AAP Issues Infant Positional Skull Deformity Guidelines

Pediatricians should diagnose, counsel parents, manage, and refer to specialists, as necessary

MONDAY, Nov. 28 (HealthDay News) -- Pediatricians and health care clinicians should be able to diagnose positional skull deformities among infants, implement preventive counseling among parents, initiate appropriate management, and make referrals, when necessary, according to a scientific statement published Nov. 28 in Pediatrics.

James Laughlin, M.D., from the American Academy of Pediatrics (AAP) Committee on Practice and Ambulatory Medicine, and colleagues looked at measures for prevention, diagnosis, and management of positional skull deformities in otherwise normal infants.

The investigators report an increase in unilateral occiput flattening since the 2009 AAP recommendation of 'Back to Sleep' positioning. Pediatricians, or other primary health care clinicians, should be able to diagnose and manage positional skull deformities. Diagnosis is made primarily by history, and confirmed by physical examination. Management includes preventive counseling for parents, mechanical adjustments, and exercises. To prevent deformity, parents should intermittently place infants in the prone position during wake time, and alternate supine positions during sleep time. Mechanical adjustments and exercises should be instituted, as necessary. Positioning and observation is the recommended treatment for mild-to-moderate deformity. Severe deformity should be managed with positional changes and molding helmets. Cranial orthoses should be used in infants with severe deformity or those not improving after 6 months of age. The infant should be referred to a pediatric neurosurgeon or craniofacial surgeon or team if the deformity progresses or does not improve after mechanical adjustments, or if there is suspicion of craniosynostosis. Surgical correction is not routinely recommended.

"Management of positional skull deformity involves preventive counseling for parents, mechanical adjustments, and exercises," the authors write.

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