Neurodevelopmental delay according to severity of deformational plagiocephaly in children.

The purpose of this study was to investigate the prevalence of neurodevelopmental delay among deformational plagiocephaly (DP) children, and to confirm relationship between neurodevelopmental delay and severity of DP.This study is retrospective study. Five hundred thirteen children who visited for abnormal head shape through outpatient department were recruited. To identify the children with neurodevelopmental delay among the 513 children with DP, Denver Development Screening Test (DDST) was performed in 38 children who suspected of neurodevelopmental delay. Cranial vault asymmetry (CVA) was measured by using caliper, and cranial vault asymmetry index (CVAI) was calculated. Thirty eight children with DP who conducted DDST were divided into 2 groups according to the degree of CVA; group 1 included 21 children with CVA under 10 mm, and group 2 included 17 children with CVA over 10 mm.There was a significant difference in number of neurodevelopmental delay between group 1 (n = 7) and group 2 (n = 14) (P < .05). Mean grade of DP, CVA, and CVAI (1.76 ±â€Š0.44, 5.90 ±â€Š2.21 mm, 4.20 ±â€Š1.51%) in group 1 was smaller than that in group 2 (3.41 ±â€Š0.8, 12.71 ±â€Š3.22 mm, 8.83 ±â€Š2.18%), respectively (P < .05).Our results found that the frequency of developmental delay was significantly increased in children with CVA more than 10 mm. Doctors who take care of children with DP had better keep developmental delays in mild.

Cognitive Outcomes and Positional Plagiocephaly.

: media-1vid110.1542/5972296741001PEDS-VA_2018-2373Video Abstract BACKGROUND: Studies have revealed an association between positional plagiocephaly and/or brachycephaly (PPB) and development, although little is known about long-term outcomes. We examined cognition and academic achievement in children with and without PPB, testing the hypothesis that children who had PPB as infants would score lower than controls. METHODS: We enrolled 187 school-aged children with a history of PPB and 149 controls. Exposures were the presence or absence and severity of infancy PPB (mild, moderate to severe). Cognitive and academic outcomes were assessed by using the Differential Ability Scales, Second Edition and Wechsler Individual Achievement Test, Third Edition, respectively. RESULTS: Children with PPB scored lower than controls on most scales of the Differential Ability Scales, Second Edition (standardized effect sizes [ESs] = -0.38 to -0.20) and the Wechsler Individual Achievement Test, Third Edition (ESs = -0.22 to -0.17). Analyses by PPB severity revealed meaningful differences among children with moderate to severe PPB (ESs = -0.47 to -0.23 for 8 of 9 outcomes), but few differences in children with mild PPB (ESs = -0.28 to 0.14). CONCLUSIONS: School-aged children with moderate to severe PPB scored lower than controls on cognitive and academic measures; associations were negligible among children with mild PPB. The findings do not necessarily imply that these associations are causal; rather, PPB may serve as a marker of developmental risk. Our findings suggest a role for assessing PPB severity in clinical practice: providing developmental assessment and intervention for infants with more severe deformation and reassurance and anticipatory guidance for patients with mild deformation.

Infant/toddler motor skills as predictors of cognition and language in children with and without positional skull deformation.

PURPOSE: To estimate associations between early motor abilities (at two age points, 7 and 18 months on average) and cognitive/language outcomes at age 3. To determine whether these associations are similar for children with and without positional plagiocephaly and/or brachycephaly (PPB). METHODS: The Bayley Scales of Infant/Toddler Development 3 were given at all age points to 235 children with PPB and 167 without PPB. Linear regressions assessed longitudinal associations between fine and gross motor scales and cognition/language. Item analyses examined the contributions of specific motor skills. RESULTS: Associations between 7-month motor skills and cognition/language were modest overall (effect sizes [ES] = - 0.08 to 0.10, p = .13 to .95). At 18 months, both fine and gross motor skills were associated with outcomes for children with PPB (ES = 0.21 to 0.41, p < .001 to .01), but among those without PPB, only fine motor skills were associated with outcomes (ES = 0.21 to 0.27, p < .001 to .001). CONCLUSIONS: Toddlers' motor skills were associated with cognition and language at 3 years, particularly among children with PPB. Interventions targeting early motor development in infants and toddlers with PPB may have downstream benefits for other outcomes.

Prevalence and Consequences of Positional Plagiocephaly and Brachycephaly.

The incidence of positional plagiocephaly and brachycephaly in infants has increased. Treatment options include physiotherapy and helmet therapy.No information exists on the prevalence, cosmetic, and psychological consequences of plagiocephaly and brachycephaly later in life. This study was performed to assess the prevalence and cosmetic relevance of plagiocephaly and brachycephaly, as well as its influence on quality of life in adolescence.The authors performed plagiocephalomety to assess cranial shape and used a questionnaire that included question about educational level, medical history, cosmetic appearance, and cranial shape. To evaluate quality of life, the authors used the KIDSCREEN-27 questionnaire.All data were analyzed using SPSS version 19.0 2010. The authors included 87 adolescents. The prevalence of plagiocephaly, defined as an oblique diameter difference index (ODDI) higher than 106%, was 10.3%; the prevalence of brachycephaly, defined as a cranial proportional index (CPI) higher than 95%, was 0%.There was no significant correlation between the level of the ODDI or CPI and the cosmetic assessment of cranial shape (P = 0.128/0.541). There was no significant correlation with the level of the ODDI (P = 0.428).There was no significant correlation between the level of the ODDI or CPI and the average T-value for quality of life using the KIDSCREEN quality-of-life questionnaire (P = 0.461/0.713). The prevalence of positional deformities in our population of adolescents, born after the "back to sleep" campaign, is low. There was no significant correlation between the presence of a cranial deformity and the cosmetic judgement and quality of life.

Positional cranial deformity--the parents' point of view.

The parents' point of view regarding positional cranial deformities and helmet therapy has not been the subject of scientific interest yet. However, carer acceptance is a key factor for therapeutic success. We therefore investigated parental perception. The parents of 218 infants were included in a telephone survey; 122 children had undergone helmet therapy and 96 had not. Satisfaction with the outcome, treatment-associated problems, and parental stress were investigated using a structured questionnaire. The great majority (90.8%) of caregivers were satisfied with the outcome, regardless of whether or not helmet therapy was used. Retrospectively, 76% of the parents of infants who had not undergone helmet therapy would decide against helmet therapy again. Therapy was either temporarily stopped (27.0%) or terminated (4.9%) in 31.9% of infants treated with a helmet. Major problems were sweating (51.1%) and skin lacerations (30.9%). The parents indicated minor (54.9%) or even great (25.4%) personal strain. Conflict with others (38.5%), stress for the child (30.3%), and a financial burden (36.9%) were mentioned most frequently. There appear to be more parental problems than expected associated with helmet therapy. Medical experts should take this into consideration. The indication for a helmet should be evaluated critically and the potential parental burdens should be addressed during counselling.

Long-term satisfaction and parental decision making about treatment of deformational plagiocephaly.

The incidence of deformational plagiocephaly (DP) has increased greatly during the last 2 decades since the recommendation of supine sleeping. Currently, there are 2 treatment options for DP, helmet therapy and repositioning therapy. This research investigated factors that influenced parental decision making about treatment choice and long-term satisfaction with head shape. A retrospective chart review identified 1660 children, now aged 2 to 10 years, seen in the DP clinic meeting inclusion criteria. Questionnaires were mailed to all eligible families. Four-hundred fifty-six completed questionnaires were returned. The questionnaires evaluated demographics of the family, factors that influenced treatment choice, and satisfaction with current head shape. Most of the respondents had white (93%) and male (70%) children. The mothers' mean age at the time of childbirth was 31 years; most of the mothers had a college degree or higher (77%) and household incomes of more than $76,000 (52.6%). Fifteen factors were used to evaluate which ones were significant in influencing parental treatment choice. Severity of the DP and time off work for follow-up appointments were the only 2 factors identified that significantly affected treatment choice. More parents who used helmet therapy reported that they were satisfied with their child's long-term head shape and would choose the same treatment again (P = 0.002) compared with those who used repositioning therapy.

Development at age 36 months in children with deformational plagiocephaly.

OBJECTIVES: Infants and toddlers with deformational plagiocephaly (DP) have been shown to score lower on developmental measures than unaffected children. To determine whether these differences persist, we examined development in 36-month-old children with and without a history of DP. METHODS: Participants included 224 children with DP and 231 children without diagnosed DP, all of who had been followed in a longitudinal study since infancy. To confirm the presence or absence of DP, pediatricians blinded to children's case status rated 3-dimensional cranial images taken when children were 7 months old on average. The Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) was administered as a measure of child development. RESULTS: Children with DP scored lower on all scales of the BSID-III than children without DP. Differences were largest in cognition, language, and parent-reported adaptive behavior (adjusted differences = -2.9 to -4.4 standard score points) and smallest in motor development (adjusted difference = -2.7). Children in the control group who did not have previously diagnosed DP but who were later rated by pediatricians to have at least mild cranial deformation also scored lower on the BSID-III than unaffected controls. CONCLUSIONS: Preschool-aged children with a history of DP continue to receive lower developmental scores than unaffected controls. These findings do not imply that DP causes developmental problems, but DP may nonetheless serve as a marker of developmental risk. We encourage clinicians to screen children with DP for developmental concerns to facilitate early identification and intervention.

Cosmetic and cognitive outcomes of positional plagiocephaly treatment.

PURPOSE: Positional plagiocephaly is an acquired deformation of an intrinsically normal infant skull by sustained or excessive extrinsic forces. Non-surgical techniques include counter-positioning, supervised prone time and orthotic molding for more refractory cases. Long-term effects of positional plagiocephaly on development remain undefined, and this study evaluated cosmetic and cognitive outcomes of plagiocephaly management. METHOD: Surveys were administered to parents of patients treated for positional plagiocephaly through the Children's Hospital of Eastern Ontario. Categorical responses interrogated cosmetic outcome, school performance, language skills, cognitive development and societal function. Pearson coefficient analysis tested outcomes dependency on gender, age, and plagiocephaly side at the 0.05 level of significance. RESULTS: Eighty respondents (51 male, 29 female) were divided as 58 right- and 22 left-sided pathology. Positional therapy was uniformly applied, and a helmet orthosis was utilized in 36% of cases. Median follow-up age was nine years with normal head appearance in 75% of cases. Only 4% of parents and 9% of patients observed significant residual asymmetry. These results did not vary by gender, age or deformity side. Left-sided disease predicted poorer language development and academic performance. Expressive speech abnormality occurred in twice as many patients with left-sided disease (36% versus 16%, p=0.04) along with three-fold greater special education requirements (27% versus 10%, p=0.04). CONCLUSIONS: Non-surgical plagiocephaly management achieved good cosmetic outcome among patients in this study. Children with left-sided disease frequently encountered difficulties with cognitive and scholastic endeavors, although the roles of the underlying disease and the treatment measures in this delay cannot be differentiated.

HElmet therapy Assessment in infants with Deformed Skulls (HEADS): protocol for a randomised controlled trial.

BACKGROUND: In The Netherlands, helmet therapy is a commonly used treatment in infants with skull deformation (deformational plagiocephaly or deformational brachycephaly). However, evidence of the effectiveness of this treatment remains lacking. The HEADS study (HElmet therapy Assessment in Deformed Skulls) aims to determine the effects and costs of helmet therapy compared to no helmet therapy in infants with moderate to severe skull deformation. METHODS/DESIGN: Pragmatic randomised controlled trial (RCT) nested in a cohort study. The cohort study included infants with a positional preference and/or skull deformation at two to four months (first assessment). At 5 months of age, all children were assessed again and infants meeting the criteria for helmet therapy were asked to participate in the RCT. Participants were randomly allocated to either helmet therapy or no helmet therapy. Parents of eligible infants that do not agree with enrolment in the RCT were invited to stay enrolled for follow up in a non-randomisedrandomised controlled trial (nRCT); they were then free to make the decision to start helmet therapy or not. Follow-up assessments took place at 8, 12 and 24 months of age. The main outcome will be head shape at 24 months that is measured using plagiocephalometry. Secondary outcomes will be satisfaction of parents and professionals with the appearance of the child, parental concerns about the future, anxiety level and satisfaction with the treatment, motor development and quality of life of the infant. Finally, compliance and costs will also be determined. DISCUSSION: HEADS will be the first study presenting data from an RCT on the effectiveness of helmet therapy. Outcomes will be important for affected children and their parents, health care professionals and future treatment policies. Our findings are likely to influence the reimbursement policies of health insurance companies.Besides these health outcomes, we will be able to address several methodological questions, e.g. do participants in an RCT represent the eligible target population and do outcomes of the RCT differ from outcomes found in the nRCT? TRIAL REGISTRATION: ISRCTN18473161.

Deformational plagiocephaly: a follow-up of head shape, parental concern and neurodevelopment at ages 3 and 4 years.

OBJECTIVES: To compare head shape measurements, parental concern about head shape and developmental delays in infancy with measurements obtained at follow-up at ages 3 and 4 years. DESIGN: Longitudinal cohort study. SETTING: Initial assessments were conducted at a plagiocephaly clinic; follow-up assessments were conducted in the children's homes. PARTICIPANTS: 129 children with a mean age of 4 years (range 3 years 3 months to 4 years 9 months), all of whom were diagnosed in infancy with deformational plagiocephaly or brachycephaly. MAIN OUTCOME MEASURES: Head shape measurements of cephalic index and oblique cranial length ratio; level of parental concern about head shape; and delays on parent-completed age-appropriate Ages and Stages Questionnaires. RESULTS: 61% of head shape measurements reverted to the normal range; 4% remained severe at follow-up. Brachycephaly improved more than plagiocephaly. Facial and frontal asymmetry reduced to almost nil. Most had good improvement, but 13% were categorised as having 'poor improvement'. Initially, 85% of parents reported being 'somewhat' or 'very' concerned; this decreased to 13% at follow-up. The percentage of children with ≥1 delay decreased from 41% initially to 11% at follow-up. CONCLUSIONS: Overall, head shape measurements, parental concern and developmental delays in infancy showed a dramatic improvement when re-measured at 3 and 4 years of age.