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Should helmets be used for flattened heads?


Company promotional literature for cranial orthotic devices (CODs) such as helmets to treat plagiocephaly contain unproven scientific claims, according to paediatricians from the Children's University Hospital, Dublin. (1) There is also no good evidence that, for the average infant presenting with a moderate degree of plagiocephaly, helmet therapy will result in a better outcome when compared with either active repositioning or no therapy, say paediatricians from Birmingham Children's Hospital. (2)

Since the recommendation in the early 1990s to place infants on their backs in order to reduce the risk of sudden infant death syndrome, there has been an increase in the incidence of positional plagiocephaly (a right- or left-sided occipital flattening) as indicated by referrals to paediatricians, neurosurgeons and craniofacial surgeons for advice and management. There is some evidence to show that positional plagiocephaly is a self-limiting condition (2) and management of the vast majority of infants should include explanation of the condition, assurance of normality and confident clinical prediction of resolution. Simple supportive measures may include: (1)

* Encouraging 'tummy time' (positioning prone) when awake

* Varying sleeping positions (counter-positioning)

* Waiting and seeing (review is essential)

* Explaining that hair growth will lessen the visual impact

* Referral to physiotherapy, particularly if torticollis is evident

* Referral to neurosurgery or craniofacial surgery in severe cases, where doubt remains or where parents fail to accept assurance

* Use of a COD.

CODs cost 1700 [pounds sterling] to 2500 [pounds sterling] for the helmet, fitting, follow up and consultation, and are not available on the NHS. Additionally, some infants will require a general anaesthetic for initial casting and fitting. CODs must be worn for 22 to 23 hours out of 24.

While some maintain that moulding helmets have an important role in the management of certain cases of plagiocephaly, (3) the Dublin researchers (1) ask whether plagiocephaly has been observed in a seven- or 15-year old UK child, and why practitioners should not learn from traditional practices in the Middle East and East Asia where 'back to sleep' has long been utilised for infants, maintaining that deformational brachycephaly is a self-resolving phenomenon.

(1) Gill D, Walsh J. Plagiocephaly, brachycephaly and cranial orthotic devices: misshapen heads and helmets. Arch Dis Child, 2008; 93(9): 805-7.

(2) Singh A, Wacogne I. What is the role of helmet therapy in positional plagiocephaly? Arch Dis Child, 2008; 93(9): 807-9.

(3) Carter MR. Head moulding for plagiocephaly. Arch Dis Child, 2008; 93(9): 809-10.
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Title Annotation:CLINICAL PAPERS
Publication:Community Practitioner
Geographic Code:1USA
Date:Nov 1, 2008
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