From the Guidelines
Plagiocephaly, also known as positional plagiocephaly, is a condition characterized by asymmetrical flattening of the skull, typically presenting in infants [ 1 ].
Causes and Risk Factors
The condition is often associated with a supine sleeping position [ 1 ], and can be exacerbated by factors such as:
- Limited time in awake, supervised tummy time [ 1 ]
- Infrequent changes in head position during sleep [ 1 ]
- Developmental delay and/or neurologic injury [ 1 ]
Prevention and Management
Prevention strategies include:
- Supervised, awake tummy time to facilitate development and minimize the risk of positional plagiocephaly [ 1 ]
- Avoiding excessive time in car seats and changing the infant's orientation in the crib [ 1 ] Management of plagiocephaly may involve conservative measures, such as physical therapy and repositioning techniques, as well as orthotic treatment with custom-molded helmets [no specific evidence provided]. It is essential to note that the incidence of plagiocephaly decreases spontaneously from 20% at 8 months to 3% at 24 months of age in healthy, normal children [ 1 ].
From the Research
Definition and Diagnosis of Plagiocephaly
- Plagiocephaly is an asymmetric deformation of the skull, which can be caused by various factors such as first birth, assisted labor, multiple pregnancy, prematurity, congenital muscular torticollis, and position of head 2.
- The condition can be diagnosed clinically and by physical examinations, with the simplest way to assess the severity being the use of a diagonal caliper to measure the difference between the diagonal lengths on each side of the head 2.
- Diagnosis can also involve skull radiographs and computed tomography to determine whether the lambdoidal sutures are patent 3.
Treatment Options for Plagiocephaly
- Treatment for plagiocephaly can be either surgical or conservative, with conservative treatments being recommended for positional plagiocephaly not accompanied by craniosynostosis 2.
- Conservative treatments involve a variety of methods, including change of positions, physiotherapy, massage therapy, and helmet therapy 2, 4, 5.
- Helmet therapy can be an effective second-line intervention in cases of moderate or severe plagiocephaly, and is most effective when started between 4 and 7 months of age 4, 6.
- Physical therapy treatment, including manual therapy, is considered the first line of intervention in plagiocephaly with non-synostotic asymmetries 5.
Risk Factors and Prognosis
- Risk factors for plagiocephaly include a preference for the supine position, first and assisted delivery, multiple pregnancy, prematurity, and congenital muscular torticollis 2, 3, 6.
- The prognosis for plagiocephaly is generally favorable, with most infants experiencing complete correction with conservative or helmet therapy 3, 4, 6.
- Early treatment is essential for optimal therapeutic outcomes, and counseling of parents or caregivers can help prevent the condition 5, 6.