Positional Plagiocephaly: Effectiveness of Current Guidelines
Positional Plagiocephaly: Effectiveness of Current Guidelines
Object Positional plagiocephaly (PP) has been on the rise in recent years. In this review, the authors' aim was to assess the effectiveness of current recommendations to parents on this exceedingly common problem through a comprehensive literature search. Additionally, the current treatment options and the most recent studies on PP are reviewed.
Methods A search of the existing literature was conducted to obtain all relevant studies on guidelines, recommendations, parental and clinician practices, and epidemiological aspects.
Results Although the incidence and risk factors for PP have been well delineated, there continues to be debates on its management and association with developmental delays. Current guidelines and recommendations on prevention set by the American Association of Pediatrics may not be easily followed by both parents and clinicians. There is also evidence that certain populations, including those with lower education, socioeconomic status, and in particular geographic regions may be more affected by the condition. Additionally, the marketing and financial aspects of PP treatments exist and should be addressed.
Conclusions Better awareness and education are necessary to inform the population as a whole, although certain populations should be given special attention. Additionally, current guidelines and recommendations can be modified to foster a better grasp of the condition by both parents and clinicians. Adjusting current recommendations, introducing initiatives, and offering elaborate educational campaigns would help deliver these aims. Educating parents on PP as early as possible through clearer guidelines and close monitoring is central to preventing and managing this common condition.
Asymmetrical deformity in an infant's cranium is referred to as plagiocephaly, a condition that has been on the rise over the past few decades following the recommendation to place infants in a supine sleeping position. This term can be used to describe asymmetry in the skull resulting from both nonsynostotic and synostotic causes, or primary premature suture closure, which is much rarer. Positional plagiocephaly (PP), also referred to as deformational plagiocephaly, occurs in the absence of suture synostosis and is due to external forces that deform the shape of the skull; forces such as those present when infants are placed supine. In this condition there is flattening of one side of the occiput, with anterior displacement of the ipsilateral ear. The region of occipital flattening relates to the side that the head is toward when in the supine sleeping position. Prior to the American Academy of Pediatrics (AAP) "Back to Sleep" (BTS) campaign, the incidence of PP was relatively low. Following this recommendation there was a gradual rise in its incidence, making it currently an especially common presentation at physicians' offices.
Considering the alarming increase in the incidence of PP, there has been much interest in investigating, managing, and preventing this condition. Figure 1 outlines the increase in publications concerning the deformity over recent decades.
(Enlarge Image)
Figure 1.
Graph showing number of publications concerning plagiocephaly between 1974 and the present. Note the increase beginning in 1996, a few years after the "Back to Sleep" campaign began.
Our aim, through a comprehensive literature search, was to assess the impact and effectiveness of the current guidelines and recommendations to parents. In addition, we reviewed current treatment options and we provide an update on the most recent studies regarding managing and preventing PP.
Abstract and Introduction
Abstract
Object Positional plagiocephaly (PP) has been on the rise in recent years. In this review, the authors' aim was to assess the effectiveness of current recommendations to parents on this exceedingly common problem through a comprehensive literature search. Additionally, the current treatment options and the most recent studies on PP are reviewed.
Methods A search of the existing literature was conducted to obtain all relevant studies on guidelines, recommendations, parental and clinician practices, and epidemiological aspects.
Results Although the incidence and risk factors for PP have been well delineated, there continues to be debates on its management and association with developmental delays. Current guidelines and recommendations on prevention set by the American Association of Pediatrics may not be easily followed by both parents and clinicians. There is also evidence that certain populations, including those with lower education, socioeconomic status, and in particular geographic regions may be more affected by the condition. Additionally, the marketing and financial aspects of PP treatments exist and should be addressed.
Conclusions Better awareness and education are necessary to inform the population as a whole, although certain populations should be given special attention. Additionally, current guidelines and recommendations can be modified to foster a better grasp of the condition by both parents and clinicians. Adjusting current recommendations, introducing initiatives, and offering elaborate educational campaigns would help deliver these aims. Educating parents on PP as early as possible through clearer guidelines and close monitoring is central to preventing and managing this common condition.
Introduction
Asymmetrical deformity in an infant's cranium is referred to as plagiocephaly, a condition that has been on the rise over the past few decades following the recommendation to place infants in a supine sleeping position. This term can be used to describe asymmetry in the skull resulting from both nonsynostotic and synostotic causes, or primary premature suture closure, which is much rarer. Positional plagiocephaly (PP), also referred to as deformational plagiocephaly, occurs in the absence of suture synostosis and is due to external forces that deform the shape of the skull; forces such as those present when infants are placed supine. In this condition there is flattening of one side of the occiput, with anterior displacement of the ipsilateral ear. The region of occipital flattening relates to the side that the head is toward when in the supine sleeping position. Prior to the American Academy of Pediatrics (AAP) "Back to Sleep" (BTS) campaign, the incidence of PP was relatively low. Following this recommendation there was a gradual rise in its incidence, making it currently an especially common presentation at physicians' offices.
Considering the alarming increase in the incidence of PP, there has been much interest in investigating, managing, and preventing this condition. Figure 1 outlines the increase in publications concerning the deformity over recent decades.
(Enlarge Image)
Figure 1.
Graph showing number of publications concerning plagiocephaly between 1974 and the present. Note the increase beginning in 1996, a few years after the "Back to Sleep" campaign began.
Our aim, through a comprehensive literature search, was to assess the impact and effectiveness of the current guidelines and recommendations to parents. In addition, we reviewed current treatment options and we provide an update on the most recent studies regarding managing and preventing PP.