Abstract
Purpose
As the incidence of deformational plagiocephaly (DP) has risen, so has the demand on clinicians to make appropriate treatment recommendations. While knowledge of risk factors and natural history continue to evolve, there is uncertainty and controversy regarding intervention approaches. The purpose of this report is to review current treatment approaches for DP, in particular the use of orthotic helmets.
Methods
A narrative literature review was conducted to summarize current evidence supporting preventative measures and re-positional and orthotic interventions.
Results
When started early at under 2 months of age, positional efforts and ‘tummy time’ can be effective in preventing and improving DP, but these strategies need to be better promoted to caregivers. The timing, severity and parental concerns as indicators for orthotic treatment are reviewed. Limitations discussed include high cost, lower level of evidence and poor understanding of long-term outcomes and caregiving implications.
Conclusion
For optimal outcome, current evidence supports use of repositioning in young infants and start of orthotic helmet treatment for infants with significant DP at 4–6 months. Further research is needed to better understand the parameters for use (stratified by age and severity), long-term outcomes and natural history and the impact on caregiving, as well as the cultural significance of head shape.
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References
American Academy of Pediatrics (1992) Positioning and SIDS. Pediatrics 89:1120–1126
Argenta LC, David LR, Wilson JA, Bell WO (1996) An increase in infant cranial deformity with supine sleeping position. J Craniofac Surg 7:5–11
Kane AA, Mitchell LE, Craven KP, Marsh JL (1996) Observations on a recent increase in plagiocephaly without synostosis. Pediatric 97:877–885
Turk AE, McCarthy JG, Thorne CHM, Wisoff JH (1996) The “back to sleep campaign” and deformational plagiocephaly: is there cause for concern? J Craniofac Surg 7:12–18
McKinney CM, Cunningham ML, Holt VL, Leroux B, Starr JR (2008) Characteristics of 2733 cases diagnosed with deformational plagiocephaly and changes in risk factors over time. Cleft Palate–Craniofac J 45:208–216
Losee JE, Mason AC (2005) Deformational plagiocephaly: diagnosis, prevention, and treatment. Clin Plastic Surg 32:53–64
Rogers GF (2011) Deformational plagiocephaly, brachycephaly, and scaphocephaly. Part I: terminology, diagnosis, and etiopathogenesis. J Craniofac Surg 22:9–16
Hutchison BL, Stewart AW, Mitchell EA (2009) Characteristics, head shape measurements and developmental delay in 287 consecutive infants attending a plagiocephaly clinic. Acta Paediatr 98:1494–1499
Rubio AS, Griffet JR, Caci H, Bérard E, Hayek TE, Boutté P (2009) The moulded baby syndrome: incidence and risk factors regarding 1,001 neonates. Eur J Pediatr 168:605–611
McKinney CM, Cunningham ML, Holt VL, Leroux B, Starr JR (2009) A case–control study of infant, maternal and perinatal characteristics associated with deformational plagiocephaly. Pediatric Perinat Epidemiol 23:332–345
Oh AK, Hoy EA, Rogers GF (2009) Predictors of severity in deformational plagiocephaly. J Craniofac Surg 20(Supplement 1):685–689
Sheu SU, Ethen MK, Scheuerle AE, Langlois PH (2011) Investigation into an increase in plagiocephaly in Texas from 1999 to 2007. Arch Pediatr Adolesc Med 165:708–713
Steinbok P, Lam D, Singh S, Mortenson PA, Singhal A (2007) Long-term outcome of infants with positional occipital plagiocephaly. Childs Nerv Syst 23:1275–1283
Hutchison BL, Stewart AW, Mitchell EA (2011) Deformational plagiocephaly: a follow-up of head shape, parental concern and neurodevelopment at ages 3 and 4 years. Arch Dis Child 96:85–90
Cavalier AC, Picot MC, Artiago C et al (2011) Prevention of deformational plagiocephaly in neonates. Early Hum Dev 87:537–543
Losee JE, Mason AC, Dudas J, Hua LB, Mooney MP (2007) Nonsynostotic occipital plagiocephaly: factors impacting onset, treatment, and outcomes. Plast Reconstr Surg 119:1866–1873
Rogers GF, Oh AK, Milliken JB (2009) The role of congenital muscular torticollis in the development of deformational plagiocephaly. Plast Reconstr Surg 123:643–652
Littlefield TR, Kelly KM, Reiff JL, Pomatto JK (2003) Car seats, infant carriers, and swings: their role in deformational plagiocephaly. J Prosthet Orthot 15:102–106
Robinson S, Proctor M (2009) Diagnosis and management of deformational plagiocephaly. J Neurosurg Pediatr 3:284–295
Van Vlimmeren LA, van der Graaf Y, Boere-Boonekamp MM, L'Hoir MP, Helders PJM, Engelbert RHH (2008) Effect of pediatric physical therapy on deformational plagiocephaly in children with positional preference. Arch Pediatr Adolesc Med 162:712–718
Kennedy E, Majnemer A, Farmer JP, Barr RG, Platt RW (2009) Motor development of infants with positional plagiocephaly. Phys Occup Ther Pediatr 29:222–235
Zachary AH, Kitzmann KM (2011) Caregiver awareness of prone play recommendations. Am J Occup Ther 65:101–106
Jennings JT, Sarbaugh BG, Payne NS (2005) Conveying the message about optimal infant positions. Phys Occup Ther Pediatr 25:3–18
Rogers GF, Miller J, Mulliken JB (2008) Comparison of a modifiable cranial cup versus repositioning and cervical stretching for the early correction of deformational posterior plagiocephaly. Plast Reconstr Surg 121:941–947
Hutchison L, Stewart AW, de Chalain TB, Mitchell EA (2010) A randomized controlled trial of positioning treatments in infants with positional head shape deformities. Acta Pediatr 99:1556–1565
Hutchison L, Stewart A, Mitchell E (2007) Infant sleep position, head shape concerns, and sleep positioning devices. J Paediatr Child Health 43:243–248
Clarren SK, Smith DW, Hanson JW (1979) Helmet treatment for plagiocephaly and congenital muscular torticollis. J Pediatr 94:43–46
Bridges SJ, Chambers TL, Pople IK (2002) Plagiocephaly and head binding: orthotic devices do not improve plagiocephaly. Arch Dis Child 86:144–145
Lee A, Van Pelt AE, Kane AA et al (2010) Comparison of perceptions and treatment practices between neurosurgeons and plastic surgeons for infants with deformational plagiocephaly. J Neurosurg Pediatr 5:368–374
Ripley CE, Pomatto J, Beals SP, Joganic EF, Manwaring KH, Moss SD (1994) Treatment of positional plagiocephaly with dynamic orthotic cranioplasty. J Craniofac Surg 5:150–159
de Ribaupierre S, Vernet O, Rilliet B, Cavin B, Kalina D, Leyvraz (2007) Posterior positional plagiocephaly treated by cranial remodelling orthosis. Swiss Med Wkly 137:368–372
Loveday BPT, de Chalain TB (2001) Active counterpositioning or orthotic device to treat plagiocephaly? J Craniofac Surg 12:308–313
Pollack IF, Losken HW, Fasick P (1997) Diagnosis and management of posterior plagiocephaly. Pediatric 99:180–185
Rogers GF (2011) Deformational plagiocephaly, brachycephaly, and scaphocephaly. Part II: prevention and treatment. J Craniofac Surg 22:17–23
Kluba S, Kraut W, Reinert S, Krimmel M (2011) What is the optimal time to start helmet therapy in positional plagiocephaly? Plast Reconstr Surg 128:492–498
Xia JJ, Kennedy KA, Teichgraeber JF, Wu KQ, Baumgartner JB, Gateno J (2008) Nonsurgical treatment of deformational plagiocephaly: a systematic review. Arch Pediatr Adolesc Med 162:719–727
Kelly KM, Littlefield TR, Pomatto JK, Manwaring KH, Beals SP (1999) Cranial growth unrestricted during treatment of deformational plagioceaphly. Pediatr Neurosurg 30:193–199
Department of Health and Human Services: Food and Drug Administration (1998) Neurological devices; classification of cranial orthoses-FDA. Final rule. Fed Regist 63:40650–40652
McGarry A, Dixon MT, Greig RJ, Hamilton DRL, Sexton S, Smart H (2008) Head shape measurement standards and cranial orthoses in the treatment of infants with deformational plagiocephaly. Dev Med Child Neurol 50:568–576
Thompson JT, David LR, Wood B, Argenta A, Simpson J, Argenta LC (2009) Outcome analysis of helmet therapy for positional plagiocephaly using a three-dimensional surface scanning laser. J Craniofac Surg 20:362–365
Graham JM, Gomez M, Halberg A et al (2005) Management of deformational plagiocephaly: repositioning versus orthotic therapy. J Pediatr 146:258–262
Moss SD (1997) Nonsurgical, nonorthotic treatment of occipital plagiocephaly: what is the natural history of the misshapen head? J Neurosurg 87:667–670
Saeed NR, Wall SA, Dhariwal DK (2008) Management of positional plagiocephaly. Arch Dis Child 93:82–84
Gill D, Walsh J (2008) Plagiocephaly, brachycephaly and cranial orthotic devices: misshapen heads and helmets. Arch Dis Child 93:805–807
Singh A, Wacogne I (2008) What is the role of helmet therapy in positional plagiocephaly? Arch Dis Child 93:807–809
Lipira AB, Gordon S, Darvann TA et al (2010) Helmet versus active repositioning for plagiocephaly: a three dimensional analysis. Pediatric 126:e936–e945
Schaaf H, Malik CY, Streckbein P et al (2010) Three-dimensional photographic analysis of outcome after helmet treatment of a nonsynostotic cranial deformity. J Craniofac Surg 21:1677–1682
Bialocerkowski AE, Vladusic SL, Howell SM (2005) Conservative interventions for positional plagiocephaly: a systematic review. Dev Med Child Neurol 47:563–570
Govaert B, Michels A, Colla C, ven der Hulst R (2008) Molding therapy of positional plagiocephaly: subjective outcome and quality of life. J Craniofac Surg 19:56–58
Pomatto JK, Calcaterra J, Kelly KM, Beals SP, Manwaring KH, Littlefield TR (2006) A study of family head shape: environment alters cranial shape. Clin Pediatr 45:55–63
Lekovic GP, Baker BJ, Lekovic JM, Preul MC (2007) New world cranial deformational practices: historical implications for pathophysiology of cognitive impairment in deformational plagiocephaly. Neurosurgery 60:1137–1147
Ayers A, Campbell A, Appelboom G et al (2010) The socio-political history and physiological underpinnings of skull deformities. Neurosurg Focus 29(E1):1–6
Romero-Vargas S, Ruiz-Sandoval JL, Sotomayor-Gonzales R et al (2010) A look at Mayan artificial cranial deformation practices: morphological and cultural aspects. Neurosurg Focus 29(E2):1–6
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Mortenson, P., Steinbok, P. & Smith, D. Deformational plagiocephaly and orthotic treatment: indications and limitations. Childs Nerv Syst 28, 1407–1412 (2012). https://doi.org/10.1007/s00381-012-1755-3
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DOI: https://doi.org/10.1007/s00381-012-1755-3