Management of Patients with Positional Plagiocephaly
Publication Date: November 1, 2016
Last Updated: March 14, 2022
RECOMMENDATIONS
1. Clinical examination is recommended for the diagnosis of plagiocephaly, and imaging is rarely necessary, except in cases in which clinical diagnosis is equivocal.
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2. In cases in which the clinical examination is equivocal, 3-dimensional surface imaging or stereophotogrammetry is recommended for the assessment of infants with plagiocephaly without synostosis. (Level II)
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3. In cases in which the clinical examination is equivocal, surface imaging (computer-based topographical scans) or stereophotogrammetry is recommended for the assessment of infants with plagiocephaly without synostosis. (Level III)
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4. Only for infants in whom x-rays or ultrasound is nondiagnostic, a computed tomography scan is recommended for definitive diagnosis. (Level III)
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5. Repositioning is an effective treatment for deformational plagiocephaly. However, there is Class I evidence from a single study and Class II evidence from several studies that repositioning is inferior to physical therapy and to use of a helmet, respectively.
- repositioning is inferior to physical therapy
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6. Physical therapy is recommended over repositioning education alone for reducing prevalence of infantile positional plagiocephaly in infants 7 weeks of age or older. (Level I)
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7. Physical therapy is as effective for the treatment of positional plagiocephaly as a positioning pillow, but physical therapy is recommended over the use of a positioning pillow to ensure a safe sleeping environment, in compliance with American Academy of Pediatrics (AAP) recommendations. (Level II)
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8. Physical therapy is recommended over repositioning education alone for reducing prevalence of infantile positional plagiocephaly in infants 7 weeks of age. (Level I)
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9. Physical therapy is as effective for the treatment of positional plagiocephaly and recommended over the use of a positioning pillow to ensure a safe sleeping environment and comply with American Academy of Pediatrics (AAP) recommendations. (Level I)
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10. Helmet therapy is recommended for infants with persistent moderate to severe plagiocephaly after a course of conservative treatment (repositioning and/or physical therapy). (Level II)
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11. Helmet therapy is recommended for infants with moderate to severe plagiocephaly presenting at an advanced age. (Level II)
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Title
Management of Patients with Positional Plagiocephaly
Authoring Organization
Congress of Neurological Surgeons
Publication Month/Year
November 1, 2016
Last Updated Month/Year
April 13, 2023
External Publication Status
Published
Country of Publication
US
Document Objectives
To create evidence-based guidelines for the treatment of pediatric positional plagiocephaly.
Target Patient Population
Infants with positional plagiocephaly
Inclusion Criteria
Female, Male, Infant
Health Care Settings
Ambulatory, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management, Treatment
Diseases/Conditions (MeSH)
D049068 - Plagiocephaly, Nonsynostotic, D059041 - Plagiocephaly
Keywords
infants, positional plagiocephaly