# Are we all seeing the same thing? Discrepancies between parent-reported and physician-reported positional plagiocephaly severity scores

## TL;DR

This study compares how parents and doctors rate the severity of head flattening in infants, finding some differences in their assessments.

## Contribution

The study provides empirical evidence of discrepancies in severity ratings between parents and physicians for positional plagiocephaly and brachycephaly.

## Key findings

- Providers and guardians showed similar median scores for plagiocephaly but significant differences for brachycephaly.
- Plagiocephaly was generally rated as mild, while brachycephaly ranged from mild to moderate severity.
- Statistical tests confirmed significant differences in brachycephaly ratings between providers and guardians.

## Abstract

Positional plagiocephaly (PP) and brachycephaly are conditions characterized by head flattening. There has been a sharp rise in the number of patients diagnosed since the American Academy of Pediatrics initiated the “Back to Sleep” policy to combat sudden infant death syndrome. This study compares providers’ and guardians’ perceived head shape differences, highlighting how these scores can alleviate parental anxiety.

A retrospective chart review was performed for all pediatric patients seen for a PP consult from January 2018 to November 2023. Fifty-nine patients (43 with plagiocephaly and 16 with brachycephaly) met the inclusion criteria, in which documentation recorded two severity scores, one rating each by the provider and parental guardian. Patient demographics, severity scores, and comorbidities were recorded. The institution utilized validated, qualitative assessment forms that evaluated plagiocephaly on a 15-point scale and brachycephaly on a 9-point scale.

For plagiocephaly, the providers and guardians rated severity with a median of 4 (IQR 3–4.5) and 4 (IQR 3–7), respectively (Wilcoxon signed rank test, p-value < 0.05). For brachycephaly, the providers and guardians rated severity with a mean of 3.59 (SD 1.28) and 4.69 (SD 1.66), respectively (paired T-test, p-value < 0.005).

Our study highlights the similarities in scores assessing clinical severity between providers and parents evaluated in a standardized, qualitative assessment for PP. On average, plagiocephaly reflected a “mild” severity, while brachycephaly reflected a “mild” to “moderate” severity on a graded scale. Future studies are needed to determine how patient-provider interactions may influence parents’ scores through shared decision-making.