MISCONCEPTIONS

COMMON PLAGIOCEPHALY MISCONCEPTIONS

Paediatric head deformity will resolve itself
It is a misconception that the infant’s head “will round out on its own as the child becomes more active, begins to roll over, and learns to sit up.” This is based in part on outdated scales of motor development and a lack of understanding on the effect of supine sleep positioning. The pattern of early motor development is affected by sleep position. On average, supine sleepers attain common motor milestones later than prone sleepers. Prior to 1992, infants’ heads often corrected in the first few months of life because infants that were placed prone to sleep were generally in a variety of positions during the day, thus avoiding prolonged time in one position. Now that supine is the position of choice and there is a four to six week delay in the acquisition of head and trunk control, infants’ heads often do not “round out” as they did previously. The role of thorough parental education, repositioning, and paediatric physical therapy when ROM issues are present needs emphasis.

It is only a cosmetic issue
Classifying cranial deformity as a cosmetic issue is oversimplified and not evidence based. When left untreated, moderate to severe deformity may lead to significant cosmetic and functional–neurological and psychological consequences. For example, the pressure exerted on the intraorbital muscles and nerves, among others, can result in sensory and motor disturbances. As a consequence, infants with head deformities attempt to compensate for the head’s abnormal orientation in space which can result in ocular and vestibular impairment.

Skull deformities are well known for inducing an inferiority complex in childhood. As adults, social issues as a result of the visible deformity are compounded by difficulties in wearing glasses and auricular asymmetries, hair style problems, temporo-mandibular joint asymmetries and teeth alignment problems.

The window of opportunity and correction is up to 12 or even 16 months of age
Though correction can be achieved up to 16 months of age, it’s important to understand the skull undergoes 85% of its postnatal growth within the first year of life. Early recognition and treatment within this small window of opportunity is paramount. Paediatric physical therapy can greatly aid motor development, and assist in reducing the effects of torticollis presentations.

In the “severe” deformation group, the earlier the cranial orthotic is treatment started, the higher symmetry ratio recovery is obtained. Treatment is especially effective when started in four-month old infants. The “mild” deformation group showed that cranial orthotic remolding was most effective if treatment started before six months of age.

The deformity is only on the back of the head, and probably will be covered with hair
The deformation of one element leads to compensatory deformation and displacement of all other connected elements. This can include facial deformation, mandibular asymmetry, congenital and/or acquired muscular torticollis, abnormal eye placement, external ear deformity and misalignment, orbital asymmetry resulting in strabismus and other ocular problems.

In addition abnormal cranial height, abnormal cranial width/breadth, and occipital flattening with ipsilateral forehead bossing may be present. This compensation for the head’s abnormal orientation in space results in ocular and vestibular impairment and distortion of the orbits with pressure on the extraocular muscles and nerves, resulting in sensorimotor disturbances

Cranial remolding orthosis only correct the posterior (occipital) flatness
Cranial orthotics fitted and managed correctly have a direct effect on frontal, parietal, sphenoid, temporal, and one of the occipital bones of the neurocranium. Indirectly, it affects the entire facial alignment (i.e. viscerocranium) due to the direct transfer of forces through the neurocranial structures. Throughout the orthotic treatment programme, measurable changes in the cranial base, cranial vault, orbitotragial depth, and cephalic index are documented. By returning the cranial and facial bones to a normal alignment, long-term dysfunction to hearing, vision, and mandibular mechanics could likely be avoided

Cranial remolding orthoses are uncomfortable to the baby and might be unsafe
The vast majority of infants have very few problems tolerating the orthotic. As can be expected, specialized care and proper fitting insures comfort and compliance. Clarren et al. and numerous other studies documented the safety and efficacy of cranial remolding orthosis for positional plagiocephaly and other positional cranial deformities.

Cranial orthotics management is not approved by insurance companies
In the event protocols are adhered too, early repositioning attempted and chronological referenced anthropometric measurements indicate, most insurance companies consider cranial remodeling orthotics as medically necessary for treatment of moderate to severe positional head deformities.

Unresolved asymmetric cranial deformity.

Information based on research from MEDICLINIC

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