Connected Paediatrics

Deformational Plagiocephaly: The Case for an Evolutionary Mismatch feat. Dr Renz Polster


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The paper we’re talking about is called “Deformational Plagiocephaly: The case for an Evolutionary Mismatch” by Dr. Renz-Polster and Prof Freia de Bock. Up until reading this piece of work, my thoughts on the matter were, in line with most who have read the Plagiocephaly literature. That the development of Plagiocephaly and Brachycephaly have to do with external pressures being applied to the developing skull and it involves certain risk factors born out in the research, such as being male, limited neck rotation, preference in head position, first born child, lower activity levels and lack of tummy time).  

 

If you search the literature, In the first paragraph of the background section of most reviews, editorials and publications on the subject, reference is made to the fact that the incidence of deformational plagiocephaly has shot up in the last 25 years which neatly co-incides with the introduction of the ‘back to sleep campaign’  in western countries around which began around 1992. This is the campaign that saw medical science pushing to have kids sleep on their backs because the data that was being accumulated at the time showed that the supine sleep position markedly decreased the incidence of SIDS. So the abiding expert theory is that more kids sleeping supine (safe) equalled more flattened skulls because of course more gravitational forces being placed on soft devepling cranial bones which, on the surface makes sense, the timing is rather plausible although most literature will add the caveat that causality has not strictly been proven.

 

As good as this reasoning sounds However, as we will hear in second the Doc has 2 major issues with this theory. One being the fact that his own systematic review didn’t bear these statitics out and secondly that, in evolutionary terms, it does not make sense that sleeping in a safe position (like being supine) should result in an alteration of head shape that would affect the childs Kindchenschema

 

The paper takes a critical look at how our western lifestyle differs from the traditional especially in the realms of feeding, transport and sleep and how these factors could been hidden confounders in the Plagiocephaly epidemic we see today.

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Connected PaediatricsBy Dr Mike Marinus