Abstract

Background: Deformational cranial asymmetries are common in infancy and their prevalence has risen since supine sleep positioning was introduced; management ranges from repositioning and physiotherapy to cranial orthosis. Objective: To characterise a paediatric cohort with deformational cranial asymmetries at a tertiary referral centre and describe craniometric evolution under a stepped conservative protocol. Materials and methods: Retrospective study of children with a deformational cranial asymmetry diagnosed in the first year of life, assessed at a paediatric rehabilitation clinic during 2024. Craniometric measurements were obtained with a handheld craniometer by a single observer: the plagiocephaly index in plagiocephaly, and the cephalic index in brachycephaly and dolichocephaly. Complete resolution was defined as a final plagiocephaly index <5 mm. Results: Forty-six patients were included, 26 (56.5%) male and 14 (30.4%) born preterm. Torticollis was present in 37 (80.4%). Diagnoses were plagiocephaly in 27 (58.7%), brachycephaly in 16 (34.8%) and dolichocephaly in 3 (6.5%). Median age at diagnosis was 2.5 months (IQR 1.0–4.0). Most patients were managed with repositioning alone (21, 45.7%) or with added physiotherapy (21, 45.7%); 4 (8.7%) required a cranial orthosis. Among 31 patients with paired measurements, the plagiocephaly index decreased from 6.0 to 4.0 mm (p=0.037; r=0.37), with complete resolution in 17 (54.8%; 95% CI 37.8–70.8%), and in 11 (50.0%) when restricted to baseline index ≥5 mm. Greater initial deformity correlated with a greater absolute reduction (rho=−0.44; p=0.014) but a lower likelihood of resolution. Conclusion: Referral occurred early, most children were managed conservatively, and only 4 (8.7%) required a cranial orthosis. Absence of a control group precludes attributing improvement to treatment.

Keywords

pediatrics, plagiocephaly, rehabilitation, cranial orthosis, torticollis, good health, well-being