• plagiocephaly
• orthosis
• physiotherapy
• positioning
• orthotics

The practice of head deformation by pressure to an infant's skull dates back to 2000 bc when the Ancient Egyptians used head binding to produce a cosmetically pleasing and fashionable skull shape.¹ With an increasing incidence of plagiocephaly (asymmetric skull) this practice, with a modern slant, is re-emerging. A simple web search resulted in five “paediatric offices” offering such a service. If an Ancient Egyptian walked into clinic today with their child's head bound between two planks of wood, we would be informing social services. Should we, as paediatricians, be advocating modern orthotic devices for plagiocephaly or condemning them?

Plagiocephaly can be subdivided into synostotic, where one or more sutures are fused, and nonsynostotic, or deformational, plagiocephaly. Surgical treatment of the synostotic variety is undisputed as the deformity is likely to progress and there is a significant risk of raised intracranial pressure. However the treatment of deformational plagiocephaly is more controversial.

There are no population based studies to establish the precise incidence or prevalence of deformational plagiocephaly, but the number of referrals to both paediatric and surgical units is increasing.^2–4

Posterior deformational plagiocephaly occurs more commonly on the right and there is a notable male predominance. The laterality may be in part a result of intrauterine position with 85% of vertex presentations lying on the left occipital anterior position. If the baby descends into the pelvis (fig 1), this may limit the growth of the right occiput and left frontal areas.^5,6 The asymmetry may be further exacerbated postnatally—when the child is laid supine, the head will automatically roll to the flattened side, which then becomes the preferred side for sleeping.

This hypothesis also explains the increase in incidence of posterior deformational plagiocephaly since the “Back to Sleep” recommendations for …