Long-Term Developmental Outcomes in Patients With Deformational Plagiocephaly

Abstract

ABSTRACT. Objectives. To determine whether there was an increased rate of later developmental delay in school-aged children who presented as infants with deformational plagiocephaly without obvious signs of delay at the time of initial evaluation.Methods. A retrospective medical record review of 254 patients evaluated at the Craniofacial Center of the Children's Hospital and Regional Medical Center in Seattle, Washington, from 1980 through 1991 was completed. Consenting patient families were interviewed via telelphone to determine what, if any, special medical or educational problems had occurred for the children who had had plagiocephaly in infancy or their siblings with normal head shapes.Results. A total of 181 families from the medical record review could be notified about the study and 63 families agreed to participate in a telephone interview. The sample of participants for the telephone interview was random to and representative of the group as a whole. The families reported that 25 of the 63 children (39.7%) with persistent deformational plagiocephaly had received special help in primary school including: special education assistance, physical therapy, occupational therapy, speech therapy generally through an Individual Education Plan. Only 7 of 91 siblings (7.7%), serving as controls, required similar services ( 2 ‫؍‬ 21.24). Delays could not be specifically anticipated at the time of the diagnosis of deformational plagiocephaly from any simple set of factors including treatment with helmet therapy, although effected males with reported uterine constraint were at the highest risk for subsequent school problems.Conclusions. Infants with deformational plagiocephaly comprise a high-risk group for developmental difficulties presenting as subtle problems of cerebral dysfunction during the school-age years. There is a need for additional research on the long-term developmental problems in infants with deformational plagiocephaly. Pediatrics 2000;105(2). URL: http://www.pediatrics.org/ cgi/content/full/105/2/e26; plagiocephaly, facial asymmetry, torticollis, developmental delay.

Positional plagiocephaly: an analysis of the literature on the effectiveness of current guidelines

“…The frequency of PP then begins to level down, with a normalization in shape by 6 months as the infant gains active control of the head. 39,44 Unfortunately, there has been an accompanying false increase in the rate of synostotic plagiocephaly due to misdiagnosis and a lack of ability to differentiate the 2 conditions, leading to unnecessary referrals. 26 Craniosynostosis is an important differential diagnosis, particularity the lambdoid type.…”

Soft-helmet skull remodeling in canine models: intracranial volume unchanged by compensatory skull growth

“…Because of this poor compliance, a concern has arisen that they might limit cranial growth and subject the wearers to the risk, although slight, of increased intracranial pressure or direct brain injury. 33 This supposition was partially refuted in a small clinical study by Kelly, et al, 24 in which it was reported that craniofacial asymmetry was decreased by the molding helmet, whereas head circumference, maximal cranial length, and maximal cranial width measurements showed continuous growth of the skull. Kelly and coworkers estimated cranial growth by using two-dimensional measurements and a crude statistical method, however; thus, it is difficult to infer from their data the safety of threedimensional skull growth after helmet therapy.…”

“…25,[28][29][30] The passive molding helmet also compresses the protuberant area to some degree, depending on its fit and weight, and thus factors that can make the dif-ference between passive and active helmets become less significant. 31,33 All molding helmets-especially those with active compression-exert some degree of pressure on the skull, a feature that results in poor compliance when they are worn by infants and young children. In our experience, the application of these commercial helmets is very difficult clinically.…”

“…Authors of a previous report on molding helmets that compress the cranium stated that such orthotics may lead to possible retardation of brain development. 33 Further confirmation of the safety of this type of treatment for long-term intelligence function must be obtained from a careful review of clinical studies in humans.…”

“…This helmet is the so-called active or dynamic orthosis. The materials used in these molding helmets are hard, however, and active compression can lead to complications such as pressure sores, 17 neurodevelopmental delay, 33 and poor compliance of the infant, resulting in difficulty in clinical applicability. As a result of their attempts to overcome these problems, Bruner, et al, 7 reported a high compliance rate of 88% through the use of a new soft-molding helmet, but they did not adequately describe the character of their helmet, which compresses the skull area of compensated growth, and they did not supply a means of verifying the safety of such procedures.…”