial concerns, and functional challenges such as difficulty with headgear. Many families are unaware of risk factors and prevention strategies, emphasizing the need for effective caregiver education. This study evaluates whether structured parental education improves awareness, adherence to preventive practices, and reduces plagiocephaly incidence.
Methods:
We are conducting a prospective, randomized controlled trial of 164 full-term newborns without craniofacial anomalies. The intervention group receives an informational pamphlet and a 3-minute video on plagiocephaly risk factors and prevention, while controls receive standard newborn care. Outcomes include cephalic index (CI) at enrollment, 2, 4, and 6 months, and parental surveys assessing adherence. Analyses include unpaired t-tests and difference-in-difference approaches.
Results:
Our prior pilot (n=39) showed a significant CI reduction in the intervention group at 4 months. In this trial (n=104 at 2 months; n=101 at 4 months; n=82 at 6 months), no significant differences were seen between groups at 2, 4, or 6 months (all p>0.2). Both groups demonstrated modest CI decreases, likely reflecting broader awareness of prevention strategies. These findings suggest the intervention's added value is limited when baseline knowledge is already high.
Conclusion:
This study highlights the role of education in the prevention of plagiocephaly. We hypothesize that repeated measurements and structured follow-up increased awareness among control families, effectively acting as an intervention, as both groups improved CI over time. Integrating standardized education into pediatric visits may enhance these effects, reinforcing caregiver engagement as a key component of pediatric plastic surgery education and quality improvement.
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