The Effect of Age on the Rate of Correction in Infants with Head Shape Deformities Treated with Cranial Remolding Orthoses

Abstract

ABSTRACT Introduction Often, health care professionals question when the opportune time is to refer a child for cranial remolding treatment and at what age the child will have the best outcome. This study was designed to observe the rate of change of a cranial deformity when treated with a cranial remolding orthosis and how age affects that rate of correction. Materials and Methods A total of 670 participants with positional head deformities were included in this retrospective study. Participants were placed into three groups: plagiocephaly, brachycephaly, and asymmetrical brachycephaly. A medical record review was completed on each infant, and 200 of the 670 participants were excluded for conflicts with criteria. The STARscan for the remaining candidates (N = 470) were obtained in the office using the STARscanner™ system. Seventy-one of the remaining 470 participants were excluded for conflicts with the scan review criteria. Results A total of 398 participants were included in this retrospective study. Ninety-eight participants were categorized in the plagiocephaly group, 156 were categorized in the brachycephaly group, and 144 were categorized in the asymmetrical brachycephaly group. A rate of in-orthosis correction was calculated for each participant. Rate of change for plagiocephaly was calculated as initial CVAI − discharge CVAI) / length of treatment. This calculation provided an average improvement in cranial vault asymmetry index (CVAI) per day. Rate of change for brachycephaly was calculated as (initial cephalic ratio − discharge cephalic ratio) / length of treatment. This calculation provided an average decrease in cephalic ratio per day. For asymmetrical brachycephaly, rate of in-orthosis correction was obtained by finding both the average rate of change for CVAI and cephalic ratio. In addition, participants were separated into age groups and deformity type to more precisely understand the relationship and note any differences. Conclusions Each deformity type showed an increased rate of correction when treatment was initiated at a younger age. By quantitatively showing that the rate of correction decreases as the child age increases, we can provide valuable information on the opportune time to provide cranial remolding treatment. The results of this study show that the fastest rate of correction occurs when started at the age of 4 to 6 months and declines quickly as the child ages.