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Australian Journal of General Practice 2022The presentation of a child with an abnormal head shape can be challenging and should be met with an appropriate clinical approach. Craniosynostosis is a common cause of...
BACKGROUND
The presentation of a child with an abnormal head shape can be challenging and should be met with an appropriate clinical approach. Craniosynostosis is a common cause of paediatric skull deformity and is best managed by a multispecialty tertiary referral unit with regular follow-up. As craniosynostosis frequently requires time-sensitive surgery, it is important to differentiate between craniosynostosis and common self-limiting conditions such as deformational plagiocephaly.
OBJECTIVE
The aim of this article is to outline the clinical approach to paediatric skull deformity in the general practice setting, and to highlight the importance of early referral if there is clinical suspicion of craniosynostosis.
DISCUSSION
Parental concern regarding infant head shape is common. General practitioners (GPs) have an important role in assessment, diagnosis and referral for paediatric skull deformities. GPs are well placed to clinically differentiate between deformational plagiocephaly and craniosynostosis and provide timely referrals to optimise patient outcomes.
Topics: Child; Craniosynostoses; Diagnosis, Differential; Humans; Infant
PubMed: 35098275
DOI: 10.31128/AJGP-09-20-5638 -
Andes Pediatrica : Revista Chilena de... Apr 2023Since the American Academy of Pediatrics recommended the supine sleeping position for infants to prevent SIDS, positional plagiocephaly (PP) prevalence has increased.... (Review)
Review
Since the American Academy of Pediatrics recommended the supine sleeping position for infants to prevent SIDS, positional plagiocephaly (PP) prevalence has increased. There are great controversies regarding the possible consequences of PP and the degree of severity required for them to manifest. There is no consensus on the efficacy of PP therapies, such as positioning, kinesiology, and cranial orthoses. This review aims to analyze the existing literature to update the causes, main characteristics, and evidence on the treatment of PP. Intervention from the newborn period is important, encompassing both prevention and management education, as well as early screening, evaluating the possible presence of congenital muscular torticollis, to start early treatment. The presence of PP can be a risk marker for psychomotor development.
Topics: Infant; Infant, Newborn; Humans; Child; Plagiocephaly, Nonsynostotic; Sleep; Torticollis; Prevalence
PubMed: 37358106
DOI: 10.32641/andespediatr.v94i2.4665 -
BMJ Paediatrics Open 2021Deformational plagiocephaly (DP) is one of the most common cranial shape disorders in infancy. It is characterised by unilateral flattening of the skull due to head...
INTRODUCTION
Deformational plagiocephaly (DP) is one of the most common cranial shape disorders in infancy. It is characterised by unilateral flattening of the skull due to head preference to one side. The literature suggests that DP is associated with comorbidities such as developmental delay, but the nature and prevalence of the comorbid impairments are still unclear and controversial. Therefore, our scoping review (ScR) aims to explore systematically the extent and nature of literature by identifying, mapping and categorising the most relevant comorbidities of DP in children up to the age of 2 years.
METHODS AND ANALYSIS
This protocol is based on the framework outlined by Arksey and O'Malley. A systematic search will be conducted to identify relevant full text studies from 1992 to 2021 using the databases of Cochrane, MEDLINE, Google Scholar, EMBASE, PubMed and University of Nicosia EBSCO. Two independent reviewers will screen abstracts and full articles in parallel, using specific inclusion and exclusion criteria. Specifically, this review will consider studies investigating DP and relevant comorbidities in children up to the age of 2 years of life without craniosynostosis, torticollis and any other diagnosed neurodevelopmental deficiency.The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for ScR Checklist will be considered for results' analysis and reporting. The results will be described in a narrative form in relation to the research question and in the context of the overall study purpose.
ETHICS AND DISSEMINATION
Research ethics approval is not required for this ScR since data will be retrieved from publicly available studies. Dissemination activities will include research findings' submission for publication in a relevant peer-reviewed journal and presentation of the results at relevant conferences.
REGISTRATION
Our protocol was registered prospectively with the Open Science Framework (https://osf.io/48am3/).
Topics: Child; Child, Preschool; Comorbidity; Delivery of Health Care; Humans; Peer Review; Plagiocephaly, Nonsynostotic; Research Design; Review Literature as Topic; Systematic Reviews as Topic
PubMed: 34151030
DOI: 10.1136/bmjpo-2021-001113 -
Developmental Medicine and Child... Aug 2008This review synthesized current research evidence on the prevalence, risk factors, and natural history of positional plagiocephaly. Research published between 1985 and... (Review)
Review
This review synthesized current research evidence on the prevalence, risk factors, and natural history of positional plagiocephaly. Research published between 1985 and 2007 was sourced from 13 databases. Evidence was categorized according to a hierarchy and rated on a standardized critical appraisal tool. These evaluations were incorporated into a narrative synthesis of the main results. Eighteen studies met inclusion criteria (prevalence: n=3, risk factors: n=17, natural history: n=1). The methodological quality of studies was fair. The point prevalence of positional plagiocephaly appears to be age-dependent and may be as high as 22.1% at 7 weeks of age. Point prevalence tends to decrease with age and may be as low as 3.3% at 2 years. When compared with historical data, the prevalence of positional plagiocephaly appears to have remained stable over the last four decades. Assisted delivery, first born child, male sex, cumulative exposure to the supine position, and neck problems may increase the risk of positional plagiocephaly. To reduce the risk of positional placiocephaly, infants should experience a variety of positions, other than supine, while they are awake and supervised, and early treatment may be warranted for infants with neck problems and/or strong head preference.
Topics: Humans; Infant; Plagiocephaly, Nonsynostotic; Prevalence; Risk Factors; Supine Position
PubMed: 18754894
DOI: 10.1111/j.1469-8749.2008.03029.x -
Journal of Chiropractic Medicine Sep 2015The purpose of this study is to review the literature for possible methods in diagnosing, classifying, and monitoring deformational plagiocephaly and brachycephaly.
OBJECTIVE
The purpose of this study is to review the literature for possible methods in diagnosing, classifying, and monitoring deformational plagiocephaly and brachycephaly.
METHODS
A search was conducted on articles through February 2014 in PubMed (Medline) and Google Scholar. Articles were included if they met the following criteria: (1) they were written in English or German; (2) they involved humans; (3) they were published in the last 10 years; (4) they had a primary research question about all possible methods for diagnosing, classifying, and monitoring deformational plagiocephaly and brachycephaly; and (5) an abstract was available.
RESULTS
The search resulted in 58 articles. After the review, the number was reduced to 16. Of the 16 articles included, 9 were reliability studies on measurements of deformational plagiocephaly. Six measurement tools for diagnosing, classifying, and monitoring deformational plagiocephaly and brachycephaly were found: visual assessment, anthropometric measurements with a caliper, measurements with a flexicurve, plagiocephalometry, 3-dimensional photography, and radiological imaging.
CONCLUSION
This study found that visual assessment, flexicurve, anthropometric measurements with a caliper, and plagiocephalometry are useful measurements. At present, the plagiocephalometry and the anthropometric measurements with a caliper are more reliable methods than the visual assessment and the measurement with a flexicurve.
PubMed: 26778933
DOI: 10.1016/j.jcm.2015.05.003 -
Plastic and Reconstructive Surgery.... May 2022Positional plagiocephaly has garnered increased research interest since the introduction of the Back to Sleep campaign in the 1990s, and the subsequent increase in...
UNLABELLED
Positional plagiocephaly has garnered increased research interest since the introduction of the Back to Sleep campaign in the 1990s, and the subsequent increase in infants with cranial deformity. Research has focused on treatment outcomes and developing new modalities to address asymmetric heads. Little attention has been given to the cost of treatment and diagnosis. This study aimed to summarize the literature and provide an overview of the costs associated with a diagnosis of positional plagiocephaly.
METHODS
A literature review was performed by searching PubMed and Ovid Embase to identify studies pertaining to the "cost" of plagiocephaly diagnosis or treatment through direct financial factors, disturbance to daily routines (ie, through treatment prolongation), or related stress.
RESULTS
Twenty-nine peer-reviewed studies were included. Treatment options for plagiocephaly are stratified by severity and age of diagnosis, with different pathways available to treat different stages of asymmetry. The common factor across all treatment modalities is that earlier diagnosis unequivocally leads to better aesthetic outcomes and shorter treatment times. This leads to lower costs for treatment, a lower stress burden for parents, and lower costs for the healthcare system in the future through reduction of long-term effects. Our theoretical cost model suggests that early diagnosis at 4 months can lead to a treatment cost of $1495, when compared with $5195 for detection of deformity at or after 6 months.
CONCLUSION
The dramatic cost disparity between early and late diagnosis highlights the need for reliable methods to accurately detect cranial deformity early in an infant's life.
PubMed: 35702535
DOI: 10.1097/GOX.0000000000004328 -
American Family Physician May 2009Sudden infant death syndrome is the leading cause of death among healthy infants, affecting 0.57 per 1,000 live births. The most easily modifiable risk factor for sudden... (Review)
Review
Sudden infant death syndrome is the leading cause of death among healthy infants, affecting 0.57 per 1,000 live births. The most easily modifiable risk factor for sudden infant death syndrome is sleeping position. To reduce the risk of sudden infant death syndrome, parents should be advised to place infants on their backs to sleep and avoid exposing the infant to cigarette smoke. Other recommendations include use of a firm sleeping surface and avoidance of sleeping with soft objects, bed sharing, and overheating the infant. Pacifier use appears to decrease the risk of sudden infant death syndrome, but should be avoided until one month of age in infants who are breastfed. The occurrence of apparent life-threatening events does not increase the risk of sudden infant death syndrome, and home apnea monitoring does not lower the risk of sudden infant death syndrome. Supine sleeping position has increased the incidence of flattening of the occiput (deformational plagiocephaly), but this condition can be prevented and treated by encouraging supervised "tummy time," meaning that when awake, infants should spend as much time as possible on their stomachs. All apparent deaths from sudden infant death syndrome should be carefully investigated to exclude other causes of death, including child abuse. Families who have an infant die from sudden infant death syndrome should be offered emotional support and grief counseling.
Topics: Humans; Infant; Infant, Newborn; Risk Factors; Sudden Infant Death; Supine Position
PubMed: 19496386
DOI: No ID Found -
Anales de Pediatria (Barcelona, Spain :... Sep 2007Positional plagiocephaly is currently the most frequent cause of consultation at pediatric neurosurgical departments in Spain and other western countries. There is... (Review)
Review
INTRODUCTION
Positional plagiocephaly is currently the most frequent cause of consultation at pediatric neurosurgical departments in Spain and other western countries. There is considerable confusion in the literature on the terminology and physiopathology of this deformity, as well as its differential diagnosis with true synostosis and treatment recommendations.
OBJECTIVES
To clarify these concepts and present a protocol for the management of positional plagiocephaly, which was recently requested by the Health Administration of the Community of Madrid.
PROTOCOL
The protocol aims to achieve coordination among pediatricians and neurosurgeons, as well as to provide precise information on this deformity for parents, pediatricians and neurosurgeons.
MATERIAL AND METHODS
Previous consensus was reached on a series of data. Infants were classified into three categories of deformity (mild, moderate, severe) according to measurements on digital photographs. Diagnosis and treatment follows two phases: a pediatric phase (up to 5 months of age) and a neurosurgical phase (from 5 months onwards). Infants are referred to neurosurgical consultation only after being treated with postural changes and physiotherapy and only after reaching the age of 5 months. The reasons for this approach are explained in the protocol, which also defines the functions and responsibilities of each specialty.
CONCLUSION
The treatment proposed in the protocol is staged, starting with postural changes and physiotherapy, followed by orthotic cranial devices and finally surgical treatment.
Topics: Clinical Protocols; Humans; Infant; Infant, Newborn; Plagiocephaly, Nonsynostotic; Posture
PubMed: 17785163
DOI: 10.1016/s1695-4033(07)70615-x -
Zhongguo Dang Dai Er Ke Za Zhi =... Apr 2023To study the effects of infantile positional plagiocephaly on the growth and neural development.
OBJECTIVES
To study the effects of infantile positional plagiocephaly on the growth and neural development.
METHODS
A retrospective study was conducted on the medical data of 467 children who underwent craniographic examination and were followed up to 3 years of age in Peking University Third Hospital from June 2018 to May 2022. They were divided into four groups: mild positional plagiocephaly (=108), moderate positional plagiocephaly (=49), severe positional plagiocephaly (=12), and normal cranial shape (=298). The general information of the four groups and the weight, length, head circumference, visual acuity screening results, hearing test results, and the scores of Pediatric Neuropsychological Developmental Scales/Gesell Developmental Schedules of the four groups from 6 to 36 months old were compared.
RESULTS
The rates of adverse perinatal factors, congenital muscular torticollis, and supine fixed sleeping posture in the mild, moderate, and severe positional plagiocephaly groups were higher than the normal cranial group (<0.05). There was no significant difference in weight, length, and head circumference among the four groups at 6, 12, 24 and 36 months of age (>0.05). The incidence rate of abnormal vision in the severe positional plagiocephaly group was higher than that in the mild positional plagiocephaly, moderate positional plagiocephaly and normal cranial shape groups at 24 and 36 months of age (<0.05). The scores of the Pediatric Neuropsychological Developmental Scales at 12 and 24 months of age and the scores of the Gesell Developmental Schedules at 36 months of age in the severe positional plagiocephaly group were lower than those in the mild positional plagiocephaly, moderate positional plagiocephaly and normal cranial shape groups, but the difference was not statistically significant (>0.05).
CONCLUSIONS
Adverse perinatal factors, congenital muscular torticollis, and supine fixed sleeping position may be associated with infantile positional plagiocephaly. Mild or moderate positional plagiocephaly has no significant impact on the growth and neural development of children. Severe positional plagiocephaly have adverse effects on the visual acuity. However, it is not considered that severe positional plagiocephaly can affect the neurological development.
Topics: Child; Humans; Infant; Child, Preschool; Plagiocephaly, Nonsynostotic; Follow-Up Studies; Prognosis; Retrospective Studies
PubMed: 37073841
DOI: 10.7499/j.issn.1008-8830.2210031 -
Journal of Developmental and Behavioral... Oct 2005Over the past decade there has been a dramatic increase in referrals to specialty clinics, craniofacial centers, plastic surgeons, and neurosurgeons for assessment and... (Review)
Review
Over the past decade there has been a dramatic increase in referrals to specialty clinics, craniofacial centers, plastic surgeons, and neurosurgeons for assessment and treatment of deformational plagiocephaly (DP). Though considered a medically benign condition, preliminary reports suggest that DP may be associated with developmental problems. However, mechanisms to account for this association have not been hypothesized or empirically tested. Although treatment justifications often center on prevention of atypical appearance, little is known about the cosmetic outcomes of treated and untreated children. In this review we hypothesize different etiological pathways linking DP with neurodevelopment (e.g., environmental positioning limitations with and without underlying CNS pathology). We outline directions for research on incidence and prevalence, developmental outcomes, sex differences, determinants of treatment participation, and craniofacial appearance. Despite the paucity of existing research, preliminary findings suggest that children with this condition should be screened and monitored for developmental delays or deficits, as we await more conclusive information from future studies.
Topics: Cognition Disorders; Craniosynostoses; Developmental Disabilities; Female; Humans; Incidence; Infant; Male; Mass Screening; Prevalence
PubMed: 16222180
DOI: 10.1097/00004703-200510000-00008