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An increase in infant cranial deformity with supine sleeping position
L C Argenta1, L R David, J A Wilson
1Department of Plastic and Reconstructive Surgery, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27157-1075, USA.
Insights
Positional occipital plagiocephaly in infants has increased due to safe sleep recommendations. Most cases resolve with conservative treatment like positioning or helmets, avoiding surgery.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Developmental Pediatrics
Background:
- Occipital cranial suture abnormalities in infants can lead to significant posterior cranial asymmetry and facial deformities.
- A notable increase in occipital skull deformation has been observed, correlating with the adoption of supine/side sleeping positions to prevent sudden infant death syndrome (SIDS).
Purpose of the Study:
- To evaluate the incidence and outcomes of occipital plagiocephaly in infants.
- To determine the efficacy of conservative management versus surgical intervention for positional cranial deformities.
Main Methods:
- A cohort of 51 infants with occipital cranial deformity was treated over 16 months.
- Treatment strategies included continuous parental positioning for older infants and soft-shell helmets for younger infants or those with poor head control.
- Follow-up ranged from 8 to 24 months.
Main Results:
- The mean age at diagnosis and treatment initiation was 5.5 months.
- Mean helmet treatment duration was 3.8 months.
- Only 3 out of 51 patients required surgical intervention; most showed spontaneous improvement with conservative care.
Conclusions:
- Most occipital plagiocephaly deformities are positional deformations, not true craniosynostoses.
- Conservative management is highly effective, with surgery reserved for progressive cases.
- The trend of back-sleeping for SIDS prevention may continue to increase the incidence of these deformities.
Abstract:
Abnormalities of the occipital cranial suture in infancy can cause significant posterior cranial asymmetry, malposition of the ears, distortion of the cranial base, deformation of the forehead, and facial asymmetry. Over the past 2 years, we have noted a dramatic increase in the incidence of deformation of the occipital skull in our tertiary referral center. Our patient referral base has not changed appreciably over the past 5 years and patients have been referred from the same primary practitioner base. The timing of this increase correlates closely with the acceptance in our area of recommended changes in sleeping position to supine or side positioning for infants because of the fear of sudden infant death syndrome (SIDS). A total of 51 infants with occipital cranial deformity, with a mean age of 5.5 months at presentation, have been evaluated and treated by a single craniofacial surgeon in the 16-month period from September 1993 to December 1994. Older infants were treated with continuous positioning by the parent keeping the infant off the involved side. Younger infants and those with poor head control were treated with a soft-shell helmet. Mean timing of initial diagnosis and start of treatment was 5.5 months. Mean duration of helmet for positional treatment was 3.8 months. To date, only 3 of 51 patients have required surgical intervention, and other patients demonstrated spontaneous improvement of all measured parameters. Follow up has ranged from 8 to 24 months. We believe that most occipital plagiocephaly deformities are deformations rather than true cranio-synostoses. Despite varying amounts of suture abnormality evidenced on computed tomographic scans, most deformities can be corrected without surgery. In cases where progression of the cranial deformity occurs, despite conservative therapy, surgical intervention should be undertaken at approximately 1 year of age. The almost universal acceptance in the State of North Carolina of positioning neonates on their backs to avoid SIDS, may well increase the incidence of these deformities in the future.