What patient handouts are recommended for infants with plagiocephaly?

Patient Education Materials for Plagiocephaly

Provide parents with comprehensive written education covering repositioning techniques, supervised tummy time, and physical therapy exercises, as this educational intervention is the foundation of treatment and reduces both prevalence and severity of plagiocephaly. 1, 2, 3

Essential Content for Patient Handouts

Safe Sleep and Prevention Strategies

• Continue back-sleeping for all infants to prevent SIDS, as the benefits vastly outweigh cosmetic concerns about head shape 2
• Instruct parents to alternate the infant's head position daily (right side one day, left side the next) during sleep to prevent asymmetric pressure 2, 3, 4
• Emphasize that supervised, awake tummy time is mandatory both for preventing plagiocephaly and facilitating normal motor development 2, 4
• Educate parents to hold the infant upright when awake rather than leaving them supine in car seats, swings, or bouncy chairs 2
• Explicitly warn against positioning pillows or soft devices in the sleeping environment, as these violate AAP safe sleep guidelines and increase SIDS risk 1, 2

Reassurance About Natural History

• Explain that plagiocephaly has no consequences on brain development and improves dramatically with time 2
• Share that incidence decreases spontaneously from 20% at 8 months to 3% at 24 months in healthy children, so most cases resolve without intervention 2
• Clarify that the condition became more common after the 1992 "Back to Sleep" campaign, which successfully reduced SIDS deaths but increased positional head flattening 2, 5

Physical Therapy Instructions

• Physical therapy is superior to repositioning education alone for infants 7 weeks or older, with Level I evidence supporting this recommendation 1, 6
• Handouts should include specific exercises for torticollis if present, as cervical imbalance is causally related to plagiocephaly development 3
• Provide detailed instructions for creating a nonrestrictive environment that promotes spontaneous physical movement and symmetrical motor development 3
• Include visual diagrams showing proper positioning techniques during feeding, carrying, and play to encourage head turning toward the non-flattened side 1, 3

Treatment Timeline and Expectations

• Inform parents that repositioning education is effective for virtually all infants with mild to moderate plagiocephaly, though improvement takes time 1
• Explain that helmet therapy corrects asymmetry more rapidly (typically 3 months) than conservative measures alone for moderate to severe cases 1, 2
• Clarify that helmet therapy is reserved for persistent moderate to severe deformity after 2-3 months of physical therapy, or for older infants presenting with significant asymmetry 6, 7
• Note that earlier treatment with helmets achieves better correction, and older infants require longer treatment duration 7

Common Pitfalls in Patient Education

• Avoid dismissing parental concerns by simply stating "it will get better with time" without providing specific repositioning instructions, as early intervention is more effective 3
• Do not recommend positioning pillows even if parents request them, as they contradict safe sleep guidelines despite comparable efficacy to physical therapy 1
• Never delay referral to physical therapy while waiting to see if repositioning alone works in moderate cases, as physical therapy has Level I evidence of superiority 1, 6
• Avoid telling parents that infants over 12 months are "too old" for treatment, as evidence shows correction occurs within similar timeframes regardless of age at presentation 8

Key Educational Messages

• Emphasize that treatment success depends on consistent implementation of positioning strategies throughout the day, not just during sleep 2, 3
• Explain that clinical examination by an experienced provider is sufficient for diagnosis, and imaging is rarely necessary unless craniosynostosis is suspected 1, 2
• Reassure parents that 81.6% of cases achieve correction to normal head shape with appropriate treatment, regardless of initial severity 8
• Stress that early educational intervention reduces both prevalence and severity at 3 months, making parental engagement critical 3