Deformational Brachycephaly in Supine-sleeping Infants
Graham, J.M Jr., Kreutzman, J., Earl, D. |
J Pediatr |
vol. 146,
253 -
257,
2005
Abstract
Objectives:
Medical dictionaries and anthropologic sources define brachycephaly as a cranial index (CI = width divided by length X 100%) greater than 81% (Fig 2). We examine the impact of supine sleeping on CI and compare orthotic treatment with repositioning.
Study Design:
We compared the effect of repositioning versus helmet therapy on CI in 193 infants referred for abnormal head shape.
Results:
Eighty percent of the infants had a pretreatment CI > 81%. Their initial mean CI at mean age 5.3 months was 89%, and after treatment, their mean CI was 87% (±2 SE = 0.9%) at mean age 9.0 months. For 92 infants with an initial CI at or above 90%, their initial mean CI of 96.1% was reduced to a mean of 91.9%.
Conclusions:
Post-treatment CI was 86% to 88%, CI in neonates delivered by cesarean section was 80%, and CI in supine-sleeping Asian children was 85% to 91%, versus 78% to 83% for prone-sleeping American children. Repositioning was less effective than cranial orthotic therapy in correcting severe brachycephaly (Fig 3). We recommend varying the head position when putting infants to sleep.
 | Figure 2: This Peruvian skull from the Field Museum in Chicago (collected in Carete Cerrodel Oro) was purposefully deformed into a brachycephalic shape using boards and binding. Highland Peruvians apparently applied circumferential bandages to the calvarium to achieve a conical head shape, whereas Coastal Peruvians applied boards to the occiput and pads to the frontal region, along with circumferential banding. (Courtesy of Graham JM Jr, Kreutzman J, Earl D, et al: Deformational brachycephaly in supine-sleeping infants. J Pediatr 146:253–257. Copyright 2005 by Elsevier.) |
 | Figure 3: This 7-month male infant (left) with right torticollis had a cranial index (CI) of 93% with a diagonal difference of 1.5 cm. After 5 months of helmet orthotic therapy (right), his CI was improved to 91% and his diagonal difference was reduced to 0.5 cm. (Courtesy of Graham JM Jr, Kreutzman J, Earl D, et al: Deformational brachycephaly in supine-sleeping infants. J Pediatr 146:253–257. Copyright 2005 by Elsevier.) |
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