Bad Science in the Baby Shop: Baby Pillows

I recall seeing one of these in a baby catalogue when I was pregnant and thinking it was one of the ridiculous things I had ever seen. Then I saw a recent study that had come out on them and thought they might be worth a closer look.

What it prevents
Developmental plagiocephaly is a condition where the infants skull is deforming due to forces acting on their soft cranium, primarily due to an infant spending the majority of its time in the same position. As head growth is most rapid in the first three months, it develops quickly particularly and generally peaks about 4 months.  Since the back to sleep campaign for SIDS began the incidence of developmental plagiocephaly has increased by 407%. Current occurrence rate is about 20%.
Some baby pillows sellers will attempt to overemphasize the link between developmental plagiocephaly and other developmental problems 1. Although there has been a connection found this is likely due to the babies with developmental problems developing plagiocephaly because of problems with movement. There is no evidence saying that plagiocephaly causes developmental problems 2.

First a warning
Most of these pillows indicate they should not be used after 4 months, this is in exact. Pillows should not be used after 4 months because on average this is when babies begin to roll. A baby that can roll onto their front or side should never be left with a pillow. They should also not be used if you are placing your baby onto its front or side to sleep.
Many of these pillows are also made of memory foam. Memory foam is considered to be more dangerous for babies than soft fabrics.
SIDS guidelines do not recommend the use of positioning devices at all  3.

The Science
A recent randomised control study 4 reported that there was a significant decrease in scores of cranial deformation in the group that received the pillow versus the group without them, they did not report on how large an effect this was.
They did report that perfect headshape was found in 29% of infants in the intervention group versus 11% outside of it but did not report on whether this difference was significant.  They also reported that 20% had significant plagiocephaly but did not report the split, so it is reasonable to assume that at least some of these babies were recieving the intervention.
Interestingly, they reported that babies who recieved the intervention but used it imperfectly (slept in car seat, used only at night time, had trouble staying on the pillow) had increased ratings of cranial deformaty.  Of the 44 babies in the intervention group, there were 12 babies who encountered these problems in using the pillow. This indicates that although the pillow is effective it is only effective when used every time the baby sleeps and 25% of the subjects in a clinical trial were unable to use it effectively. This does not speak well for its real world applicability.

Conclusion
Although the pillow may be able to help prevent plagiocephaly, it appeared to be the conclusion of the researchers that there were other better ways to do so (they certainly devoted more time to explaining those in their paper and discussing those differences than discussing the findings in regards to the pillow).
The pillow alone is likely insufficient in preventing plagiocephaly considering that many of those who used it had some degree of cranial deformity. There are other methods to prevent plagiocephaly, may of which are considered advantagous for baby's brain and muscle development. These include:

• Giving tummy time from birth more than three times a day
• Not allowing baby to spend time only on their back but instead alternating holding them on their back with holding them on their front and on their side
• Alternating the side of the cot that the baby is laid down in
• Alternating the side that the baby turns its head when sleeping
• If baby has a strong preference for turning head to one side, using a wedge (under the mattress) to encourage them to turn to the other side
• Avoiding prolonged periods in carseats, strollers, swings and bouncers
• Alternating the side the baby is held in when feeding
• Carrying and cuddling baby in upright positions

Most babies will naturally grow out of plagiocephaly as they become more active.

The study showed that the pillow was effective if used with every sleep. However this pillow was made of a soft material and not memory foam. The main baby head rest sold in Australia the Mije baby head rest is made of memory foam and has no clinical data to back up its efficacy.

So to summarise:
  - Effective if used perfectly
  - No more effective than other methods
  - Possibly detrimential if overused e.g. allows baby to spend too long lying on back
  - Expensive (starting price is $40)
  - Possibly dangerous

Based on all of this my opinion has not much changed from my initial reaction. A ridiculous product that prays on parents fear and lack of knowledge.