History of Management of Positional Plagiocephaly in Children

Understanding of Disease

• 1981 – Description of positional plagiocephaly: Positional plagiocephaly was recognized several decades ago but received little attention due to a prevalence of only approximately 1 in 300 (8). 
• 1992 – Back-to-sleep campaign: Positional plagiocephaly has become much more common since 1992.  This increase in prevalence to up to 46.6%% at 3 months of age is likely secondary to the AAP Task Force on Infant Positioning and SIDS recommendation that healthy infants be positioned on their backs when put down for sleep (1, 2, 3, 37, 46). 
• 1990s – 2000s: Increase use of devices of convenience: Complex cranial distortion caused by frequent use and increased time in car seats, infant carriers, bouncy seats and infant swings (31).

Technological Development

• Cranial orthotics for severe or refractory cases: For those infants with severe positional plagiocephaly or those that fail to improve with repositioning by 6 months of age, many can be treated with cranial orthotic devices, also known as cranial bands or helmets.  The cranial orthotic is typically worn 23 hours per day, for 3 months or longer (49).

Surgical Technique

• Surgery is typically not recommended: The only evolution in the surgical treatment of this condition has been its abandonment in all but the most unusual cases. There is rarely a role for surgery in the management of positional plagiocephaly (36).