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plagiocephaly; skull deformity
Deformity or mishaping of the skull.
Etiology:
- sleeping in supine position as infant*
* sleeping in supine position is STILL recommended by the American Academy of Pediatrics for prevention of SIDS
Radiology:
- x-rays or ultrasound imaging of the suspect suture*
- computed tomography if x-rays or ultrasound nondiagnostic
* imaging if diagnosis is equivocal (rarely necessary) [NGC]
Complications:
- facial or frontal deformities (uncommon)
- developmental delay
Management:
1) active repositioning [NGC]
2) helmets 23 hours/day may be superior to repositioning [2]
- recommended for infants with persistent moderate-severe plagiocephaly conservative treatment (repositioning &/or physical therapy [NGC]
- recommended for infants with moderate to severe plagiocephaly presenting at an advanced age [NGC]
- helmets of no long-term benefit for infants with positional skull deformity
3) physical therapy may be superior to repositioning [NGC]
4) prognosis [2]
- 87% of children normalize by agee 4 without use of a helmet
Related
brachycephaly
General
skeletal deformity
References
- Journal Watch 23(13):105, 2003
Hunt CE et al,
Arch Pediatr Adolesc Med 157:469, 2003
- Hutchison BL et al.
Deformational plagiocephaly: A follow-up of head shape,
parental concern and neurodevelopment at ages 3 and
4 years.
Arch Dis Child 2010 Sep 29;
PMID: 20880942
http://dx.doi.org/10.1136/adc.2010.190934
- Lipira AB et al.
Helmet versus active repositioning for plagiocephaly:
A three-dimensional analysis.
Pediatrics 2010 Oct; 126:e936.
PMID: 20837585
- van Wijk RM et al
Helmet therapy in infants with positional skull deformation:
randomised controlled trial.
BMJ 2014;348:g2741
PMID: 24784879
http://www.bmj.com/content/348/bmj.g2741
- Collett BR
Helmet therapy for positional plagiocephaly and brachycephaly.
BMJ 2014;348:g2906
PMID: 24784880
http://www.bmj.com/content/348/bmj.g2906