Current Consensus on the treatment of Positional Plagiocephaly

In Australia, the current consensus is that positional plagiocephaly may be prevented or treated by simple repositioning techniques and by minimising pressure on the head when baby is awake. These simple measures are most effective if implemented from birth. For most babies, regular repositioning of the baby’s head before the baby is 4 months old will result in optimal outcomes. Parent counselling and education, mechanical adjustments using positioning strategies, and physiotherapy are recommended, with only severe cases resorting to the use of specially designed helmets to correct the deformity. Currently there are few studies demonstrating the efficacy of helmet therapy, and there are considerable costs, inconvenience, possible complications and problems with compliance associated with their use.

The use of helmet therapy has been controversial in particular with websites marketing to parents about its efficacy. It is therefore important to find out if other paediatric experts have the same consensus as in Australia with respect to the treatment and prevention of positional plagiocephaly.

The following are the recommendations from the resource from the Canadian Paediatric Society:

The levels of recommendations are described using the evaluation of evidence criteria outlined by the Canadian Task Force on Preventive Health Care.

• 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. (Level II-2, Grade A)
• Prone position during awake time (tummy time) for 10 min to 15 min at least three times per day reduces the development of plagiocephaly. (Level II-2, Grade A)
• Evaluation for craniosynostosis, congenital torticollis and cervical spine abnormalities should be part of the examination of a child with plagiocephaly. (Level III, Grade A)
• Repositioning therapy plus physiotherapy as needed are the interventions of choice in most children with mild or moderate Positional Plagiocephaly. (Level II-1, Grade B)
• 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. (Level II-3, Grade I)

Conclusion:

The current consensus for the prevention and management of positional plagiocephaly is consistent around the world. It is important to ensure that the correct diagnosis is being made for an effective management plan and successful outcome. The examination of a child with plagiocephaly should include an evaluation for dysmorphisms and syndromes. Verifying the range of active and passive motion of the neck is important to detect congenital torticollis, which will improve with physiotherapy. As the torticollis improves, so will cranial asymmetry.  Although much less frequent, abnormalities of  the  cervical  spine  can  also  lead  to plagiocephaly.

If you are concerned about your child having a mis-shapened head due to positional plagiocephaly, please contact our paediatric physiotherapist for an appointment today.