Deformational Plagiocephaly Follow-up at 3 & 4 Years

Abstract

Research Article| July 01 2011 Deformational Plagiocephaly Follow-up at 3 & 4 Years AAP Grand Rounds (2011) 26 (1): 6. https://doi.org/10.1542/gr.26-1-6 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Deformational Plagiocephaly Follow-up at 3 & 4 Years. AAP Grand Rounds July 2011; 26 (1): 6. https://doi.org/10.1542/gr.26-1-6 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: plagiocephaly, nonsynostotic Source: Hutchison BL, Stewart AE, Mitchell EA. Deformational plagiocephaly: a follow-up of head shape, parental concern and neurodevelopment at ages 3 and 4 years. Arch Dis Child. 2011; 96(1): 85– 90; doi: https://doi.org/10.1136/adc.2010.190934Google Scholar Investigators from the University of Auckland, New Zealand, performed a longitudinal cohort study of children with positional deformations of the occipital skull to compare head shape measurements at 3 or 4 years of age with those from infancy, examine factors common to children whose head shapes had not improved, and evaluate the level of parental concern regarding the child’s head shape. All enrolled children were diagnosed with deformational plagiocephaly or brachycephaly in the only dedicated plagiocephaly clinic in the Auckland region and were at least 3.25 years of age during the followup period. Parents were counseled regarding positioning, and infants referred for physical therapy if indicated for torticollis; no child in the cohort was treated with banding/helmet therapy. Developmental outcomes were assessed using the Ages and Stages Questionnaire (ASQ), parental concern outcomes were based on a Likert scale, and cranial shape was assessed using the Cranial Index (CI) for brachycephaly deformation (bilateral occipital flattening) and Oblique Craniofacial Length Ratio (OCLR) for plagiocephaly (unilateral occipital flattening). The authors used a previously reported photographic and mathematical protocol1 to objectively evaluate head shape (“Heads Up”). Among the age-eligible patients followed at the clinic (n=220), 161 were study-eligible, and 129 (80% of study-eligible) were available for follow-up. Overall, 87% of patients showed substantial improvement. At initial presentation deformations were classified as 47% severe, 31% moderate, 22% mild, and 0% normal. At reevaluation, deformations were classified as 4% severe, 7% moderate, 28% mild, and 61% normal. Reductions in severity occurred in all groups, including some children with severe deformation who moved into the normal range. Only 6% of children had residual frontal/facial asymmetry. No child had residual torticollis. Children (n=10) who failed to progress at all or were worse at follow-up had unilateral occipital deformations (plagiocephaly rather than brachycephaly) with significantly higher OCLR measurements (x=109.2, SD=1.8, P=.02). Age-appropriate development was assessed with the ASQ which evaluates gross motor, fine motor, problem solving, personal-social, and communications skills. The cohort had significantly higher delays than expected at presentation and had reverted to the expected number of delays by follow-up. There was no difference in ASQ scores between the good and poor improvement groups at initial involvement, but at follow-up 29% of the poor improvement group exhibited delays as compared to only 8% in the good improvement group. These delays were primarily found on the communication domain of the ASQ. Parental concern decreased over the time interval. At presentation, 85% of parents were very concerned to somewhat concerned. At follow-up, 13% were concerned and 87% were not very or not at all concerned. The authors conclude that 87% of children with positional deformations of the occiput experienced improvement in the severity of deformation by treating with repositioning and physiotherapy. At... You do not currently have access to this content.