Plagiocephaly and torticollis: Etiology, natural history, and helmet treatment

Clarren, Sterling K.

doi:10.1016/s0022-3476(81)80549-5

Cited by 201 publications

(155 citation statements)

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“…Synostotic plagiocephaly usually requires surgical correction, whereas deformational plagiocephaly improves with crib positioning and, more predictably, with a molding helmet. [1][2][3][4][5] Earlier intervention results in improved outcome. 6 Plagiocephaly is either preponderantly anterior or posterior, or both.…”

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“…Thus, some investigators use the term "positional" plagiocephaly to underscore that the cranial flattening is postnatal, caused by sleeping in the "position of comfort." 2 Other observers think that deformational plagiocephaly begins prenatally. They note the association with intrauterine constraint, resulting from a large fetus, a small or malformed uterus, increased abdominal muscular tone, or decreased amniotic fluid.…”

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Incidence of Cranial Asymmetry in Healthy Newborns

Peitsch¹,

Keefer²,

et al. 2002

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ABSTRACT. Objective. During recent years, coincident with the recommendation to position infants supine, the incidence of posterior deformational plagiocephaly has increased dramatically. The purpose of our study was to determine whether early signs of cranial flattening could be detected in healthy neonates and to document incidence and potential risk factors.Design. A cross-sectional study was performed in healthy newborns. Physical findings, anthropometric cranial measurements, and data on pregnancy and birth were recorded.Results. The incidence of localized cranial flattening in singletons was 13%; other anomalous head shapes were found in 11% of single-born neonates. In twins, localized flat areas were much more frequent with an incidence of 56%. The following risk factors for cranial deformation were identified: assisted vaginal delivery, prolonged labor, unusual birth position, primiparity, and male gender. ABBREVIATIONS. SIDS, sudden infant death syndrome; TCD, transcranial difference. Conclusion. We propose that localized lateral or occipital cranial flattening at birth is a precursor to

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Incidence of Cranial Asymmetry in Healthy Newborns

Peitsch¹,

Keefer²,

et al. 2002

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“…More commonly, deformational plagiocephaly occurs postnatally and is associated with congenital torticollis, vertebral anomalies, neurologic impairment, or forced sleeping position. [3][4][5] Few reports document any late effects of deformational plagiocephaly other than potential cosmetic concerns and the potential for strabismus, especially involving vertical eye movements. 6,7 Plagiocephaly may be morphometrically evident in as many as 14% of adults, but it is rarely recognized.…”

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“…In ϳ10% of affected infants with plagiocephaly, there will be a permanent deformity with a mild to severe cosmetic effect. 5 Patients with moderate to severe asymmetry are often referred to a craniofacial center for consideration of treatment. Cranial surgery is almost never indicated for plagiocephaly without synostosis unless the presentation is very severe.…”

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“…Helmet therapy is an effective treatment option based on the mechanism that pressure from a rapidly growing brain against a concave surface should round flattened areas caused by earlier pressure against a flat surface. 5,9 Helmet therapy is gen-erally recommended between 6 and 18 months of age in an attempt to use remaining brain growth to redirect head shape. From 1980 to 1991, 295 patients were recorded as evaluated at the Craniofacial Center of the Children's Hospital and Regional Medical Center (CHRMC) in Seattle, Washington for plagiocephaly and consideration of helmet therapy.…”

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Long-Term Developmental Outcomes in Patients With Deformational Plagiocephaly

2000

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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.

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