Positional plagiocephaly is characterized by cranial asymmetry and can be the result of prolonged uneven pressure on the developing skull. Extrauterine causes include extended time in the supine position, one-sided feeding, or insufficient tummy time. Beyond cosmetic concerns, it can affect visual, auditory, dentofacial, and speech development. Following the "Back-to-Sleep Campaign," prevalence rose to 16% to 22.1% in 6-week-old infants ( Iran J Child Neurol. 2022;16(2):85-92). Despite its extensive impact on development and finances, many caregivers and parents lack awareness, underscoring the need for improved education and prevention strategies. In this 2-arm, partially blinded randomized controlled trial (June 2022 to April 2025) at UMass Memorial Medical Center, we compared standard care to an educational intervention for plagiocephaly prevention. The primary outcome was cephalic index (CI), measured at 2, 4, and 6 months, with higher values indicating greater deformity. Secondary outcomes included parent-reported adherence to prevention strategies. Group comparisons used unpaired t tests and difference-in-difference models. A total of 109 subjects were enrolled (intervention, 62; control, 47). The average CI differed significantly between groups at the 4-month mark (control, 89.84; intervention, 86.91; P = 0.05). Difference-in-difference analysis did not yield statistically significant results at any time point, but all intervention groups had a lower average CI. Survey data assessing parental adherence to plagiocephaly prevention behaviors showed a significant difference at 4 months (control, 15.87; intervention, 13.75; P = 0.03), with no significant differences at 2 or 6 months. The intervention was associated with reduced cranial deformation, reaching statistical significance by 4 months. This correlated with better parental compliance, suggesting early education as an effective preventive strategy.

Association between cranial morphology and dysgnathias in adolescents and adults: A prospective case-control study.

BACKGROUND:Prevalence of deformational plagiocephaly (DP) has increased since the “Back to sleep” campaign to counter sudden infant death syndrome. Cranial remolding orthosis (CRO) is commonly used to manage severe DP in infants, yet evidence from randomized controlled trials (RCT) remains limited.OBJECTIVES:This pilot RCT aimed to assess the feasibility of a future large-scale RCT on cranial remolding orthosis for severe DP in infants aged 4 to 7 months. Specific objectives included evaluating recruitment, retention, coordination, and parental acceptability. A secondary objective was exploring trends in cranial shape outcomes between groups over 6- and 12-week periods.METHODOLOGY:Seventy-eight infants were screened at a single pediatric tertiary-care center between December 2023 and June 2024, and 31 families were approached for consent after initial clinical evaluation. Following consent, head shape severity was assessed using three-dimensional surface imaging, and seven infants were excluded prior to randomization due to insufficient severity. Twenty-four infants were randomized to receive immediate (n = 12) or delayed (six-week delay) (n = 12) CRO. One participant randomized to the delayed arm received the orthosis earlier than planned due to a protocol deviation. Feasibility metrics included recruitment timelines, protocol adherence, appointment coordination, and parental acceptability. Exploratory efficacy analyses evaluated cranial vault asymmetry (CVA), cranial vault asymmetry index (CVAI), oblique diameter diagonal difference (ODDI), cranioproportional index (CI), Argenta severity scores, and parent-reported head shape perception and satisfaction.FINDINGS:Of the 24 randomized infants, 20 were male and four were female. Mean age at enrollment was 5.3 ± 0.9 months in the intervention arm and 5.1 ± 0.9 months in the control arm. Recruitment and retention targets were met within seven months despite scheduling challenges. Parental satisfaction was high (mean score of 4.5 ± 0.1 on a 5-point scale), and all families reported willingness to repeat treatment despite common but minor side effects, including sweating, orthosis odor, and mild skin irritation. Significant improvements over time were observed in CVA, ODDI, and CI (all p < 0.001), with no significant between-group differences observed at 6 or 12 weeks.CONCLUSION:This pilot trial confirmed the feasibility and acceptability of conducting a larger RCT on CRO for DP, demonstrating successful recruitment, retention, and protocol implementation. Cranial symmetry improved over time in both groups, with no statistically significant differences observed between immediate and delayed treatment arms over the 12-week period. Future larger studies are needed to assess clinical effectiveness and should consider broader inclusion criteria, refined measurement techniques, and dedicated coordination to address scheduling challenges and ensure rigorous implementation and generalizability.

Background: Helmet therapy is considered to be a treatment for infants with positional plagiocephaly. Although some studies suggest that anterior fontanelle (AF) size may also affect treatment outcomes, evidence and influence remain unclear. The aim of this study is to assess the impact of anterior fontanelle size on the effectiveness of helmet therapy, with the goal of determining the optimal timing and patient criteria for treatment. Methods: We conducted a retrospective study of 94 infants treated with helmet therapy for positional plagiocephaly at Kwangju Christian Hospital between January 2020 and December 2021. Patients were divided into two age groups (≤6 months and >6 months) and three SAF quartiles (≤25%, 25-75%, ≥75%). Parameters reflecting the degree of cranial asymmetry correction, including cranial vault asymmetry (CVA) and cranial vault asymmetry index (CVAI), were recorded at the start and end of treatment. Results: Infants aged ≤6 months showed significantly greater improvements in cranial vault asymmetry (CVA) and cranial vault asymmetry index (CVAI) compared to older infants (CVA: 4.57 ± 2.30 mm vs. 7.04 ± 3.85 mm, p = 0.003; CVAI: 3.10 ± 1.55% vs. 4.45 ± 2.44%, p = 0.011). When analyzed by anterior fontanelle (AF) size quartiles (≤25%, 25-75%, ≥75%), no significant differences in treatment outcomes were observed at the end of therapy for CVA (p = 0.88) or CVAI (p = 0.91). In infants ≤6 months, SAF quartile analysis also showed no significant differences in CVA (p = 0.97) or CVAI (p = 0.98) improvements. Conclusions: Our findings indicate that anterior fontanelle size is not a predictor of helmet therapy outcomes in positional plagiocephaly. Early initiation of helmet therapy (≤6 months) remains the most critical factor for achieving optimal results.

Diffusion magnetic resonance imaging has emerged as an opportunity to explore brain white matter fiber tracts (WMFTs) through 3D digital reconstruction. This method could be useful in investigating the relationship between positional plagiocephaly and developmental problems; however, this has not been fully explored. Evaluate WMFTs of healthy infants in two age groups with a range of positional plagiocephaly from normal to severe. This exploratory study, conducted at a free-standing, quaternary pediatric hospital in the Northeastern United States, utilized an existing database of healthy infants' MRIs obtained between 1 month and 4 months of age. MRIs were included if deemed good quality and had complete T1- and diffusion-weighted sequences and excluded if there were measurement disagreements or MRI data processing problems. Positional plagiocephaly severity was calculated using the Cranial Vault Asymmetry Index (CVAI). A repeated-measures regression model was constructed to assess the association of positional plagiocephaly severity with WMFTs fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). Median age of 18 infants was 64.5 (IQR 71) days at the time of MRI. FA had a negative association with CVAI overall (β±SE=-0.53±0.51% per unit CVAI, P=0.32) and in both age groups. MD and RD had a positive association with CVAI overall (β±SE=1.31±0.46% per unit CVAI, P=0.013; β±SE=1.54±0.54% per unit CVAI, P=0.012) and in both age groups and all pathways. As the severity of positional plagiocephaly increases, differences in WMFT formation are observed, suggesting the need for longitudinal studies with cognitive and behavioral assessments.

IntroductionHelmet treatment is a worldwide acknowledged method to improve motor function, quality of life and aesthetics in patients with plagiocephaly.Research questionThe objective of this study is to assess percentile escape in head circumference in newborns receiving helmet therapy (HMT) for plagiocephaly.Material and methodsAll patients underwent HMT over 124.32 days on average (SD = 72.56), with 3D scans (Rodin4D neo) taken of their heads before, during and after the treatment. Eight participants were excluded due to insufficient data. Ten patients were excluded for either craniosynostosis or discontinuation of helmet therapy.“German Health Interview and Examination Survey for Children and Adolescents” (KiGGS study) served as reference for the assessment of head circumference growth. Percentiles were calculated using the LMS-method.ResultsOut of 272 patients (94 females, 178 males), 238 had suitable parameters for the LMS-method. The average age at the onset of therapy was 5.99 (SD = 2.23) months, concluding at 10.06 months (SD = 3.01). The median percentile before HMT was 50.00 (SD = 39.5), which decreased significantly to 25.00 (SD = 33.84) after HMT (p < 0.001). Only 59 patients showed percentile adherence during the treatment. The mean difference in head circumference was 21.51 mm (SD = 14.81), ranging from −44.4 mm to 69.1 mm. Clinical examination revealed that the patients exhibit developmental progress consistent with respective ages.Discussion and conclusionSignificant decrease in head circumferential growth was observed following HMT. Even though patients did not show clinical signs of raised ICP, to ascertain the clinical relevance of this percentile escape, conducting longer follow-ups involving a larger cohort of patients is crucial.

Deformational plagiocephaly is a head deformity in newborns that can be treated in some cases with cranial remodeling orthoses that constrain head growth to reshape it. To mitigate complications arising from the treatment with these orthoses, and for the exploration of novel functionally graded lattice structures, a biological model that mimics some aspects of human head growth could provide a development and testing platform for these lattices. In this work, we propose a novel biological model of infant heads in which watermelons are used for the study of cranial remodeling orthoses during head growth and the correction of deformities. First, we reshaped ten watermelons with infant head shapes with deformities via custom molds, which were generated from MRI scans of infants with head deformities. The shaped watermelons were subsequently compared with the original head scans to assess the accuracy of the process via standard clinical measurements. Finally, the growth of four of these watermelon shapes was monitored after the molds were left for several days. The watermelon head shapes registered an average shape difference from the original models of 1.6 millimeters, with a standard deviation of 1.88 millimeters. After leaving the molds, the shapes continued growing, maintaining the ability to be reshaped by external physical constraints. By mimicking two key mechanical aspects of head growth in newborns — growth and deformability — this preliminary approach to a biological phantom offers a promising platform for studying the mechanical behavior of novel lattice structures in the development of cranial remodeling orthoses.

HighlightsWhat are the main findings?Helmet therapy significantly reduces head deformity of infants with deformational plagiocephaly.Wearing the helmet for at least 6 h per day during sleep improves head shape.Low helmet compliance (0–5 h/day) results in no improvement or deterioration, whereas all patients with high compliance (≥18 h/day) demonstrate improvement.What is the implications of the main findings?Early initiation of helmet therapy and good compliance, particularly nighttime use, is strongly encouraged to enhance the effectiveness of helmet therapy.Background/Objectives: Deformational plagiocephaly (DP) is defined as an asymmetrical flattening of infants’ occipital skull. Helmet therapy is one of the treatments reported that can reduce skull deformity by guiding the growing direction of the head. However, its effectiveness remains insufficiently validated in the literature due to variability in treatment protocols and regimes. This study aims to evaluate the clinical outcomes of helmet therapy in infants with deformational plagiocephaly. Methods: This single-center retrospective study was conducted at a tertiary university hospital and included 30 consecutive infants (mean age 7.83 ± 2.51 months) who attended a pediatric orthopedic outpatient clinic between 2022 and 2025. Infants without craniosynostosis and with cranial vault asymmetry index (CVAI) ≥ 5% were prescribed a course of helmet therapy (mean duration 3.77 ± 2.37 months). The primary outcome was the change in CVAI. Results: The mean CVAI (%) significantly decreased from 7.57 ± 2.45 to 6.10 ± 2.63 (p = 0.002). The effect of helmet therapy was dose-dependent, with greater improvement observed in infants wearing the helmet for at least 6 h per day. Poor compliance and predominantly daytime helmet use were associated with less improvement. Increased sweating and mild skin redness were the most common reported adverse effects, but the skin redness can be relieved by proper donning of the helmet. Conclusions: Helmet therapy is effective for infants with plagiocephaly when initiated early and with high compliance of helmet use. Greater improvements were observed in infants using the helmet during sleeping. Further multi-center studies with a larger sample size and longer follow-up are recommended.

The incidence of positional skull deformities in infants has increased following campaigns promoting supine sleeping to reduce SIDS. Although various measurement methods exist to quantify cranial asymmetries, discrepancies between direct anthropometry, 3-dimensional photogrammetry, and plagiocephalometry may lead to differing severity classifications and treatment indications. Comparison of the available measurement protocols is crucial to harmonize assessment of these deformities. To prospectively compare 3 measurement techniques-caliper-based (spreading caliper and measuring tape), 3D photogrammetry, and plagiocephalometry-for evaluating cranial deformity in early infancy, to assess their reproducibility and their individual impact on clinical decision-making. In a prospective study, 51 infants aged 3 to 12 months were examined during an outpatient "helmet consultation." Each infant underwent measurements using: (1) standardized direct anthropometry (caliper and tape measurement), (2) 3D photogrammetry with a multicamera system and subsequent semiautomated analysis via the Software Cranioform Analytics 4.0, and (3) plagiocephalometry (PCM) using a thermoplastic strip technique and indirect measurement. Key indices-the cephalic index (CI) and cranial vault asymmetry index (CVAI) (or ODDI for plagiocephalometry)-were calculated. For PCM, a variance component analysis was performed to assess inter- and intraobserver variability. Bland-Altman analyses were used to compare CI and CVAI/ODDI values among the methods, treatment cutoffs were evaluated. Since reproducibility for caliper measurements was already tested for inter- and intraobserver variability, this method was defined "gold standard" at our center. The treatment threshold for this analytical method was a CVA ≥ 1.0cm. 3D photogrammetry-with a treatment cutoff at values above the 97th percentile of normative values-demonstrated excellent reproducibility with minimal bias (systematic error in CI of -0.77), whereas plagiocephalometry-with predefined cutoffs-exhibited a slightly higher bias in CI (-1.35). Cranial vault asymmetry index values varied-also due to differing calculation methods described in the available literature. Variance component analysis of plagiocephalometry indicated interobserver and intraobserver contributions below 3%. Discrepancies in measurement planes, angles, and index calculation furthermore led to differences in treatment indications: caliper screening identified more infants with an indication for orthotic treatment for deformational plagiocephaly than did the other 2 methods. While all 3 techniques provide valuable information, caliper measurement remains a rapid, cost-effective, and fast screening tool. Subsequent evaluation with 3D photogrammetry is recommended for treatment planning. Plagiocephalometry-although provided with high intra- and interrater reliablity-offers no significant advantages in daily practice. Standardization of measurement landmarks and definition of index calculation is needed to internationally standardize and harmonize clinical decision-making.

Background Positional plagiocephaly (PP) is a common cranial asymmetry of infancy. Its treatment options include conservative management and helmet therapy. However, the efficacy of each, particularly at achieving a normal cranial shape, remains uncertain.Purpose This study aimed to compare the efficacy of conservative management and helmet therapy for PP.Methods We retrospectively analyzed 199 infants with PP treated in 2015–2024. A total of 72 patients with a minimum treatment duration of 90 days and minimum plagiocephaly severity level of 2 (Children's Healthcare Atlanta Plagiocephaly Severity Scale) were included. Of them, 36 received conservative management and 36 received helmet therapy. Each infant underwent three-dimensional surface scanning of the cranium (StarScanner).Results The mean±standard deviation age at treatment initiation was 31.9±6.6 weeks in the helmet group versus 21.0±5.7 weeks in the conservative management group (P<0.001). The average treatment duration was 21.9 (interquartile range [IQR], 15.3–31.4) weeks vs. 20.6 (IQR, 14.1–26.6) weeks (P=0.171), respectively. The monthly correction speed of the cranial vault asymmetry index (CVAI) was comparable between groups (0.66±2.09 vs. 0.64±0.55, P=0.964). Plagiocephaly degree was reduced to level 1 in 9 of 36 patients (25%) who received helmet therapy versus 4 of 36 patients (11%) in the conservative management group (P=0.220), whereas a reduction in severity level was observed in 24 of 36 (67%) versus 15 of 36 (42%), respectively (P=0.058). In the helmet group, an earlier treatment initiation was significantly associated with a greater severity level reduction (r=-0.480, P=0.003). A longer treatment duration showed a trend toward a greater reduction in CVAI (r=0.331, P=0.052). In the conservative management group, both earlier treatment initiation (r=-0.537, P<0.001) and longer treatment duration (r=0.381, P=0.022) correlated significantly with improved outcomes.Conclusion Conservative management and helmet therapy reduced cranial asymmetry with no significant difference in correction speed. An early treatment initiation was the strongest predictor of improvement, while a longer treatment duration was associated with better outcomes. A trend toward a greater reduction in severity level was observed with helmet therapy, suggesting its potential benefits in more severe cases.

To assess the agreement between severity level classifications of plagiocephaly using measurement of the difference between transcranial diagonals (DTD) and the Cranial Vault Asymmetry Index (CVAi), based on different references found in the literature. Observational study conducted with 50 babies with a possible diagnosis of plagiocephaly. Diagnosis and cranial measurements were obtained through 3D cranial scanning. The cranial measurements selected for the study were DTD (in cm) and CVAi (in %), which determined, according to different classification systems, the severity level of the asymmetry as absent, mild, moderate, or severe. Three different classification references using DTD and four using CVAi were applied to determine severity, and agreement between classifications were analyzed using the κ index. Agreement between the classifications using DTD and CVAi measurements ranged from weak to moderate across all references found in the literature. All analyses were statistically significant. Findings suggest that there may be conflicts and discrepancies in classifying the deformity as mild, moderate, or severe, which can lead to different clinical treatment decisions.

HighlightsWhat are the main findings?Cranial remolding orthoses (CROs) are an effective, evidence-backed treatment for isolated deformational plagiocephaly in infants.Treatment efficacy has a negative relationship with infant age and severity rating, highlighting the need for earlier referrals to optimize treatment outcomes.What is the implication of the main finding?This study provides useful information to pediatric health care providers regarding the significant clinical efficacy of CROs in treating plagiocephaly.Study findings help guide pediatric health care providers in the referral process by highlighting the main factors that impact CRO treatment outcomes in infants.Background/objectives: The purpose of this study was to examine the overall efficacy and treatment outcomes of CROs in the treatment of isolated deformational plagiocephaly and investigate the variables that influence treatment efficacy. Methods: This was a 10-year retrospective review of N = 27, 990 infants with Isolated Deformational Plagiocephaly (IDP) who completed Cranial Remolding Orthosis (CRO) treatment between 3 and 18 months of age. Results: There was a significant overall mean change in CVAI(S) of −3.42 ± 0.011 (p < 0.001), and a significant improvement in CVAI(S) in all age groups, even in older babies (i.e., >11 months). Up to 96% of infants aged 4–6 months at initiation of treatment achieved a “good” or “great” outcome rating, and up to 77.6% of infants over 11 months exited with a similar outcome. The following were identified as significant predictors of greater change in CVAI(S): (1) younger entry age (p < 0.001, β = 0.01), (2) larger initial CVAI(S) scores (p <0.001, β = −0.43), (3) left plagiocephaly (p < 0.001, β = −0.36), and (4) and the absence of torticollis (p < 0.001, β = −0.17). Conclusions: CROs are an effective, research-supported treatment for IDP. Pediatric health care providers and parents should be aware of the efficacy of CRO therapy across age groups and severity ratings, the risk factors that may influence CRO outcomes, and the benefits of an early referral at a young age.

Deformational Plagiocephaly (DP) is the most common cranial deformity in infants. It may be treated using molding cranial helmet therapy (CHT) or active counter-positioning (ACP). Molding CHT has proven to be highly effective, especially in moderate to severe cases. Although many studies have explored this topic, few have investigated the use of 3D-printed CHT. This method may offer greater accuracy and convenience in measurement compared to traditional helmet types. Furthermore, no studies on this subject have been conducted in the Middle East. A retrospective study design. Electronic medical records from the only medical center fitting infants with 3D-printed CHT were reviewed. Infants diagnosed with DP who were fitted with and completed treatment using 3D-printed CHT were included. Infants who received 3D-printed CHT for other cranial deformities were excluded. Descriptive statistics (mean ± SD) were used to present results related to Cranial Vault Asymmetry Index (CVAI) and participants' characteristics. A Linear Mixed Model was used to assess changes in CVAI over time, accounting for age, gender, and treatment duration. Model assumptions were tested, and findings were validated using a Wilcoxon signed-rank test. Records of eleven infants diagnosed with DP were included, eight boys and three girls. A significant reduction in CVAI was reported in all cases. No significant correlation was found between CVAI improvement and gender, age, or treatment duration. Following treatment with customized 3D-printed CHT, infants in the study demonstrated significant improvement in the CVAI. The helmets effectively guided cranial growth toward the flattened area, aiding in the correction of the deformity. Although 3D-printed CHT showed results comparable to traditional molding CHT, it offers potential advantages such as increased measurement accuracy through 3D scanning, easier monitoring of progress, and reduced cost and time associated with fabrication through 3D printing.

Deformational plagiocephaly (DP), a distortion of a baby's head shape due to sleeping position, can cause ear malposition, facial asymmetry, and malocclusion. Helmet therapy only surfaced as a recommended treatment in severe cases. However, the number of patients who have grown up with severe deformities without treatment has increased. It is unclear whether these deformities spontaneously resolve during growth. This study investigated the incidence of examining cranial deformities in patients seeking facial contour surgery. Patients presenting with facial asymmetry, jaw deformity, or other facial concerns were included. Complaints were categorized as malar asymmetry, lateral malar protrusion, or anterior malar protrusion. DP was classified using the Argenta system based on cone-beam CT images. Among patients with malar asymmetry (n=32), Type IV deformities were most frequent (84.4%), followed by Type I (12.5%) and Type II (3.1%). Anterior protrusions (n=19) comprised Type I (47.4%), Type II (42.1%), and Type IV (10.5%), whereas lateral protrusions (n=47) included Type II (51.1%), Type I (40.4%), and Type IV (6.4%). Type IV malar asymmetry was significantly prevalent (P<0.05). Severe untreated craniofacial deformities may persist by impacting facial structures including the cheeks and jaw. These findings suggest that untreated severe DP in infancy can cause residual facial deformities, thereby highlighting the importance of early intervention to avoid severe distortion.

This study aimed to investigate whether cranial shape measurements obtained immediately after birth can be used to determine the timeline and mechanisms underlying the development and progression of cranial deformities in healthy infants. This study examined the cranial geometry of normal newborns immediately after birth at Nihon University Itabashi Hospital and Kasukabe Medical Center. Measurements were obtained using stereophotogrammetry and 3-dimensional cranial data were analyzed using image analysis software. According to international criteria, positional deformational plagiocephaly (PDP) was identified at a cranial vault asymmetry index >3.5%, whereas positional brachycephaly was identified at a cephalic index ≥81%. These data were compared with those from a previously reported database of 1-month-old infants. A total of 130 newborns with a mean gestational age of 39 weeks, a mean birth weight of 3075 g, a mean head circumference of 33.5 cm, and a male sex ratio of 48.5% were included. The mean age at measurement was 3.3 days. The prevalence of PDP and positional brachycephaly was 19.2% and 86.2%, respectively. No notable differences in the background characteristics were observed between the PDP and non-PDP groups. The mean cephalic index was significantly lower in breech fetuses (P = .015), with no significant differences between the delivery methods. The symmetry-related parameters of cranial deformities were more pronounced at 1 month than at birth, with a substantially higher median cranial vault asymmetry index of 4.9% and 2.1%, respectively (P < .01). The prevalence of PDP increased significantly from 19.2% at birth to 66.1% at 1 month of age. Our findings suggest that cranial deformities become more pronounced within the first month after birth. Prevention at an early stage will be the focus of future research.

BackgroundCranial orthosis is a widely accepted treatment approach for moderate to severe deformational plagiocephaly. Custom-fit helmets molded tightly to the head are worn for 23 hours a day for several months2. This poses a challenge for children with concurrent conductive hearing loss who benefit from hearing devices, specifically bone anchored hearing aids (baha), that are intended to contact the skull directly1. We theorized the bone conducted signals could be transferred through the helmet to the baha device given its tight fit to the cranium.MethodsThis is a pilot study in which we present a case report of three patients in whom baha with headbands were used over their helmet therapy. Feedback management settings were adjusted to account for this. Given the age and development of the children, aided testing was performed.ResultsGood aided benefit was seen with using baha placement over the helmet. Optimal results were achieved with placement of the processor on the flat section of the helmet near the ear pinna. One patient, however, did not tolerate stimulus well and the baha was discontinued. For the other two patients, the baha over the helmet was utilized until they completed helmet therapy. Baha program settings were re-measured/adjusted when the device was used without the helmet. Parents reported positive responses when their child was wearing the baha compared to without.ConclusionPlacement of the baha with headband over a molding helmet is an important alternative method for patients with concurrent deformational plagiocephaly and conductive hearing loss. This modification allows for earlier baha implementation to facilitate auditory and language development, and minimize communication delays, while permitting optimal head reshaping without compromising speech development or head shape.

Among infants with any degree of positional plagiocephaly, do cranial molding helmets serve as a more effective treatment than conservative therapy?

Regarding the therapy for positional plagiocephaly, adistinction is made between physiotherapeutic-osteopathic treatment and treatment using individual head orthoses. This retrospective study aimed to compare the outcome of these treatment modalities for correcting positional plagiocephaly in infants. From an initial pool of 148 patients, two groups were matched based on age, sex, and Argenta classification. Therapy was either helmet therapy in combination with physiotherapeutic-osteopathic therapy (experimental group/95patients) or physical therapy alone (control group/28patients). The helmet was worn 23 h per day and adjusted if necessary. Aphoto-optical scan was performed pretherapeutically (T0) and posttherapeutically (T1). Besides other parameters, cephalic index (CI) and 30° diagonal difference (DD) were assessed and evaluated statistically. The mean age was 5.4 ± 1.1months in the experimental group and 5.1 ± 1.0months in the control group. The sex ratio in the experimental group was 61males (64.2%) to 34females (35.8%), and in the control group, it was 19males (67.9%) to 9females (32.1%). After alignment of the groups, the range of correction of DD in the control group (-0.4 mm ± 2.3 mm) was lower than that in the experimental group (-4.8 mm ± 2.8 mm) which was statistically significant (p = 0.001). The control group presented an average CI reduction from T0 to T1 of 0.1% ± 2.1%, while the experimental group showed asignificantly higher reduction of CI of 3.6% ± 3.6% (p < 0.001). Treatment time in the helmet therapy group averaged 2.2 ± 0.6months, and in the control group, it averaged 1.6 ± 0.5months (p < 0.001). In the matched groups, the reduction in CI and DD was significantly greater in the experimental group compared to the control group. Treatment with an individual head orthosis for positional plagiocephaly appears to be more effective than physical treatment alone.

PURPOSE: Positional plagiocephaly (PP) is commonly encountered by medical professionals, but less has been studied about public perception and understanding. This study aims to elucidate public understanding of PP, treatment options, and safe practices as it relates to various demographics. METHODS: A compensated Amazon Mechanical Turk (MTurk) survey was distributed to adults in the United States. Demographics, knowledge of PP, perceptions of infants in molding helmets, and decisions made in their own children’s PP management was gathered. Descriptive analysis and Chi-Square analysis were performed. RESULTS: 482 surveys were completed. Respondents were majority white (76%), male (65%), and age 30-40 (63%). Most were parents (99%) and had children with PP (78%). Midwest respondents were more likely to think that infants wearing helmets had autism (24.5%,p=0.0018), were clumsy (34.7%,p=0.0003), and that the parent was irresponsible (30.6%,p<0.0001). Women were more likely to see a pediatrician (70% vs 55%,p=0.0055), men were more likely to see a plastic surgeon (34% vs 17%,p=0.0004). West Coast respondents were more likely to see an orthotist (26%,p=0.0046) and treat with helmet molding therapy (56%,p<0.0001). CONCLUSION: With increased awareness of PP, the authors sought to characterize knowledge gaps and the use of unsafe devices and techniques in the treatment of PP. Results show a regional and gender bias with regard to perceptions of infants in molding helmets and treatment options pursued for PP. Respondents with the highest level of education and highest median income were most likely to purchase a commercial head shaping device.

PurposePositional plagiocephaly (PP) and brachycephaly are conditions characterized by head flattening. There has been a sharp rise in the number of patients diagnosed since the American Academy of Pediatrics initiated the “Back to Sleep” policy to combat sudden infant death syndrome. This study compares providers’ and guardians’ perceived head shape differences, highlighting how these scores can alleviate parental anxiety.MethodsA retrospective chart review was performed for all pediatric patients seen for a PP consult from January 2018 to November 2023. Fifty-nine patients (43 with plagiocephaly and 16 with brachycephaly) met the inclusion criteria, in which documentation recorded two severity scores, one rating each by the provider and parental guardian. Patient demographics, severity scores, and comorbidities were recorded. The institution utilized validated, qualitative assessment forms that evaluated plagiocephaly on a 15-point scale and brachycephaly on a 9-point scale.ResultsFor plagiocephaly, the providers and guardians rated severity with a median of 4 (IQR 3–4.5) and 4 (IQR 3–7), respectively (Wilcoxon signed rank test, p-value < 0.05). For brachycephaly, the providers and guardians rated severity with a mean of 3.59 (SD 1.28) and 4.69 (SD 1.66), respectively (paired T-test, p-value < 0.005).ConclusionsOur study highlights the similarities in scores assessing clinical severity between providers and parents evaluated in a standardized, qualitative assessment for PP. On average, plagiocephaly reflected a “mild” severity, while brachycephaly reflected a “mild” to “moderate” severity on a graded scale. Future studies are needed to determine how patient-provider interactions may influence parents’ scores through shared decision-making.