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Research Spotlight: Cognitive Outcomes and Positional Plagiocephaly

Cognition and academic outcomes of children with and without Plagiocephaly and/or Brachycephaly

Who's Talking About This?

Today we are looking at the article: Outcomes and Positional Plagiocephaly. This article was published by Collett et al. (2019) in the Journal of American Academy of Pediatrics.

What Does This Article Say?

The researchers in this study found that school-aged children with moderate to severe positional plagiocephaly and/or brachycephaly (PPB) scored lower than children without PPB on cognitive and academic measures using the Differential Ability Scales assessment. Severity of PPB was measured using the Argenta Scale. The results of this standardized assessment during the research process were recorded as follows:

  • Significant differences among children with moderate to severe PPB for 8 out of 9 measures on Differential Ability Scales

  • Few differences were found in children with mild PPB

The researchers found that school-aged children who had moderate to severe PPB as infants had lower score on measures of cognition and academic achievement than children without PPB.

Researchers assert that PPB does not necessarily cause cognitive differences; rather, PPB might serve as a marker for developmental risk.

How Did Researchers Prove It?

187 school-aged children with a history of PPB and 149 school-aged children without a history of PPB (controls) were enrolled into this study. The researchers separated the children with a history of PPB into categories of (mild, moderate, and severe) and the control group. The children were originally assessed for PPB at 4-11months of age and then reassessed for cognitive and academic outcomes at 7 years old using the standardized Differential Ability Scales, Second Edition and Wechsler Individual Achievement Test, Third Edition, respectively.

What Does This Mean for My Baby?

This research strengthens the current recommendations that providing developmental assessment and intervention for infants with moderate to severe PPB would be beneficial for their future cognitive and neurodevelopmental outcomes.

This study found that the relationship of PPB and its effects on cognition and academic achievement is not causal, it is correlational. PPB could serve as a red flag for children that are having some disturbance in typical development and early motor learning is a prerequisite to successful classroom learning. This suggests that infants with PPB would benefit from skilled early intervention from occupational/physical therapy to ensure there is no delay in neurodevelopment.

What Does This Mean for Me As A Caregiver?

Does your baby have positional plagiocephaly? Take a deep breath! Plagiocephaly itself does not cause cognitive development delays and this correlation depends on severity and other factors.

This article is not meant to add stress, it is meant for parents to be empowered knowing the potential risks in cognitive development which allows you to be proactive in your baby’s care! If you are noticing delays, are unsure, or want another opinion, then speak with your pediatrician and see if there are ways to intervene early, promoting the best outcomes for your baby as they grow! For you the “let’s wait and see” method is not an option when you are armed with this information.

What Does This Mean for the Medical Community?

Healthcare providers should be cognizant of the potential “red flag” developmental associations with positional plagiocephaly and brachycephaly. This provides parents with the resources needed to promote the best cognitive and motor outcomes. Moderate to severe plagiocephaly does not cause developmental delays but the research does suggest it as a marker for developmental risk and should not be ignored (Collett, et al. 2019). Early intervention with therapy and helmets can help mitigate delays and should be determined based on each baby’s needs. Assessing PPB should be a part of a standard developmental evaluation.

Who Else Should Know About This?

Others who might benefit from knowing the potential developmental risks linked to positional plagiocephaly and brachycephaly would include other caregivers of your baby or toddler such as teachers, nannies, family/friends, and other healthcare professionals. Spreading your knowledge to those who are around your baby the most can help promote consistency in the continuum of care.

More Questions?

Do you have more questions about your baby’s development with plagiocephaly or brachycephaly after reading this blog? Head over to our Q and A brunch at our website at and post any and all of your questions! We like to think of this as a way for parents to get your questions answered in a supportive environment where others might be thinking the same thing! Connect with others about the helmet journey and know we are here to help in this process in any way we can!


Collett, B. R., Wallace, E. R., Kartin, D., Cunningham, M. L., & Speltz, M. L. (2019). Cognitive Outcomes and Positional Plagiocephaly. Pediatrics, 143(2).

Information prepared by Creighton University OTD Fieldwork Students

Special Thanks to Amy Eckert & Joe Della Lucia


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