Introduction: With the Back to Sleep campaign, the incidence of sudden infant death syndrome decreased while the prevalence of positional skull deformation increased dramatically. We aimed to review our institutional experience (2008-2014) in treatment of positional plagiocephaly to explore factors associated with measured improvement while in treatment.
Methods: A retrospective chart review was conducted, with risk factors and treatment for positional head shape deformity recorded. Univariate and multivariate analysis was used to assess the impact of these variables on the change in measured oblique diagonal difference (ODD) on head surface scanning pre- and post-treatment.
Results: 991 patients presented at age <12 months with occipital brachycephaly (18.4%), occipital plagiocephaly(69.5%), or both (12.1%). Recommended treatment included repositioning(RP), physical therapy(PT), or helmet(HM) according to our age- and risk factor-dependent algorithm. 552 patients had pre- and post-treatment surface scanner evaluations. Average presenting age was 6.2 months (corrected for prematurity for treatment considerations). 543 patients had RP or PT as first recommended treatment. 137 patients transitioned to HM. The remainder had failed RP/PT prior to presentation and the starting treatment recommendation was HM. The % improvement in ODD were 36.7%, 33.5%, and 15.1% for patients receiving HM, RP/PT, and RP/PT/HM, respectively. Univariate analysis showed gender, race, insurance, diagnosis, sleep position preference, torticollis history, and multiple gestation were not significantly associated with magnitude of ODD change during treatment. On multivariate analysis, corrected age at presentation and type of treatment received were significantly associated with magnitude of ODD change. Helmet therapy corresponded with the largest ODD change, while the RP/PT group had the least. Earlier age at presentation corresponded with larger ODD change.
Conclusions: Earlier age at presentation and type of treatment impact the degree of measured deformational head shape correction in positional plagiocephaly.
Patient Care: These results will help practitioners understand and apply assessment of factors that impact the amount of correction achieved in treatment of positional skull deformation.
Learning Objectives: By the conclusion of this session, participants should be able to:
(1) describe variables included in management decisions of infant positional skull deformity
(2) name factors associated with larger measured changes in oblique diagonal difference during head shape deformity treatment