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Published on: February 5, 2019
Long-term outcome of infants with positional occipital plagiocephaly
Paul Steinbok1, David Lam, Swati Singh
1Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Long-term outcomes for positional plagiocephaly (PP) are generally good, with no significant differences found between children who used cranial orthoses and those who did not. This study provides insights for better parental counseling regarding PP.
Area of Science:
- Pediatric medicine
- Developmental pediatrics
- Craniofacial abnormalities
Background:
- Positional plagiocephaly (PP) is common in infants, but its long-term natural history and outcomes remain unclear.
- Understanding the cosmetic and developmental trajectories of children with PP is crucial for effective management and parental guidance.
Purpose of the Study:
- To determine the cosmetic and developmental outcomes at a minimum of 5 years of age in children diagnosed with positional plagiocephaly (PP) in infancy.
- To evaluate the impact of cranial orthotic use on these long-term outcomes.
Main Methods:
- A questionnaire survey was distributed to parents of children diagnosed with PP in infancy and now over 5 years old.
- Retrospective chart review and prospective follow-up assessments were conducted for consenting families.
Main Results:
- Of 65 participants, 18 used cranial orthoses. Parents perceived cosmetic appearance as normal in 38, mildly abnormal in 25, and very abnormal in 2.
- Residual asymmetry was reported by 58% of parents, though only 21% were concerned. Developmental outcomes, including learning assistance or special class placement, showed no significant difference based on orthotic use.
Conclusions:
- Long-term cosmetic and developmental outcomes for positional plagiocephaly (PP) are generally favorable, irrespective of cranial orthotic intervention.
- These findings support improved parental counseling, aiming to reduce anxiety and guide management decisions more rationally.
Background:
Despite much interest in positional (deformational) plagiocephaly, the natural history is unclear. The purpose of this study was to determine cosmetic and developmental outcomes at a minimum of 5 years of age in children diagnosed in infancy with positional plagiocephaly (PP) and the impact of cranial orthotic use.
Methods:
A questionnaire survey was sent to parents of children diagnosed with PP in infancy and now aged more than 5 years. A retrospective review of the child's clinic chart was performed of consenting families, and prospective follow-up was done when families agreed to return for assessment.
Results:
Of 278 eligible children with plagiocephaly, questionnaires were completed by 65 parents, and 27 brought their child for assessment. Participants and nonparticipants were similar. Cranial orthoses were used in 18 of 65 children. Parents perceived the cosmetic appearance of their child as "very abnormal" in 2, "mildly abnormal" in 25, and "normal" in 38. Residual asymmetry was noted by parents in 58%, but only 21% were concerned about appearance. In the last year, 7.7% of children commented about asymmetry of head, and 4.6% were teased occasionally. Thirty-three percent had received learning assistance, and 14% were in a special class. Long-term outcomes, as perceived by the parent or child, were no different between children with and without orthosis use.
Conclusions:
The results allow better counselling of parents about outcome of infants with PP, reducing anxiety, and allowing more rational selection of management modality.
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