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Management of deformational plagiocephaly: repositioning versus orthotic therapy
John M Graham1, Mayela Gomez, Andy Halberg
1Medical Genetics Institute, Ahmanson Department of Pediatrics, Steven Spielberg Pediatric Research Center, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Insights
Cranial orthotic therapy is more effective than repositioning for correcting head asymmetry in infants. Early orthotic intervention yields better outcomes, resulting in a greater decrease in diagonal difference.
Area of Science:
- Pediatric orthopedics
- Craniofacial abnormalities
Background:
- Head asymmetry, also known as positional plagiocephaly, is common in infants.
- Treatment options include repositioning and cranial orthotic therapy (helmets).
Purpose of the Study:
- To compare the effectiveness of repositioning versus cranial orthotic therapy for correcting head asymmetry in infants.
- To evaluate the impact of age and treatment timing on outcomes.
Main Methods:
- A study of 298 infants with head asymmetry compared repositioning (n=176), helmets (n=159), and combined therapy (n=37).
- Reductions in diagonal difference (RDD) were measured to assess treatment efficacy.
- Helmet therapy was typically initiated for infants over 6 months with a diagonal difference (DD) greater than 1 cm.
Main Results:
- Infants treated with repositioning (mean age 4.8 months) achieved a mean RDD of 0.55 cm.
- Infants treated with cranial orthotics (mean age 6.6 months) achieved a mean RDD of 0.71 cm.
- Orthotic therapy resulted in a greater percentage decrease in DD (61%) compared to repositioning (52%).
Conclusions:
- Cranial orthotic therapy was more effective than repositioning in reducing head asymmetry.
- Early initiation of orthotic therapy (65% decrease in DD) was more effective than later treatment (51% decrease in DD).
- Infants receiving orthotics were older and required longer treatment durations.
Objectives:
We compare positioning with orthotic therapy in 298 consecutive infants referred for correction of head asymmetry.
Study Design:
We evaluated 176 infants treated with repositioning, 159 treated with helmets, and 37 treated with initial repositioning followed by helmet therapy when treatment failed. We compared reductions in diagonal difference (RDD) between repositioning and cranial orthotic therapy. Helmets were routinely used for infants older than 6 months with DD >1 cm.
Results:
For infants treated with repositioning at a mean age of 4.8 months, the mean RDD was 0.55 cm (from an initial mean DD of 1.05 cm). For infants treated with cranial orthotics at a mean age of 6.6 months, the mean RDD was 0.71 cm (from an initial mean DD of 1.13 cm).
Conclusions:
Infants treated with orthotics were older and required a longer length of treatment (4.2 vs 3.5 months). Infants treated with orthosis had a mean final DD closer to the DD in unaffected infants (0.3 +/- 0.1 cm), orthotic therapy was more effective than repositioning (61% decrease versus 52% decrease in DD), and early orthosis was significantly more effective than later orthosis (65% decrease versus 51% decrease in DD).
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