In response to the pleas of parents and the requests of insurance companies, doctors are starting to pay more attention to the need for randomized, controlled studies on the diagnosis and treatment of positional plagiocephaly. In May, a study in the British Medical Journal revealed that in a sample of 84 infants, the treatment of plagiocephaly with helmets did not differ statistically from allowing nature to take its course.
Sounds good, right? Maybe your child doesn’t need a helmet after all.
There are a few major problems, however. In the study, patients with severe positional plagiocephaly were eliminated from the sample groups. It was also a very small sample, and the compliance of parents with the recommendation to wear treatment helmets for 23 hours per day was not measured.
In addition to these potential problem areas, the study faced further criticism from experts working to reduce the impact of plagiocephaly on children. These include the failure to include children with muscular torticollis – a condition present in more than 75% of positional plagiocephaly cases, and the fact that the study’s authors did not match the trial groups for severity.
Although flawed in many ways, the results of this study are promising – they show how many of our children, particularly those with mild cases of plagiocephaly, will do just fine without helmets. But we shouldn’t jump to conclusions. The results were not statistically significant, and they do provoke a few problems for parents whose children have more severe cases of PP:
- Insurance companies already refuse to cover the costs of care in many cases. This can exacerbate the problem.
- Long-term impacts were not assessed – the study only analyzed skull shape response in the short term, and did not look for associated conditions.
- The sample size may not be large enough to provide accurate expectations for the general population, but despite the suggestion by the study’s authors that more research is necessary, the idea that PP corrects itself can be taken out of context and applied to severe cases, where it may not be accurate.
If your child has PP, listen to the doctor who is treating the condition. If he or she thinks a helmet is required, don’t ignore the need. As exciting as this new research is, it doesn’t necessarily apply to all children.
The take home lesson from this study isn’t necessarily in the results. It’s in the promise they show – that scientists and doctors are now more interested in the growing prevalence of plagiocephaly, and are starting to place a research focus on randomized studies of the condition. We’ve been asking for this for a while. Perhaps this is the first sign that real research on our children’s conditions is forthcoming.