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Cranial Remolding Helmet Treatment of Plagiocephaly: Comparison of Results and Treatment Length in Younger Versus Older Infant Populations

It is well known throughout the medical community that children’s heads grow most rapidly during the first 12 months of life, followed by continued growth at a much slower rate. This fact is very important in the timing of the application of cranial remolding orthosis therapy for children with plagiocephaly. Most of the reviewed literature mentions the need to exploit this rapid growth period, but evidence is lacking that compares the degree of correction and length of treatment in children who undergo cranial remolding orthotic therapy before and after the critical 12-month-old time point. The purpose of this study was to determine whether there is a difference between results of orthotic treatment and length of treatment for children with plagiocephaly who complete at least half of cranial remolding helmet therapy earlier than 12 months of age (young group) and those who complete at least half of treatment at or after 12 months of age (old group). The “beginning of therapy” is defined as the date of casting. The study was conducted by retrospective chart review of patients seen at Atlantic Prosthetics and Orthotics at the University of North Carolina Hospitals, tracking the changes in asymmetry and amount of correction through the course of treatment, as well as the overall length of treatment and comparing the results between the two groups. Ninety-eight charts were reviewed; 58 subjects met inclusion criteria, with 48 in the young group and 10 in the old group. A major excluding factor was parents choosing not to complete helmet therapy. The results of this study showed that cranial remolding treatment is effective for patients in the old group and that similar amounts of asymmetry correction can be obtained as with patients in the young group (asymmetry correction comparison, p = 0.95). However, a significant difference in treatment length exists with treatment length almost doubling to obtain similar amounts of correction in the old group compared with the young group (p = 2.85 × 10−5). Educating physicians on the importance of encouraging parents to start treatment as early as possible may help to increase effectiveness by increasing parental compliance as treatment length is almost halved when starting a few months earlier.