Loading...
The incidence of deformational plagiocephaly (abnormal head shape) has increased since introduction of the Back to Sleep campaign to prevent sudden infant death syndrome. Controversy exists about whether deformational plagiocephaly is associated with developmental delays and whether orthotic helmets are effective. Two studies try to shed light on these issues.
Researchers in New Zealand compared head shape and neurodevelopmental outcomes during infancy and at a mean age of 4 years in 129 children with positional head shape deformities who were referred to a specialty clinic and treated with repositioning techniques. At initial exams, head deformity (determined on the basis of two-dimensional measurements) was severe in 47% of children, moderate in 31%, and mild in 22%. At follow-up, 61% of children had head measurements in the normal range, and 13% had poor improvement (deformity was worse, still severe, or did not improve). Only 4% of children had persistent severe deformity, few had facial or frontal deformities, and all children with brachycephaly improved. Initially, 41% of children had one or more developmental delays, and 22% had two or more delays (based on parent report). At follow-up, 11% of children had one or more delays, and 4% had two or more delays (similar to the general population). Significantly more children with poor improvement in head shape had developmental delays than children with good improvement (29% vs. 8%). Concerns about head shape had resolved or lessened in 87% of parents.
Dutch investigators used three-dimensional whole-head surface scans to compare 70 infants with deformational plagiocephaly (mean age, 4.8 months) who were treated with helmets (23 hours/day) or active repositioning. Parents decided about type of treatment, children were matched for initial severity of deformity, and treatment duration was determined by parent and clinician satisfaction with outcomes (mean duration, 3 months for helmets and 5 months for repositioning). The helmeted group had significantly greater reductions in asymmetry than infants who were repositioned (maximum reductions, 4.0% vs. 2.5%; mean, 0.9% vs. 0.5%).
Hutchison BL et al. Deformational plagiocephaly: A follow-up of head shape, parental concern and neurodevelopment at ages 3 and 4 years. Arch Dis Child 2010 Sep 29; [e-pub ahead of print]. (http://dx.doi.org/10.1136/adc.2010.190934)
Lipira AB et al. Helmet versus active repositioning for plagiocephaly: A three-dimensional analysis. Pediatrics 2010 Oct; 126:e936.
Comment
In the first study, deformational plagiocephaly normalized or improved in 87% of children by age 4 without use of a helmet. Parental assessment of development and concerns about head shape also improved. The second study suggests that helmets are superior to repositioning on the basis of asymmetry measures. However, the study was not randomized, and developmental assessments were not performed. Further, parental assessment of head shape might be a better outcome measurement than direct measurements. Helmets for deformational plagiocephaly are “big business,” (helmets can cost as much as US$5000 and are rarely covered by insurance). Whether treatment with helmets is superior to repositioning remains uncertain.