Management of deformational plagiocephaly: repositioning versus orthotic therapy

J Pediatr. 2005 Feb;146(2):258-62. doi: 10.1016/j.jpeds.2004.10.016.


Objectives: We compare positioning with orthotic therapy in 298 consecutive infants referred for correction of head asymmetry.

Study design: We evaluated 176 infants treated with repositioning, 159 treated with helmets, and 37 treated with initial repositioning followed by helmet therapy when treatment failed. We compared reductions in diagonal difference (RDD) between repositioning and cranial orthotic therapy. Helmets were routinely used for infants older than 6 months with DD >1 cm.

Results: For infants treated with repositioning at a mean age of 4.8 months, the mean RDD was 0.55 cm (from an initial mean DD of 1.05 cm). For infants treated with cranial orthotics at a mean age of 6.6 months, the mean RDD was 0.71 cm (from an initial mean DD of 1.13 cm).

Conclusions: Infants treated with orthotics were older and required a longer length of treatment (4.2 vs 3.5 months). Infants treated with orthosis had a mean final DD closer to the DD in unaffected infants (0.3 +/- 0.1 cm), orthotic therapy was more effective than repositioning (61% decrease versus 52% decrease in DD), and early orthosis was significantly more effective than later orthosis (65% decrease versus 51% decrease in DD).

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Age Factors
  • Eye Diseases / etiology
  • Eye Diseases / therapy
  • Female
  • Head Protective Devices
  • Humans
  • Infant
  • Longitudinal Studies
  • Male
  • Plagiocephaly, Nonsynostotic / complications
  • Plagiocephaly, Nonsynostotic / physiopathology
  • Plagiocephaly, Nonsynostotic / therapy*
  • Skull / abnormalities
  • Supine Position / physiology*
  • Treatment Outcome