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Research Article: Prognostic factors for cranial deformities in infancy: a retrospective cohort study

Date Published: 2026-06-25

Abstract:
This study aimed to investigate the prognostic factors on the natural recovery time of positional cranial deformities in infants. A retrospective cohort study was conducted including 1,219 infants diagnosed with positional cranial deformities who attended the Children's Health Development Center of our hospital on at least two occasions between January 2022 and April 2025. The cohort comprised 228 preterm infants and 991 full-term infants. Cranial parameters, including cranial vault asymmetry (CVA), cranial vault asymmetry index (CVAI), and cephalic ratio (CR), were measured using the STARscanner 2.0 system. Median recovery time was estimated using survival analysis. The effects of age, sex, gestational age at birth, maternal age, birth weight, cranial shape, and severity of deformity on recovery time were evaluated using multivariate proportional hazards Cox regression analyses. Multivariate analysis demonstrated that age was an independent predictor of natural recovery (hazard ratio?=?0.44, P <?0.001), with younger age exhibiting a significantly faster recovery. Deformity severity was a key determinant, as infants with mild deformities recovering significantly faster than those with severe deformities ( P <?0.001). In contrast, sex and cranial shape were not significantly associated with recovery time. Younger age at diagnosis and milder deformity severity were associated with a higher likelihood and faster rate of natural recovery from positional cranial deformities in infants. Enhanced follow-up and targeted management are recommended for infants diagnosed at an older age at diagnosis and for those presenting with more severe deformities in clinical practice.

Introduction:
Infantile positional cranial deformity, characterized by asymmetrical head shape in infants, is manifested as differences in the height and width of the head or skull, and may be accompanied by abnormalities in facial structures, such as the ears or eyes ( 1 ). Studies indicate that the overall incidence of cranial deformities in infants is approximately 13% ( 2 ). Recently, the American Academy of Pediatrics has recommended that parents adopt the “supine sleeping position” for their infants ( 3 ). With the…

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