When a pediatrician makes a diagnosis of plagiocephaly or flat head syndrome, they will sometimes include technical terms and measurements. As someone new to the diagnosis how are you to make sense of all of this technical information? This guide will walk you through the levels of the Plagiocephaly Severity Scale in simple terms that any parent can understand.
What is the Plagiocephaly Severity Scale?
In 1999 Dr. J. Mulliken set out to create a scale that could be used by physicians worldwide to properly classify the levels of plagiocephaly. He made the distinction of mild, moderate, or severe cases of flat head syndrome and included a detailed five-point scale to measure each child properly. This measure allows pediatricians to take more accurate measurements and track progress. Most pediatricians will note a CVAI score when making a formal diagnosis, which can range from 3.5 percent to upwards of 11 percent. This measurement is a universal equation that uses two cranial measurements, one of either side of the skull to classify the severity. The scale also evaluates things like ear shifting, anterior skull involvement and how many quadrants are involved.
Level 1 Plagiocephaly Severity Scale
Although level one is included on this scale, children with a CVAI score of less than 3.5 percent are considered within normal limits. There would be no treatment need, but careful repositioning is always recommended to avoid any problems.
Level 2 Plagiocephaly Severity Scale
At this level the malformation is considered very mild. Children in this level will have minimal irregularity in only one area of the skull. The CVAI score associated with this level is between 3.5 and 6.25 percent. The treatment would likely begin by starting a repositioning program; if after two months of repositioning there is no change, cranial remolding become an option but is generally considered cosmetic.
Level 3 Plagiocephaly Severity Scale
Level three of flat head syndrome is labeled as a moderate malformation. A CVAI score between 6.25 and 8.75 percent would classify as level three. Doctors would also make the diagnosis if one or more of the following are present:
- Two quadrants involved
- Moderate to severe flattening
- Minimal ear shift or anterior involvement
The treatment options at this level vary based on a case-by-case basis. Some pediatricians take a more laid-back approach and create a repositioning program for home use, while other docs will move more aggressively and use cranial remolding as the first course of action. The decision on what plan to use depends upon a number of factors, but most importantly age and family history.
Level 4 Plagiocephaly Severity Scale
The fourth level of plagiocephaly is considered severe with a CVAI score of 8.75 to 11 percent. Doctors would also observe one or more of the following in order to make a diagnosis:
- Two or three quadrant involvement
- Severe flattening
- Moderate ear shift
- Anterior involvement including noticeable orbit asymmetry
Once a diagnosis of level four is made the standard treatment is to begin cranial remolding immediately.
Level 5 Plagiocephaly Severity Scale
Children with a CVAI score of great than 11 percent are considered to be at level five, which is the very severe category. At this level it would be typical to see some or all of the following:
- Three or four quadrant involvement
- Severe flattening
- Severe ear shift
- Anterior involvement including orbit and cheek asymmetry
Like level four, at this level cranial remolding is the choice of pediatricians.
Advances in plagiocephaly devices have made treatment options available at all levels of the malformation. Receiving a level five diagnosis doesn’t mean that you don’t have options. There are excellent treatments available at every level of the diagnosis.