Conservative Therapy Corrects Positional Cranial Deformation

Diedtra Henderson

March 10, 2015

Deformational plagiocephaly and brachycephaly were corrected in 77.1% of infants with conservative repositioning therapy as a first-line treatment, according to a retrospective cohort study. Moreover, 94.4% of the infants who had helmet therapy as a first-line treatment achieved complete correction.

"The results of this study demonstrate that conservative treatment (repositioning therapy with or without physical therapy) and helmet therapy are each effective in correcting positional cranial deformation," write Jordan P. Steinberg, MD, PhD, from the Ann and Robert H. Lurie Children's Hospital of Chicago and the Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and colleagues in an article published in the March issue of Plastic and Reconstructive Surgery.

"For patients with minimal risk factors (e.g., age younger than 6 months, cranial ratio <0.95, diagonal difference <10 mm, absence of neuromuscular developmental delay, or persistent torticollis), we strongly favor an initial trial of conservative therapy because of the high potential for success with these techniques alone."

Dr Steinberg and colleagues note that since the "Back to Sleep Campaign" began in 1992, with the aim of lowering the rate of sudden infant death syndrome, the incidence of positional cranial deformation has soared by an estimated 600%. To investigate the efficacy of various treatment options, the authors enrolled 4378 infants who were treated for deformational plagiocephaly or brachycephaly by a single pediatric craniofacial surgeon from 2004 to 2011.

After evaluation, the researchers assigned 383 infants to conservative repositioning therapy, 2998 infants to repositioning therapy plus physical therapy, and 997 infants to helmet therapy. Parents were trained in such techniques as stretching babies' neck muscles and were counseled on the importance of infants spending more than 50% of waking hours on their stomachs and limiting use of walking devices. Infants assigned to helmet therapy wore specially made helmets 23 hours daily.

Thirteen of the infants originally assigned to receive repositioning therapy and 521 who had conservative therapy plus physical therapy were transitioned to helmets after they failed to improve. These "crossover" patients were older when they began conservative therapy and had significantly greater deformity. There was little difference in their outcomes when compared with infants who had received helmet therapy as a first-line treatment.

Ultimately, 92.8% of all infants achieved complete correction.

The authors endorse counseling parents of infants with significant risk factors for treatment failure with the conservative approach. Patients with "moderate" risk factors could begin with repositioning therapy as "an initial trial." The authors suggest additional research to clarify the "critical age" after which brain growth slows and helmet therapy can no longer achieve complete correction.

"Delaying the initiation of helmet therapy for a trial of conservative treatment does not preclude complete correction, provided that the helmet therapy is begun while brain growth is ongoing and patients are compliant," the authors conclude.

The authors have disclosed no relevant financial relationships.

Plast Reconstr Surg. 2015;135:833-842. Full text

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