Positional plagiocephaly

Question 1

What is the incidence of PP at 6wk?

Answer 1

16%

Question 2

What is the incidence of PP at 4mo?

Answer 2

19.7%

Question 3

What is the incidence of PP at 12mo?

Answer 3

6.8%

Question 4

What is the incidence of PP at 24mo?

Answer 4

3.3%

Question 5

What factors increase the risk of PP?

Answer 5

1. Male sex
2. Firstborn
3. Limited passive neck rotation at birth (congenital torticollis)
4. Supine sleeping position at birth and at 6wk
5. Only bottle feeding
6. Awake “tummy time” fewer than TID
7. Lower activity level
8. Slower achievement of milestones
9. Sleeping with the head to the same side
10. Positional preference

Question 6

How can PP be differentiated from craniosynostosis?

Answer 6

Craniosynostosis
1. Ridging of affected suture (lambdoid)
2. Cranial asymmetry if unilateral
3. Ipsilateral occiptomastoid bossing with posterior displacement of the ear
PP
1. Ipsilateral anterior displacement of the ear

Question 7

How to prevent plagiocephaly?

Answer 7

1. Alternate the positioning of the infant in bed

2. “Tummy time” 10-15min TID minimum

Question 8

What is the treatment of plagiocephaly?

Answer 8

1. Surgical intervention for confirmed craniosynostosis only
2. Repositioning therapy 0-4mo with mild to moderate asymmetry
3. Physiotherapy and positioning
4. Moulding helmet therapy to max. 8mo

Question 9

What are the CPS recommendations regarding positional plagiocephaly?

Answer 9

1. Prevention of plagiocephaly begins with positioning of the head to encourage lying on each side in the supine position. More effort may be required for the child with a strong positional preference to lie more on one side of the head.
2. Prone position during awake time (tummy time) for 10 min to 15 min at least three times per day reduces the development of plagiocephaly.
3. Evaluation for craniosynostosis, congenital torticollis and cervical spine abnormalities should be part of the examination of a child with plagiocephaly.
4. Repositioning therapy plus physiotherapy as needed are the interventions of choice in most children with mild or moderate PP.
5. Moulding therapy (helmet therapy) may be considered for children with severe asymmetry. In these children, helmet therapy has been shown to influence the rate of improvement of asymmetry but not its final outcome. There is insufficient evidence to recommend helmet therapy based on studies published to date for mild or moderate asymmetry.