In the UK, there have been few, if any, academic or clinical papers published about plagiocephaly. As you may be aware, the NHS does not regard plagiocephaly as a medical condition and, therefore, head shapes are not measured at birth, or, indeed, subsequently. There is, therefore, no academic incentive to begin a study of the condition or the different effects of treatments/therapies that are available.
We have had to look elsewhere for relevant research and have tried to pick out those which offer some measurable evidence for their conclusions. We have written a short summary and then provided a link to the paper in question for those who wish to download the whole paper (please be aware that in most cases the publication will charge a fee for this service).
Effectiveness of Conservative Therapy and Helmet Therapy For Positional Cranial Deformation
This is a retrospective study of the effectiveness of treatment for 4,378 babies between 2004 and 2011 at the Children’s Memorial Hospital, Chicago, Illinois. It compares conservative treatment (repositioning with or without physiotherapy) and helmet therapy for plagiocephaly and brachycephaly.
The research paper was published in March 2015 in the Journal of Plastic & Reconstructive Surgery.
Complete correction was achieved in 77.1% of conservative treatment patients, 15.8% required transition to helmet therapy and 7.1% ultimately had incomplete correction.
For babies who received helmet therapy as first line therapy, complete correction was achieved in 94.4% of cases and in 96.1% of infants that received helmet therapy after the failure of conservative therapy.
The babies in the helmet group on average started with more severe head and neck deformity, and were older than the babies in the conservatively treated group.
This is the biggest research sample to date. The initial treatment regime was jointly agreed by health professionals and parents.
The authors have identified risk factors for failure of conservative treatment:
- poor compliance;
- advanced age of baby;
- prolonged torticollis;
- severity of the initial cranial ratio;
- developmental delay.
Risk factors for failure of helmet treatment were:
- poor compliance;
- advanced age of baby.
This study confirms our clinician’s view that helmet therapy is the correct treatment for babies with moderate to severe plagiocephaly or brachycephaly, but repositioning does work for young babies with mild cranial deformation.
Treatment of positional plagiocephaly – helmet or no helmet?
To our knowledge, this recently published study is based on the largest sample to date comparing babies who received helmet therapy treatment with those that did not. This research supports our long held clinical opinion that helmet therapy is an appropriate and successful treatment for babies with moderate and severe plagiocephaly
A total of 128 infants were enrolled in this prospective, non-randomized, longitudinal study. Of those, 62 were treated with and 66 without a helmet. Although the babies who received treatment had more severe asymmetry initially, they showed significantly better improvement (68% vs. 31%).
Possible link of cognitive and motor delays in babies with ‘flat head syndrome’
In a study published in March 2010 in Pediatrics, infants averaging six months of age who exhibited positional plagiocephaly had lower scores than typical infants in observational tests to evaluate cognitive and motor development. In the study conducted by Seattle Children’s Research Institute 472 babies were screened, half had been diagnosed with some level of’ ‘flat head syndrome’ and half were a 'normal' control group. The study found that those babies who exhibited some degree of flatness at the back of the head were more likely to perform worse on motor test functions by an average of 10%.
Though the findings indicated an association between flat head syndrome and developmental delay, that does not necessarily indicate a direct causal link. Indeed, there could be a reverse correlation – babies with pre-existing motor delays are more likely to end up with flatter heads because they move less and remain in one position for longer periods of time.
Risk factors for deformational plagiocephaly at birth and at seven weeks of age
A total of 400 healthy babies were measured within 48 hours of birth and then at seven weeks at a General District Hospital in the Netherlands in 2004/5. Twenty (5%) of the children were lost to follow-up for a variety of reasons, so 380 babies could be analysed at the follow-up stage.
At birth, 23 (6%) babies presented with deformational plagiocephaly. At seven weeks, only nine of these still had deformational plagiocephaly. However, in another 75 babies, plagiocephaly developed between birth and follow-up. So, at the age of seven weeks, a total of 84 babies from a sample of 380 had plagiocephaly (22%).
This study would suggest that the primary cause of plagiocephaly is positional and perhaps we ought to distinguish between it and deformational plagiocephaly (which is caused by something that happens during the birth process).
Incidence of otitis media in children with deformational plagiocephaly
The purpose of this study in 2009 was to determine if there is an increased risk of development of otitis media (ear infection) in children with the diagnosis of deformational plagiocephaly.
The study did not show a statistically significant increase in the incidence of otitis media among the study group of 1,259 patients, compared to the national average. However, among 124 patients, changes in ear pressure were studied with the use of tympanometry, which is a tool that provides quantitative information on the presence of middle ear fluid. In this sample deformational plagiocephaly was directly correlated with otitis media. The more severe cases of deformational plagiocephaly had a higher percentage of otitis media than the less severe cases.