Cosmetic and cognitive outcomes of positional plagiocephaly treatment.

PURPOSE Positional plagiocephaly is an acquired deformation of an intrinsically normal infant skull by sustained or excessive extrinsic forces. Non-surgical techniques include counter-positioning, supervised prone time and orthotic molding for more refractory cases. Long-term effects of positional plagiocephaly on development remain undefined, and this study evaluated cosmetic and cognitive outcomes of plagiocephaly management. METHOD Surveys were administered to parents of patients treated for positional plagiocephaly through the Children's Hospital of Eastern Ontario. Categorical responses interrogated cosmetic outcome, school performance, language skills, cognitive development and societal function. Pearson coefficient analysis tested outcomes dependency on gender, age, and plagiocephaly side at the 0.05 level of significance. RESULTS Eighty respondents (51 male, 29 female) were divided as 58 right- and 22 left-sided pathology. Positional therapy was uniformly applied, and a helmet orthosis was utilized in 36% of cases. Median follow-up age was nine years with normal head appearance in 75% of cases. Only 4% of parents and 9% of patients observed significant residual asymmetry. These results did not vary by gender, age or deformity side. Left-sided disease predicted poorer language development and academic performance. Expressive speech abnormality occurred in twice as many patients with left-sided disease (36% versus 16%, p=0.04) along with three-fold greater special education requirements (27% versus 10%, p=0.04). CONCLUSIONS Non-surgical plagiocephaly management achieved good cosmetic outcome among patients in this study. Children with left-sided disease frequently encountered difficulties with cognitive and scholastic endeavors, although the roles of the underlying disease and the treatment measures in this delay cannot be differentiated.