Related Experiment Video
Updated: Jul 12, 2026
Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling
Published on: February 5, 2019
[Doubts and confusions in the diagnosis and treatment of positional plagiocephaly. Management protocol]
J Esparza Rodríguez1, J Hinojosa Mena-Bernal, María J Muñoz-Casado
1Servicio de Neurocirugía Pediátrica, Unidad de Cirugía Craneofacial, Hospital Infantil 12 de Octubre, Madrid, España. jesparza12oct@yahoo.es
Insights
Positional plagiocephaly management is clarified with a staged protocol for infants. This approach coordinates care between pediatricians and neurosurgeons, starting with conservative treatments before considering surgery.
Area of Science:
- Pediatric Neurosurgery
- Cranial Deformities
- Developmental Pediatrics
Context:
- Positional plagiocephaly is a common pediatric consultation, often misdiagnosed.
- Existing literature lacks consistent terminology and understanding of its pathophysiology.
- A standardized management protocol is needed for consistent care.
Purpose:
- To clarify concepts surrounding positional plagiocephaly.
- To present a standardized management protocol for positional plagiocephaly.
- To improve coordination between pediatricians and neurosurgeons.
Summary:
- A two-phase management protocol (pediatric and neurosurgical) is proposed for positional plagiocephaly.
- Infants are classified by severity (mild, moderate, severe) based on digital photograph measurements.
- Referral to neurosurgery is reserved for infants over 5 months who have not responded to initial conservative treatments like postural changes and physiotherapy.
Impact:
- Provides clear guidelines for diagnosing and managing positional plagiocephaly.
- Facilitates better communication and collaboration between healthcare professionals.
- Ensures appropriate and timely treatment for infants with cranial deformities.
Introduction:
Positional plagiocephaly is currently the most frequent cause of consultation at pediatric neurosurgical departments in Spain and other western countries. There is considerable confusion in the literature on the terminology and physiopathology of this deformity, as well as its differential diagnosis with true synostosis and treatment recommendations.
Objectives:
To clarify these concepts and present a protocol for the management of positional plagiocephaly, which was recently requested by the Health Administration of the Community of Madrid.
Protocol:
The protocol aims to achieve coordination among pediatricians and neurosurgeons, as well as to provide precise information on this deformity for parents, pediatricians and neurosurgeons.
Material And Methods:
Previous consensus was reached on a series of data. Infants were classified into three categories of deformity (mild, moderate, severe) according to measurements on digital photographs. Diagnosis and treatment follows two phases: a pediatric phase (up to 5 months of age) and a neurosurgical phase (from 5 months onwards). Infants are referred to neurosurgical consultation only after being treated with postural changes and physiotherapy and only after reaching the age of 5 months. The reasons for this approach are explained in the protocol, which also defines the functions and responsibilities of each specialty.
Conclusion:
The treatment proposed in the protocol is staged, starting with postural changes and physiotherapy, followed by orthotic cranial devices and finally surgical treatment.
