Dramatic rise in skull flattening in Texas babies

NEW YORK (Reuters Health) - The number of infants born with "flat-head" syndrome has risen dramatically in Texas - but is probably not cause for concern, according to a new study.

Between 1999 and 2007, the number of cases of plagiocephaly -- misshapen areas in the skull that most commonly manifest as a flattening at the back of the head - increased by more than 9-fold in the state.

To investigate why, Dr. Peter Langlois of the Texas Department of State Health Services and his colleagues reviewed entries in the state's official birth defects registry, looking for patterns.

The verdict? The change is probably simply a result of more cases being entered into the state's official birth defect registry, not necessarily an actual increase in plagiocephaly, Langlois told Reuters Health.

In Texas, registry staff track the number of birth defects by going through the records of hospitals, birthing centers, and midwife centers. It appears that more parents are bringing their children with plagiocephaly to hospitals for treatment, even for mild cases, perhaps because that's where specialists or particular treatments are located. These cases would then be added to the registry, Langlois explained.

"I'm pretty confident that the majority of what we're seeing is due to the Texas birth defects registry picking up kids with plagiocephaly better over time."

It's "very possible" that other states are noticing similar increases in official cases of plagiocephaly, Langlois noted, but he has not formally investigated. He and his colleagues decided to look more closely at Texas after an employee noticed a large increase in the registry.

Factors both before and after birth contribute to plagiocephaly. Crowding in the womb is a risk factor, for instance, with the problem being more common in twins and other multiples.

After birth, repetitive pressure on one area of an infant's head -- from repeatedly sleeping in the same position, or spending too much time in swings or "bouncy seats" -- can lead to plagiocephaly.

Since pediatricians began recommending that infants be put to sleep on their backs to lower the risk of sudden infant death syndrome (SIDS), studies have noted a rise in plagiocephaly. To counter that, experts generally recommend that infants get plenty of supervised "tummy time" when they are awake, and that parents avoid leaving them in carriers, swings or other seats for a prolonged period.

Treatment for plagiocephaly is often similar -- tummy time during waking hours and periodically turning the baby's head when he or she is sleeping, for instance. In some cases, infants are outfitted with a helmet that they wear for a few months to help reshape the skull as it grows.

It may be that more parents are choosing to use a helmet for their children, and that's only available at a hospital, Langlois noted, so cases that would simply have been handled by a pediatrician are now being picked up by the official birth defects registry, he said.

But it's not clear why more parents would be choosing to see specialists for the problem, the researcher said - it may be fueled by recommendations from primary care doctors, more marketing of treatments, or changes in insurance practice.

In addition, a small percentage of the increase in cases may stem from the 1992 recommendation that kids sleep on their backs - but is likely not the entire explanation, since the study period began 7 years later, Langlois noted. Plus, cases in 2007 were not diagnosed any later in life than those in 1999, which one would expect if the condition resulted from many nights of back sleeping, he said.

Reporting in the Archives of Pediatrics & Adolescent Medicine, he and his team found that the official rates of plagiocephaly increased from 3 cases for every 10,000 live births in 1999 to nearly 29 cases in 2007, an average increase of 21 percent per year.

To find possible explanations, the researchers scanned multiple factors that might be related - rates of multiple births, demographics, severity of the condition, and age of diagnosis, for instance.

Dr. Pedro Sanchez of the Children's Hospital Los Angeles, who did not participate in the study, agreed that the findings should not necessarily be worrying to parents.

Plagiocephaly is very common, he said, and most cases are not associated with any developmental issues in babies. "Most of the kids have no problem with their development, and most of the kids have a very good outcome when they get treated."

Sanchez added that the authors' explanation for the increase in official cases largely "does" make sense, but noted he was slightly concerned that the increase in referrals to specialists at hospitals may mean the condition is being diagnosed later, when simple stretches or basic interventions a pediatrician can handle are no longer as possible.

"It's a puzzle," said Langlois. "And we think we're only seeing part of the picture, but it's all we can see right now."

SOURCE: bit.ly/dZtV70 Archives of Pediatrics & Adolescent Medicine, online April 4, 2011.