Unraveling How Craniofacial Conditions Affect Development

Speltz craniofacial story

By unraveling how craniofacial conditions affect childhood development, Dr. Matthew Speltz is dedicated to catching developmental problems earlier, when treatment could help children lead happier, more fulfilling lives.

Speltz, a psychologist and faculty member in the Center for Child Health, Behavior and Development, started researching craniofacial conditions more than two decades ago, when he studied how cleft lip and palate disorders affect mothers’ bonding to their infants with these anomalies. As this research drew more craniofacial patients to Speltz’s clinic, he suspected that craniosynostosis – a condition that occurs when the sutures (or seams) between a child’s skull bones fuse too early and stop the skull from expanding – was associated with children’s developmental delays.

“Clinical impressions and rumors suggested that craniosynostosis caused everything from learning disabilities to behavior problems,” Speltz says, “but no one knew if this was scientifically accurate.”

So he spearheaded the Child and Infant Learning Project, a large, longitudinal study that follows children with single-suture craniosynostosis (SSC), which occurs when just one of the skull seams fuses early. Speltz’s team found that children with SSC score lower than matched control group children on an infant IQ test called the Bayley Scales of Infant Development.

Now researchers are investigating whether these delays continue until the kids are school age. If they do, Speltz and his colleagues plan to test therapies that could prevent long-term problems.

Speltz is conducting similar research on patients with positional plagiocephaly, a skull deformation that often occurs when infants develop flat spots on the back of their heads. Plagiocephaly cases have skyrocketed since the 1980s, when doctors started advising parents to place infants on their backs to sleep as a way to prevent sudden infant death syndrome (SIDS), widely known as the Back to Sleep campaign.

In an interesting twist, Speltz thinks plagiocephaly might be caused by underlying motor skills problems in the early months of life. The idea is that children with these problems can’t easily reposition themselves, causing them to develop flat spots.

“We suspect that a subgroup of children have always had these motor problems but we didn’t pick up on them because they were sleeping in many different positions before the Back to Sleep campaign,” Speltz says. Speltz’s team found that infants and preschoolers with plagiocephaly are more likely to have mild developmental delays. Speltz is following a group of patients to see if these delays go away by the time they start school. If the delays persist, Speltz plans to test treatments that could overcome them.

A newer area of Speltz’s research looks into whether children who are put under anesthesia are at greater risk of developmental problems. By studying children who undergo craniosynostosis surgery, Speltz hopes to shed light on whether anesthesia exposure alters brain development.

Speltz takes particular delight in seeing his research make a tangible difference in patients’ lives. For instance, when he recently published a paper about SSC and developmental problems, Speltz got emails from parents around the country who wanted advice.

“It’s very gratifying to be able to answer those parents’ questions and give them more tools to help their kids,” he says. “That’s why I got into this research in the first place.”