Chiropractic Care For Plagiocephaly Cohort Study Released

An isolated shot of a cute asian baby

Plagiocephaly has been called “The most common craniofacial problem today,” by the Royal Children’s Hospital [1].  The disorder is that of a misshapen or asymmetrical head shape often seen in newborns and infants as the thin, flexible bones of their heads are affected by lying on one side more than the other. A newly released cohort study on chiropractic care for the condition has something to say on the issue.

Interestingly, the prevalence of Plagiocephaly has increased significantly over the last 20 years, possibly due to the SIDS recommendation for babies to sleep on their backs. Although this recommendation has resulted in a dramatic decrease in the incidence of SIDS, it coincided with a dramatic increase in Plagiocephaly [2]. The stats currently stack up at around 20% of 2 month-old infants suffering from the condition.

Usually diagnosed in the first 4 months of life and ordinarily resolving by 2 years old, Plagiocephaly was originally thought not to affect development. More recent research is revealing a ‘growing association between Plagiocephaly and developmental delay later in infancy extending into childhood [3]. Despite this, the recommendations for dealing with plagiocephalic infants extend mainly to “tummy time.”

While many chiropractors will have witnessed the impact of gentle, age appropriate adjustments on an infant’s ability to turn her/his head, no research had yet been done on the impact of chiropractic care on Plagiocephaly.

This makes the cohort study (referenced below) a unique and important one. It was conducted at the Anglo-European College of Chiropractic (AECC) clinic in the UK. In addition to a literature review, they took a sample group of participants (infants aged between 0-12 months) diagnosed with Plagiocephaly whose parents presented at the clinic and consented to chiropractic care for their infant [3].

The level of Plagiocephaly (or Positional Head Deformation) was determined “by two cranial measurements taken from the external occipital protuberance (EOP) to the anterior ear for both left and right side. A difference of more than 0.4 cm between the two sides was recorded as Plagiocephaly or PHD present [3].” The babies were then checked and adjusted following the standard AECC clinic protocol for infants and children, and measured again at the first, fourth and seventh Adjustment visit.

This was done for a maximum of six weeks – a time chosen because “reduction in that time frame would be considered well ahead of the natural history of the disorder [3].”  The researchers were unable to have a control group for this study, due to ethical considerations tied up with the long-term negative impacts of the condition.

There were more males in the sample group (as is reflective of the disorder’s prevalence [2]), and 64 participants were included in total. They came from a mix of natural, assisted and caesarean births, a variety of gestational lengths and feeding methods. There was also a mix of single and multiple births, and ranged in age from 2 – 44 weeks old although all but one were under six months old. The results of the study were quite definitive [3].

  • “The average difference in side-to-side EOP to anterior ear measurement for this group of infants before chiropractic treatment was 1.71± 0.84cm, 95%CI (1.50 to 1.91cm).
  • At the end of the course of chiropractic care these measurements reduced to 0.67 ± 0.65cm, 95%CI (0.50 to 0.83cm)
  • The mean change in the occipital measurement was a reduction of 1.13cm ± 0.89cm, p=0.000, 95%CI (-1.36 to -0.92cm), on average a 33% decrease in difference side to side.
  • Overall, 20 out of the 64 participants showed a full resolution of head deformation with a measurement difference below 0.4cm.” This is widely regarded as a normal, almost imperceptible difference.”
  • The remaining infants “showed a reduction in the Plagiocephaly measurement with a mean reduction of 1.13cm ± 0.89cm, p=0.000, 95% CI (-1.36 to -0.92cm)
  • That improvement was “both statistically and clinically significant and shows a percentage decrease of one third, and the improvement would be expected to continue with head growth, with the impediment to cervical range of motion removed.”
  • All participants (n=64) had full range of cervical motion restored following the course of chiropractic care.”
  • In addition to checking and adjusted according to the AECC protocol, the chiropractor also gave at-home instructions for tummy time.
  • There were no negative side effects or adverse events reported during the course of chiropractic care.

This was the result of an average of five adjustments over the six-week period, and results took into consideration the natural growth of the infant’s head over that time. Interestingly, all infants in this sample had cervical mobility restrictions. In interpreting the results, the researchers stated the following:

“Research has suggested when the infants neck has limited movement, the infant will have a preference for a particular side to turn as they are unable to turn equally to both right and left. These findings also support research that cervical restriction and Plagiocephaly are linked with neurological disruption and developmental delay due to factors associated with inactivity and variable tone. It is unlikely that the association with developmental delay is due to the head deformation, but more likely to be related to the poor movement patterns associated with it. This highlights the need for manual therapy to restore normal range of motion and beneficial movement [3].”

Of course, this type of study has its limitations. We are yet to see a large sized sample, and the lack of a control group due to ethics does represent a challenge. Still, the results are quite compelling. This is another piece of evidence that age-appropriate care for infants is not only safe but can be very beneficial, and that there is something we can do in addition to recommending tummy time.

Congratulations to the researchers at the Anglo-European College of Chiropractic for bringing us this piece of evidence in a fledgling area of study for chiropractic.

 

Reference

[1] Staff Writer, “Plagiocephaly – misshapen head,” Royal Childrens Hospital, 

[2] Staff Writer, 2017, “Epidemiology of Positional Plagiocephaly in Children,” International Society for Pediatric Neurosurgery,

[3] Douglas N, Browning M, Miller J (2016), “Chiropractic care for the cervical spine as a treatment for Plagiocephaly: a prospective cohort study,” Journal of clinical chiropractic pediatrics, Volume 15, No. 3, December 2016

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