Neurologic Findings in Infants With Deformational Plagiocephaly

Fowler, Elizabeth A.; Becker, Devra B.; Pilgram, Thomas K.; Noetzel, Michael J.; Epstein, Jay; Kane, Alex A.

doi:10.1177/0883073808314362

Cited by 50 publications

(36 citation statements)

References 20 publications

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“…39,46 More recently, however, studies have built a possible association between disruptions in infant development and PP. 10,21,28,30,63 Multiple reports over the past decade have pointed to links between PP and abnormal ophthalmological findings, auditory processing, and motor development. 4,10,25,27,28,35,44,47,62,63,68 Two case-controlled studies, by Speltz et al 63 and Fowler et al, 21 found significant variability in gross motor development and body tone.…”

Section: Established Risk Factorsmentioning

confidence: 99%

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

Shweikeh

Nuño

Danielpour

et al. 2013

FOC

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Object Positional plagiocephaly (PP) has been on the rise in recent years. In this review, the authors' aim was to assess the effectiveness of current recommendations to parents on this exceedingly common problem through a comprehensive literature search. Additionally, the current treatment options and the most recent studies on PP are reviewed. Methods A search of the existing literature was conducted to obtain all relevant studies on guidelines, recommendations, parental and clinician practices, and epidemiological aspects. Results Although the incidence and risk factors for PP have been well delineated, there continues to be debates on its management and association with developmental delays. Current guidelines and recommendations on prevention set by the American Association of Pediatrics may not be easily followed by both parents and clinicians. There is also evidence that certain populations, including those with lower education, socioeconomic status, and in particular geographic regions may be more affected by the condition. Additionally, the marketing and financial aspects of PP treatments exist and should be addressed. Conclusions Better awareness and education are necessary to inform the population as a whole, although certain populations should be given special attention. Additionally, current guidelines and recommendations can be modified to foster a better grasp of the condition by both parents and clinicians. Adjusting current recommendations, introducing initiatives, and offering elaborate educational campaigns would help deliver these aims. Educating parents on PP as early as possible through clearer guidelines and close monitoring is central to preventing and managing this common condition.

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Section: Established Risk Factorsmentioning

confidence: 99%

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

Shweikeh

Nuño

Danielpour

et al. 2013

FOC

View full text Add to dashboard Cite

show abstract

“…Although there have been no rigorous prospective studies to address this concern, there is currently no evidence to suggest that positional skull deformity causes developmental delays. 8,[16][17][18] There has been some early motor skill developmental delay of all infants placed supine related to upper body strength and rolling over, which resolves over time. 19 Long-term follow-up studies have primarily been retrospective and questionnaire in nature and have not noted delays in cognitive or neurologic function.…”

Section: Introductionmentioning

confidence: 99%

“…5 Most of these deformities improve spontaneously during the first few months of life if the infant does not rest his or her head predominantly on the flattened area of the skull. If the infant continues to rest his or her head on the flattened side of the occiput, an initially occipital plagiocephalic deformity may be perpetuated or worsened by gravitational forces [6][7][8] and will be referred to in the remainder of this report as positional skull deformity as it relates to otherwise normal infants. Plagiocephaly is less commonly caused by unilateral lambdoidal or unilateral coronal craniosynostosis, which is a progressive and potentially devastating condition that requires early detection and surgical management.…”

Section: Introductionmentioning

confidence: 99%

Prevention and Management of Positional Skull Deformities in Infants

Laughlin¹,

Luerssen²,

Dias

2011

Pediatrics

131

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Positional skull deformities may be present at birth or may develop during the first few months of life. Since the early 1990s, US pediatricians have seen an increase in the number of children with cranial asymmetry, particularly unilateral flattening of the occiput, likely attributable to parents following the American Academy of Pediatrics “Back to Sleep” positioning recommendations aimed at decreasing the risk of sudden infant death syndrome. Positional skull deformities are generally benign, reversible head-shape anomalies that do not require surgical intervention, as opposed to craniosynostosis, which can result in neurologic damage and progressive craniofacial distortion. Although associated with some risk of positional skull deformity, healthy young infants should be placed down for sleep on their backs. The practice of putting infants to sleep on their backs has been associated with a drastic decrease in the incidence of sudden infant death syndrome. Pediatricians need to be able to properly differentiate infants with benign skull deformities from those with craniosynostosis, educate parents on methods of proactively decreasing the likelihood of the development of occipital flattening, initiate appropriate management, and make referrals when necessary. This report provides guidance for the prevention, diagnosis, and management of positional skull deformity in an otherwise normal infant without evidence of associated anomalies, syndromes, or spinal disease.

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“…Greater numbers of studies are confirming the correlation between positional plagiocephaly and neurodevelopmental delay seen in fine motor skills. 7,9,12,19 Whether the developmental delay or the plagiocephaly is the causative factor remains unanswered. The importance of regular repositioning and observed tummy time cannot be overstated.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of passive helmet therapy for deformational plagiocephaly: report of 1050 cases

Couture¹,

Crantford

Somasundaram³

et al. 2013

FOC

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Object There has been a tremendous increase in the incidence of deformational plagiocephaly in children throughout the world. Therapeutic options include observation, active counterpositioning, external orthotics, and surgery. The current treatment in the US is highly debated, but it typically includes external orthotic helmets in patients with moderate to severe plagiocephaly presenting between 4 and 10 months of age or in children with significant comorbidities limiting passive (no-pressure) therapy. The present study was designed to evaluate 3 key issues: 1) the accuracy of the Argenta classification in defining a progressive degree of severity, 2) identification of an upper age limit when treatment is no longer effective, and 3) the effectiveness of an off-the-shelf prefabricated helmet in correcting deformational plagiocephaly. Methods An institutional review board–approved retrospective study was conducted of all patients at the authors' clinic in whom deformational plagiocephaly was assessed using the Argenta classification system over a 6-year period; the patients underwent helmet therapy, and a minimum of 3 clinic visits were recorded. Inclusion criteria consisted of an Argenta Type II–V plagiocephalic deformity. Patients' conditions were categorized both by severity of the deformity and by patients' age at presentation. Statistical analysis was conducted using survival analysis. Results There were 1050 patients included in the study. Patients with Type III, IV, and V plagiocephaly required progressively longer for deformity correction to be achieved than patients with Type II plagiocephaly (53%, 75%, and 81% longer, respectively [p < 0.0001]). This finding verified that the Argenta stratification indicated a progressive severity of deformity. No statistically significant difference in the time to correction was noted among the different age categories, which suggests that the previously held upper time limit for correction may be inaccurate. An overall correction rate to Type I plagiocephaly of 81.6% was achieved irrespective of severity and degree of the original deformity. This suggests that an inexpensive off-the-shelf molding helmet is highly effective and that expensive custom-fitted orthoses may not be necessary. The patients in the older age group (> 12 months) did not have a statistically significant longer interval to correction than the patients in the youngest age group (< 3 months). The mean length of follow-up was 6.3 months. Conclusions Patients treated with passive helmet therapy in the older age group (> 12 months) had an improvement in skull shape within the same treatment interval as the patients in the younger age group (< 3 months). This study supports the use of passive helmet therapy for improvement in deformational plagiocephaly in infants from birth to 18 months of age and verifies the stratification of degree of deformity used in the Argenta classification system.

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Neurologic Findings in Infants With Deformational Plagiocephaly

Cited by 50 publications

References 20 publications

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

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

Prevention and Management of Positional Skull Deformities in Infants

Efficacy of passive helmet therapy for deformational plagiocephaly: report of 1050 cases

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