What will happen if positional cephalic disorders are not treated?
Unfortunately no definitive studies have been conducted to-date on the long term developmental and physical health consequences that could occur if positional cephalic disorders, such as plagiocephaly and brachycephaly, go untreated. Despite the lack of research, many doctors, physical therapists and caregivers believe that children who suffer from severe cranial deformities in infancy may face consequences similar to those experienced by children with craniosynostosis. Evidence for this exists in a recent study which showed that the propensity for developmental delays was actually higher for infants with deformational cephalies than their peers with craniosynostosis.
However, much of the medical community views positional cranial deformities as cosmetic in nature. Evidence to the contrary has been largely anecdotal, and without controlled clinical studies, it will be difficult to develop a true understanding of the potential long-term consequences of plagiocephaly, brachycephaly and scaphocephaly.
Studies on the long term effects of cranial deformities
Two studies have been conducted on the long-term physical effects of cranial deformities. In a survey of 22 untreated cases of positional plagiocephaly in children ages 18-48 months, Spragg (2008) found that 17 cases showed an improvement of roughly 1.6% on the Cranial Vault Asymmetry Index (CVAI) compared to an average of 4% for cranial remodeling techniques. 77% of study participants would still be referred to orthotic treatment based on their head shapes.
A 2011 study by Barnett Roby et al took cranial measurements of 1045 participants ranging from 12-17 years old. These participants were born after the start of the Back to Sleep campaign, but no mention was made of their parents’ compliance with the campaign or the number of children in the group who had been diagnosed with or treated for cranial deformities in infancy. 1.1% of study participants were plagiocephalic, another 1.0% were brachycephalic. Of these, 38.1% had noticeably abnormal facial characteristics. The prevalence of cranial deformities is significantly lower than the estimated number of infants with cranial deformities, but more studies are needed to evaluate which children truly require treatment. The authors of this study believe that most individuals will eventually outgrow cranial deformities, except in the most severe cases.
Despite the somewhat promising results of the studies on cranial vault asymmetry, both face methodological problems which make their results questionable. Recent studies on the short term effects of deformational cranial deformities emphasize the need for treatment. A 2012 study by Meyer-Marcotty noted that orthotic treatment for positional plagiocephaly is advisable based on the potentially long-term damaging effects of the condition on the facial bones. In the same year, in a paper describing ways to differentiate between lambdoid synostosis and positional plagiocephaly, Kalra and Walker reported that positional plagiocephaly has been associated with developmental problems. A 2011 report by Marchac et al noted the need for surgery in extreme cases of positional plagiocephaly that fails to improve after orthotic and repositioning therapies. The procedure is only advised for children over 15 months of age with severe deformities that are potentially life-threatening.
In short, the medical community is divided as to how and when it is alright to forgo treatment for positional cranial deformities. Parents of children who have foregone treatment often report mixed reactions. In some cases, emotions of guilt and self-deprecation can be overwhelming. Other parents report that they are happy with the decision to wait and see. The difference in reaction has more to do with their initial feelings towards helmeting, and not necessarily with the extent of their child’s deformity. There is no right answer to the decision of whether or not to use a helmet.
Your doctor’s experience with other plagiocephaly, brachycephaly and scaphocephaly patients will allow him or her to suggest a treatment plan that is appropriate for your child’s case. By being open about how you and your partner feel towards treatment and asking for honest input, you are more likely to achieve an outcome that is best for your child.