The apparent prevalence of plagiocephaly has increased in recent years as indicated by referrals to paediatricians, neurosurgeons and craniofacial surgeons for advice and management.1 For the purposes of this article, we are referring to posterior deformational plagiocephaly (PDP) as shown in fig 1 and deformational brachycephaly (DB) as shown in fig 2. Synonyms used to describe PDP are shown in box 1. PDP is seen more frequently on the right side, has a male preponderance and is related to intrauterine position. Increasing foetal size may be a contributory factor. The asymmetry of PDP is frequently accentuated postnatally by the infant’s preference of sleeping on the flattened side.

The problem of PDP has been increased by the “back to sleep” programme for the prevention of sudden infant death syndrome (SIDS).2 3 This has resulted in noticeable DB (fig 2) and accentuation of PDP. We were unable to find current population figures on the incidence of either PDP or DB. PDP is asymmetrical, while DB is symmetrical. PDP is present at birth, while DB is acquired as a result of a supine sleep position.

Companies promoting cranial orthotic devices (CODs) are active on the internet and in the lay press, and one company had a stand at the RCPCH meeting in York in 2008. It would appear that CODs are being widely promoted and used in the USA. At least six companies and orthotists are providing a service in the UK, with some trusts providing CODs on the NHS. The most balanced and informative internet site is, in our opinion, that of Great Ormond Street Hospital.4

In an effort to inform ourselves on current practice, in 2006 we sent a …