Elsevier

The Journal of Pediatrics

Volume 146, Issue 2, February 2005, Pages 258-262
The Journal of Pediatrics

Original Article
Management of deformational plagiocephaly: Repositioning versus orthotic therapy

https://doi.org/10.1016/j.jpeds.2004.10.016Get rights and content

Objectives

We compare positioning with orthotic therapy in 298 consecutive infants referred for correction of head asymmetry.

Study design

We evaluated 176 infants treated with repositioning, 159 treated with helmets, and 37 treated with initial repositioning followed by helmet therapy when treatment failed. We compared reductions in diagonal difference (RDD) between repositioning and cranial orthotic therapy. Helmets were routinely used for infants older than 6 months with DD >1 cm.

Results

For infants treated with repositioning at a mean age of 4.8 months, the mean RDD was 0.55 cm (from an initial mean DD of 1.05 cm). For infants treated with cranial orthotics at a mean age of 6.6 months, the mean RDD was 0.71 cm (from an initial mean DD of 1.13 cm).

Conclusions

Infants treated with orthotics were older and required a longer length of treatment (4.2 vs 3.5 months). Infants treated with orthosis had a mean final DD closer to the DD in unaffected infants (0.3 ± 0.1 cm), orthotic therapy was more effective than repositioning (61% decrease versus 52% decrease in DD), and early orthosis was significantly more effective than later orthosis (65% decrease versus 51% decrease in DD).

Section snippets

Methods

Longitudinal data were collected on 298 consecutive normal infants, who were referred and treated for plagiocephaly at Cedars-Sinai Medical Center between January 1, 1994, and December 31, 2001. Cranial diagonal differences (DD) were compared before and after treatment. Institutional Review Board review was obtained to use anonymized patient care data. We compared size at birth and at the last treatment visit between the two sexes. Cranial diagonal measurements were taken by anthropometric

Results

The mean age of 298 infants treated for plagiocephaly was 5.4 months; the mean length of treatment was 4.3 months; 70% were boys; 68% were left-sided. Size differences between boys and girls were not significant (Table I). Among 176 infants treated with repositioning, the mean RDD was 0.55 cm (±0.33), from a starting mean DD of 1.05 cm at 4.8 months. In 159 infants treated with helmets, the mean RDD was 0.71 cm (±0.36), from a mean starting DD of 1.13 cm at 6.6 months. The final DD for

Discussion

Before 1992, anterior deformational plagiocephaly predominated when infants slept on their stomachs.14 Among supine-sleeping infants with torticollis, one side of their occiput (more commonly the right side) becomes flattened, resulting in posterior deformational plagiocephaly. The incidence of torticollis was 1.3% among 250,000 Hong Kong infants followed in a prospective study of 1086 patients with congenital muscular torticollis seen in one center over a 12-year period.8 Torticollis was more

References (28)

  • J.C.Y. Cheng et al.

    Clinical determinants of the outcome of manual stretching in the treatment of congenital muscular torticollis in infants

    J Bone Joint Surg

    (2001)
  • S. Moss

    Nonsurgical, nonorthotic treatment of occipital plagiocephaly: what is the natural history of the misshapen neonatal head?

    J Neurosurg

    (1997)
  • C.E. Ripley et al.

    Treatment of positional plagiocephaly with dynamic orthotic cranioplasty

    J Craniofac Surg

    (1994)
  • I. Pollack et al.

    Diagnosis and management of posterior plagiocephaly

    Pediatrics

    (1997)
  • Cited by (0)

    Supported by SHARE's Childhood Disability Center, the Steven Spielberg Pediatric Research Center, the Cedars-Sinai Burns and Allen Research Institute, the Skeletal Dysplasias NIH/NICHD Program Project Grant (HD22657-11), and the Medical Genetics NIH/NIGMS Training Program Grant (GM08243).

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