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14
Jul

Positional Plagiocephaly

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Pediatric neurologist or child neurologist usually deals with Positional skull deformity (PSD) that is a common problem of infancy. Approximately 45% of infants ages 7 to 12 weeks are estimated to have PSD, although three-quarters of them have mild cases.The incidence of PSD began to increase in 1992 after the American Academy of Pediatrics (AAP) introduced its “Back to Sleep” campaign, which encouraged parents to place their infants on their back at bedtime to reduce sudden infant death syndrome. PSD is a common problem in the field of child neurology or pediatric neurology. Dr Hamza Alsayouf used to run a clinic called plagiocephaly and craniosynostosis clinic.

There are 2 common forms of PSD: plagiocephaly, and brachycephaly. Plagiocephaly is unilateral occipital flattening, which may be accompanied by ipsilateral forehead prominence and asymmetrical ears. Brachycephaly is symmetric flattening of the back of the head, which can lead to prominence of the temporal areas, making the head appear wide. Children with severe plagiocephaly have a misshapen, asymmetric skull, while children with brachycephaly have a flattened skull. The cranial sutures remain open in both kinds of PSD.

Evaluating infants for PSD is part of the routine physical exam, and when the condition is noted, the exam should also differentiate PSD from other causes of skull deformity, such as craniosynostosis. Infants and preschool-aged children with PSD may score lower on developmental testing than children without skull deformity. However, these differences are small and inconsistent (2-3 points on a 100-point scale). Skull deformity persists into adolescence in only 1% to 2% of patients.

Neither the AAP nor the American Academy of Family Physicians has a guideline or consensus statement on PSD. Helmets are intended to correct PSD by fitting closely to an infant’s head but allowing room for the skill to grow at the flattened area. A 2011 clinical report by Laughlin et al recommended against using helmets for infants with mild to moderate deformities, but stated that there was little evidence of harm. Earlier studies have suggested that physical therapy might be effective for plagiocephaly caught early (7 and 8 weeks of age). Biggs suggested considering helmet therapy for infants whose cranial sutures remain open and who do not respond to 4 to 8 weeks of physical therapy for PSD. van Wijk et al conducted an RCT to explore the risks and benefits of helmet therapy for children with PSD. Plagiocephaly is seen commonly in the field of pediatric neurology or child neurology. It is better managed by a pediatric neurologist or child neurologist who has experience in treating such cases.

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