Patient evaluation

Examination of the infant skull is essential to differentiate deformational skull shape abnormalities from deformities secondary to craniosynostosis.

What is craniosynostosis?

The Clinicians at The Pediatric HeadShape Clinic have all received specialized training to recognize Craniosynostosis. Craniosynostosis is the premature closure of one or more cranial sutures. Craniosynostosis causes restriction of growth at the suture and abnormal growth perpendicular to the fused suture. Early referral to a specialist is always recommended. There are different types of craniosynostosis, including: sagittal, coronal, metopic and lambdoid. Infants diagnosed with craniosynostosis usually require surgery and should be referred immediately to a paediatric neurosurgeon or craniofacial specialist for further evaluation and treatment. Early diagnosis is vital. Endoscopic surgeries are often recommended before three months of age.

Evaluating neck strength and range of motion for torticollis

  • Evaluate active neck strength and range of motion to determine whether torticollis or a positional neck preference is contributing to the abnormal skull shape
  • Stimulate the infant to visually track an object to each side. Babies with torticollis may compensate for limited range by turning the shoulders at the endpoint of their range or tipping their head back while simultaneously jutting their chin forward
  • Assess head tilt, skin fold symmetry and occipital hair growth patterns, which may indicate prolonged head/neck positioning
  • Hold the infant at arm’s length and gently tip to each side. If the baby shows asymmetric head righting ability, neck weakness or limitation may be present
  • Refer the infant to a paediatric physical therapist if torticollis or neck asymmetry is present, particularly if a home developmental programme fails to resolve the problem after three months of age

Can deformational plagiocephaly be prevented?

While not all deformational plagiocephaly cases will correct on their own, there are some efforts that can help prevent or reduce its effects:

  • Timely diagnosis and protocol referenced treatment including acquiring accurate anthropometric data
  • Comprehensive and timely parent education especially in high risk cases
  • Frequent changes in body and head positions (repositioning strategies) incorporated into a tummy time home programme
  • Prone positioning when the infant is awake and supervised
  • Limit time in carriers and positioning devices
  • Use of a cranial remolding orthosis when indicated
  • Prescribe paediatric physiotherapy or occupational therapy at three months or earlier if there is:
    • Strong positional head/neck preference
    • Torticollis
    • Developmental delay
    • Cranial deformity

Assessment of severity and suggested action

The Pediatric HeadShape Clinic is your “one-stop shop” for all things HeadShape! Once your consultation has been completed, there are many options we can discuss with your family. We can provide your family with ongoing screening, referral to one of our clinical partners, provide you with select preventative products or custom made cranial orthoses, if needed.

Treatment of plagiocephaly with a cranial remolding orthosis

Cranial remolding orthoses derive their name from their purpose — symmetry through active remolding

  • Functions to accommodate growth, promote symmetry and improve proportion
  • Refer for a cranial remolding orthosis if the skull deformity is moderate to severe. Mild deformities should be documented and monitored
  • Ideal cranial orthosis treatment results are achieved when infants begin treatment before six months of age when the skull is rapidly growing.
  • The cranial band is best prescribed during the 1st year of life, but can be used on infants up to 18 months of age
  • Multiple studies have demonstrated that cranial remolding orthoses are more effective than repositioning in correcting skull deformities
  • Many infants benefit from concurrent physical therapy and orthotic intervention, particularly if the infant has significant neck/torticollis issues
  • The Band gently molds the infant’s skull into a more symmetrical and well-proportioned shape
  • The Bands we treat with are proven and safe, with 510k clearance from the FDA and/or Licensed by the Canadian Medical Devices regulator.
  • Depending on age and severity, we have night-time only and full-time use Cranial Bands. Both are used for an average of three to four months
  • Most infants successfully complete treatment for plagiocephaly with a single Cranial Band. If needed, we are the only clinic to provide a “Retainer” Band once head shape symmetry has been achieved.
  • Treatment success directly correlates with parental compliance

Contraindications of cranial remolding orthoses

Infants with head shape asymmetry are not candidates for cranial remolding orthosis treatment if:

  • The infant is younger than three months
  • The infant is older than 18 months
  • The infant has untreated craniosynostosis
  • The infant has hydrocephalus

Laser data acquisition system

The Spectra scanner is a non-contact laser data acquisition system used by leading physicians, hospitals and treatment centres throughout the world, including The Pediatric HeadShape Clinics.

  • Accurate—scans to an accuracy of +/- 0.5 m
  • Fast head shape acquisition
  • Provides precise anthropometric data and measurements
  • Infant can be scanned to follow progression of deformity prior to treatment
  • Provides pre-treatment documentation for medical justification and insurance coverage
  • Ongoing measurements for evaluation of progress throughout treatment
  • Comparisons can be utilised to determine modifications
  • Software can compare head shape changes over time
  • Assessment tool to determine need for treatment

Key benefits:

  • Used in the leading prestigious paediatric care institutions in the world
  • Scans infant’s head shape in five seconds or less
  • Captures 3-D data that can be viewed in multiple planes
  • Allows comparison to previous scanning results enabling outcome review
  • Facilitates improved insurance and third party communication
  • Facilitates improved documentation and care pathway introduction
  • Detailed scan reports are filed in the patient file

Information based on research from MEDICLINIC