Advertisement

Child's Nervous System

, Volume 23, Issue 11, pp 1275–1283 | Cite as

Long-term outcome of infants with positional occipital plagiocephaly

  • Paul SteinbokEmail author
  • David Lam
  • Swati Singh
  • Patricia A. Mortenson
  • Ashutosh Singhal
Original Paper

Abstract

Background

Despite much interest in positional (deformational) plagiocephaly, the natural history is unclear. The purpose of this study was to determine cosmetic and developmental outcomes at a minimum of 5 years of age in children diagnosed in infancy with positional plagiocephaly (PP) and the impact of cranial orthotic use.

Methods

A questionnaire survey was sent to parents of children diagnosed with PP in infancy and now aged more than 5 years. A retrospective review of the child’s clinic chart was performed of consenting families, and prospective follow-up was done when families agreed to return for assessment.

Results

Of 278 eligible children with plagiocephaly, questionnaires were completed by 65 parents, and 27 brought their child for assessment. Participants and nonparticipants were similar. Cranial orthoses were used in 18 of 65 children. Parents perceived the cosmetic appearance of their child as “very abnormal” in 2, “mildly abnormal” in 25, and “normal” in 38. Residual asymmetry was noted by parents in 58%, but only 21% were concerned about appearance. In the last year, 7.7% of children commented about asymmetry of head, and 4.6% were teased occasionally. Thirty-three percent had received learning assistance, and 14% were in a special class. Long-term outcomes, as perceived by the parent or child, were no different between children with and without orthosis use.

Conclusions

The results allow better counselling of parents about outcome of infants with PP, reducing anxiety, and allowing more rational selection of management modality.

Keywords

Occipital plagiocephaly Positional plagiocephaly Outcome Headband Orthotic Counter-positioning 

References

  1. 1.
    Aliberti F, Pittore L, Ruggiero C, Cinalli G, Maggi G, Loveday BP, de Chalain TB, Vles JS, Colla C, Weber JW, Beuls E, Wilmink J, Kingma H, Boere-Boonekamp MM, van der Linden-Kuiper LL, David DJ, Menard RM, Pollack IF, Losken HW, Fasick P (2002) The treatment of the positional plagiocephaly with a new thermoplastic orthotic device. Childs Nerv Syst 18:337–339PubMedGoogle Scholar
  2. 2.
    Bialocerkowski AE, Vladusic SL, Howell SM (2005) Conservative interventions for positional plagiocephaly: a systematic review. Dev Med Child Neurol 47:563–570PubMedCrossRefGoogle Scholar
  3. 3.
    Boere-Boonekamp MM, van der Linden-Kuiper LL (2001) Positional preference: prevalence in infants and follow-up after two years. Pediatrics 107:339–343PubMedCrossRefGoogle Scholar
  4. 4.
    Bridges SJ, Chambers TL, Pople IK (2002) Plagiocephaly and head binding. Arch Dis Child 86:144–145PubMedCrossRefGoogle Scholar
  5. 5.
    Bruner TW, David LR, Gage HD, Argenta LC (2004) Objective outcome analysis of soft shell helmet therapy in the treatment of deformational plagiocephaly. J Craniofac Surg 15:643–650PubMedCrossRefGoogle Scholar
  6. 6.
    Budreau G (1989) The perceived attractiveness of preterm infants with cranial molding. J Obstet Gynecol Neonatal Nurs 18:38–44PubMedCrossRefGoogle Scholar
  7. 7.
    Elwood ET, Petronio J, Wood RJ (2005) Parental satisfaction with the CranioCap: a new cranial orthosis for deformational plagiocephaly. Cleft Palate Craniofac J 42:340–343PubMedCrossRefGoogle Scholar
  8. 8.
    Graham JM Jr, Gomez M, Halberg A, Earl DL, Kreutzman JT, Cui J, Guo X (2005) Management of deformational plagiocephaly: repositioning versus orthotic therapy. J Pediatr 146:258–262PubMedCrossRefGoogle Scholar
  9. 9.
    Hellbusch JL, Hellbusch LC, Bruneteau RJ (1995) Active counter-positioning treatment of deformational occipital plagiocephaly. Nebr Med J 80:344–349PubMedGoogle Scholar
  10. 10.
    Huang MH, Gruss JS, Clarren SK, Mouradian WE, Cunningham ML, Roberts TS, Loeser JD, Cornell CJ (1996) The differential diagnosis of posterior plagiocephaly: true lambdoid synostosis versus positional molding. Plast Reconstr Surg 98:765–774; discussion 775–766PubMedCrossRefGoogle Scholar
  11. 11.
    Hutchison BL, Hutchison LA, Thompson JM, Mitchell EA (2004) Plagiocephaly and brachycephaly in the first two years of life: a prospective cohort study. Pediatrics 114:970–980PubMedCrossRefGoogle Scholar
  12. 12.
    Kordestani RK, Patel S, Bard DE, Gurwitch R, Panchal J (2006) Neurodevelopmental delays in children with deformational plagiocephaly. Plast Reconstr Surg 117:207–218; discussion 219–220PubMedCrossRefGoogle Scholar
  13. 13.
    Lee WT, Richards K, Redhed J, Papay FA (2006) A pneumatic orthotic cranial molding helmet for correcting positional plagiocephaly. J Craniofac Surg 17:139–144PubMedCrossRefGoogle Scholar
  14. 14.
    Littlefield TR, Kelly KM, Pomatto JK, Beals SP (1999) Multiple-birth infants at higher risk for development of deformational plagiocephaly. Pediatrics 103:565–569PubMedCrossRefGoogle Scholar
  15. 15.
    Littlefield TR (2004) Cranial remodeling devices: treatment of deformational plagiocephaly and postsurgical applications. Semin Pediatr Neurol 11:268–277PubMedCrossRefGoogle Scholar
  16. 16.
    Littlefield TR, Saba NM, Kelly KM (2004) On the current incidence of deformational plagiocephaly: an estimation based on prospective registration at a single center. Semin Pediatr Neurol 11:301–304PubMedCrossRefGoogle Scholar
  17. 17.
    Losee JE, Mason AC (2005) Deformational plagiocephaly: diagnosis, prevention, and treatment. Clin Plast Surg 32:53–64, viiiPubMedCrossRefGoogle Scholar
  18. 18.
    Loveday BP, de Chalain TB (2001) Active counterpositioning or orthotic device to treat positional plagiocephaly? J Craniofac Surg 12:308–313PubMedCrossRefGoogle Scholar
  19. 19.
    Miller RI, Clarren SK (2000) Long-term developmental outcomes in patients with deformational plagiocephaly. Pediatrics 105:E26PubMedCrossRefGoogle Scholar
  20. 20.
    Mortenson PA, Steinbok P (2006) Quantifying positional plagiocephaly: reliability and validity of anthropometric measurements. J Craniofac Surg 17:413–419PubMedCrossRefGoogle Scholar
  21. 21.
    Moss SD (1997) Nonsurgical, nonorthotic treatment of occipital plagiocephaly: what is the natural history of the misshapen neonatal head? J Neurosurg 87:667–670PubMedGoogle Scholar
  22. 22.
    Mulliken JB, Vander Woude DL, Hansen M, LaBrie RA, Scott RM (1999) Analysis of posterior plagiocephaly: deformational versus synostotic. Plast Reconstr Surg 103:371–380PubMedCrossRefGoogle Scholar
  23. 23.
    O’Broin ES, Allcutt D, Earley MJ (1999) Posterior plagiocephaly: proactive conservative management. Br J Plast Surg 52:18–23PubMedCrossRefGoogle Scholar
  24. 24.
    Panchal J, Amirsheybani H, Gurwitch R, Cook V, Francel P, Neas B, Levine N (2001) Neurodevelopment in children with single-suture craniosynostosis and plagiocephaly without synostosis. Plast Reconstr Surg 108:1492–1498; discussion 1499–1500PubMedCrossRefGoogle Scholar
  25. 25.
    Persing J, James H, Swanson J, Kattwinkel J, American Academy of Pediatrics Committee on P, Ambulatory Medicine SoPS, Section on Neurological S (2003) Prevention and management of positional skull deformities in infants. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery. Pediatrics 112:199–202PubMedCrossRefGoogle Scholar
  26. 26.
    Pollack IF, Losken HW, Fasick P (1997) Diagnosis and management of posterior plagiocephaly. Pediatrics 99:180–185PubMedCrossRefGoogle Scholar
  27. 27.
    Pople IK, Sanford RA, Muhlbauer MS (1996) Clinical presentation and management of 100 infants with occipital plagiocephaly. Pediatr Neurosurg 25:1–6PubMedCrossRefGoogle Scholar
  28. 28.
    Rekate HL (1998) Occipital plagiocephaly: a critical review of the literature. J Neurosurg 89:24–30PubMedCrossRefGoogle Scholar
  29. 29.
    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; discussion 160PubMedCrossRefGoogle Scholar
  30. 30.
    St John D, Mulliken JB, Kaban LB, Padwa BL (2002) Anthropometric analysis of mandibular asymmetry in infants with deformational posterior plagiocephaly. J Oral Maxillofac Surg 60:873–877PubMedCrossRefGoogle Scholar
  31. 31.
    Teichgraeber JF, Seymour-Dempsey K, Baumgartner JE, Xia JJ, Waller AL, Gateno J (2004) Molding helmet therapy in the treatment of brachycephaly and plagiocephaly. J Craniofac Surg 15:118–123PubMedCrossRefGoogle Scholar
  32. 32.
    Vles JS, Colla C, Weber JW, Beuls E, Wilmink J, Kingma H (2000) Helmet versus nonhelmet treatment in nonsynostotic positional posterior plagiocephaly. J Craniofac Surg 11:572–574PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Paul Steinbok
    • 1
    • 2
    Email author
  • David Lam
    • 1
  • Swati Singh
    • 1
  • Patricia A. Mortenson
    • 3
  • Ashutosh Singhal
    • 1
  1. 1.Division of Neurosurgery, Department of SurgeryUniversity of British ColumbiaVancouverCanada
  2. 2.Division of Paediatric NeurosurgeryVancouverCanada
  3. 3.Department of Occupational TherapyChildren’s and Women’s Health Centre of British ColumbiaVancouverCanada

Personalised recommendations