Motor Function in School-Aged Children With Positional Plagiocephaly or Brachycephaly.

This was an observational cohort, so it shows an association between infant PPB history and later motor scores, not that PPB caused the motor differences. The authors state that early motor deficits may make PPB more likely, meaning PPB may be a marker of developmental risk rather than a cause. Families who did not participate were lower in socioeconomic status, more likely to have had moderate-severe PPB in infancy (90% vs 72% among participants), and more likely to have had developmental delays as infants or toddlers (53% vs 38% among participants). The study did not adjust P values for multiple comparisons, so some significant differences need replication. The sample did not include specific measures of muscle tone or range of motion, so the authors could not test whether those factors explain the motor differences. Many children with PPB had received occupational or physical therapy, and the rate may have been influenced by feedback from the research assessment, but the study could not examine treatment type, timing, or intensity. BOT-2 scores were lower than expected for both groups, possibly due to examiner stringency or fatigue, although the same order was used for cases and controls.

The authors declared no conflicts of interest. The article is listed as supported by NIH extramural funding.

Do not read this as proof that positional skull deformation causes later motor problems or that helmet treatment improves them. The study was observational, and the authors suggest PPB may be a marker of early motor vulnerability rather than a cause.