Best Practice for Conservative
Management of Plagiocephaly:
Prevention
What is Plagiocephaly??
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“skewed head”
Mechanical factors
alter head shape
Post natal
positioning of
infant on same side
of head
Parallelogram
Incidence:
‘Back to Sleep” campaign: SIDS
 Incidence of SIDS reduced from
2.6/1000 in 1986 to 1/1000 in 1998
 Incidence of plagiocephaly has
increased from 1/300 to 1/60
between 1974 and 1996
 Huge increase in referrals to
physiotherapy
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Objectives:
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To review the evidence for the best
practice in the conservative management
of infants with Plagiocephaly
To develop guidelines for physiotherapy
management of infants who are seen
through the EIP Program
Ensure knowledge transfer occurs to
clinicians at QACCH
Literature Review:
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1 Systematic Review: Bialocerowski et al reviewed
all research reports related to conservative
management between Jan 1983 and December
2003. Two studies subsequent to Bialocerowski
were also evaluated
Of 18 studies reviewed, none were RCT’s. ie Level
I evidence All were case series or comparison
studies, not randomly assigned, ie. Level III or IV.
Considerable biases were present within each
study.
Centre protocols, based on expert opinion of best
practice, influenced many study designs
Treatment of existing positional
plagiocephaly
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Counterpositioning is
recommended for babies up
to about 6 months of age
when supervised
If your baby has a flat spot,
turn your baby slightly off
his or her back at about a 45
degree angle. This will take
the pressure off the flat
spot. Use a crib roll to
prevent your baby from
rolling onto the tummy.
Neck mobility activities
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Studies have found that up to 12% of
infants with PP may have congenital
muscular torticollis
Another 64% may have sternocleidomastoid imbalance
These muscular asymmetries perpetuate
the positional preference of the infant.
Early physiotherapy to restore active and
passive cervical mobility is recommended if
any muscle imbalance is found in PP
Repositioning
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Caregivers instructed in:
Do not allow infant to sleep on flat spot
Position interest on non flattened side
Adjust carry, hold, feeding positions
Active head turning incorporated in play
Adjust/ minimize time in baby seats/car
seats
Early supervised tummy time
Helmet Therapy
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In infants with
moderate to severe
plagiocephaly, parents
will be given
information that
helmetting may be
beneficial
Comments re helmetting:
Expense (up to $2000) and travel
 Hot, sweaty, skin injury
 Brachycephalic children hard to fit
 Lack of infant acceptance, more so in
older infants
 Parent embarrassment
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Determinants:
Predominantly male: 60-70%
 Predominantly right-sided
 Caucasian
Increased incidence associated with:
 multi-parity
 Prematurity
 Breech delivery
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Determinants:
Higher prevalence of PP found in children
that:
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Sleep on their back
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Don’t have head position varied
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Spend less than 5 minutes/day in prone
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Are always bottle fed with same hand
Associated Problems:
There is some evidence of increased
incidence of the following in infants with
PP:
 Scoliosis, rib, hip, foot problems
 Visual disturbances (strabismus,
astigmatism, field defects)
 Subtle developmental delay
The cause/effect relationship of these is
unclear.
Prevention: Counseling of
parents should include:
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Limit time infant is on back during the day
Alternate head position
Tummy time for more than 5 minutes per
day while baby is awake,gradually
increasing
Minimizing time in car seats/seats
Watch for positional preference
Change orientation to activities
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Physiotherapists in the Early
Intervention would like to ensure that
the necessary information for
prevention of plagiocephaly is
available to families within VIHA by
sharing it with our partners in pre,
peri and post natal health