Prevention and management

Abstract

The incidence of posterior plagiocephaly had significantly increased since the AAP (American Academy of Pediatrics) published a position statement recommending that all infants be placed to sleep in supine position with the intended purpose of decreasing the incidence of sudden infant death syndrome (SIDS). Positional plagiocephaly results when an external molding force is applied to the infant’s skull and is characterized by changes in skull shape that results from mechanical forces in prenatal or postnatal age. The recent rise in the incidence of PPP could be related, beyond sleeping supine, to a lack of stimulation and to little encouragement to physical movement. Pediatricians need to be able to properly diagnose skull deformities, to educate parents on methods to proactively decrease the likelihood of the development of occipital flattening, to start appropriate management, and to make referrals when necessary. Early postnatal intervention in the maternity ward reduces the prevalence of PPP. A simple and inexpensive intervention shortly after birth, offering information on environmental measures that promote the newborn’s spontaneous and unhindered movement, leads to a significant reduction of PPP prevalence while at the same time corresponding to recommendations for avoiding SIDS. Along with supine sleep position, it is essential to provide supervised prone playtime, as well as repositioning during the day to avoid gross motor milestone delays, head molding, shoulder retraction, and associated postural torticollis. Conservative strategies to prevent or treat PPP are parental counseling, counterpositioning, and physical therapy. Osteopathy could be a complementary therapeutic approach. In most severe cases or following late diagnosis, a cranial orthotic treatment could be employed.