Deformational plagiocephaly and craniosynostosis: trends in diagnosis and treatment after the "back to sleep" campaign

J Craniofac Surg. 2015 Jan;26(1):147-50. doi: 10.1097/SCS.0000000000001401.

Abstract

Background: In 1992, the American Academy of Pediatrics discouraged prone sleeping positions because of its association with sudden infant death syndrome. After this was an increased incidence of deformational plagiocephaly (DP).

Methods: A retrospective review was completed for patients with DP and craniosynostosis seen by plastic surgeons at a tertiary medical center during a 19-year period. Two groups of patients were evaluated before (1988-1995) and after (1996-2007) implementation of the "Back to Sleep" campaign.

Results: Of the 5169 patients, those with craniosynostosis (n = 279) had a mean age at initial evaluation before and after 1996 of 12.4 versus 5.6 months (P = 0.0008). There was a trend of decreasing age at initial evaluation and first surgery after 1996. For patients with DP (n = 4890), the mean age at initial evaluation before and after 1996 was 11.5 versus 6.0 months (P = 0.10). There was a trend of decreasing age at initial evaluation and DP correction after 1996. The majority of patients had right-sided DP (50.2%), followed by left-sided (24.7%) and bilateral (18.9%). There was no significant difference in DP correction rate (67% versus 87%) or the mean age that DP was corrected (12.8 versus 11.8 mo) before and after 1996. Compared with 1996 to 1999, there was a 214% and 390% increase in DP referrals from 2000 to 2003 and 2004 to 2007. For craniosynostosis, there was a 27% and 129% increase in referrals.

Conclusions: The increasing incidence of DP since the Back to Sleep campaign is concerning, but a positive outcome is that patients are being referred and treated at a younger age.

MeSH terms

  • Acrocephalosyndactylia / epidemiology
  • Age of Onset
  • Comorbidity
  • Craniosynostoses / diagnosis*
  • Craniosynostoses / epidemiology
  • Craniosynostoses / surgery*
  • Female
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Infant, Premature, Diseases / epidemiology
  • Male
  • Otitis / epidemiology
  • Plagiocephaly, Nonsynostotic / diagnosis*
  • Plagiocephaly, Nonsynostotic / epidemiology
  • Plagiocephaly, Nonsynostotic / surgery*
  • Plastic Surgery Procedures / statistics & numerical data
  • Prone Position*
  • Referral and Consultation / statistics & numerical data
  • Retrospective Studies
  • Sudden Infant Death / prevention & control
  • United States / epidemiology