By Joanna Clark Nottingham

Putting babies to sleep in the supine position, as recommended by the international "Back to Sleep" cot death prevention campaign, causes positional plagiocephaly, claims the American Academy of Pediatrics (AAP) in a report published by Pediatrics (2003;112:199-202).

According to the academy, flattening of the occiput may result from static supine positioning during the first months of life, when the skull is still soft. The deformation may affect as many as 48% of healthy infants less than 1 year of age, and cases have increased notably in number since 1992, after it was recognised that sleeping prone increases the risk of cot death.

Positional plagiocephaly does not affect brain function or development and often corrects itself by 1 year of age, but some cases may persist into adulthood.

Cot death remains the leading cause of death in babies aged between 1 month and 1 year, and clinicians at the AAP stress that parents should continue to put their babies to sleep lying on their backs. Positional plagiocephaly may be prevented by alternating head position and vantage point relative to the door.