Misconceptions
Let’s start with the biggest misconception there is. It’s incorrect to assume that infant head deformation will resolve spontaneously. Parental concerns should never be downplayed. All cranial deformation will need some form of intervention. What the intervention depends on the age of the infant and the severity of the presentation. This intervention starts with detailed screening and if caught at a very early age, includes parent education on correct positioning practices.
This is the reason the possibility of cranial deformation, and preventing it, should be discussed in prenatal classes. When these issues are identified later, other strategies need to discussed ensuring fully educated decisions can be made that would result in the best possibility of improvement. This should include the incredibly important role of pediatric therapy and when indicated, the role of cranial orthotic management.
It is a misconception that the infant’s head “will round out on its own as the child becomes more active, begins to roll over, and learns to sit up.”
This is based in part on outdated scales of motor development and a lack of understanding of the effect of supine sleep positioning. The pattern of early motor development is affected by sleep position. On average, supine sleepers attain common motor milestones later than prone sleepers.
Prior to 1992, infants’ heads often corrected in the first few months of life because infants that were placed prone to sleep were generally in a variety of positions during the day, thus avoiding prolonged time in one position. Now that supine is the position of choice and there is a four to six-week delay in the acquisition of head and trunk control, infants’ heads often do not “round out” as they did previously.
Thinking the deformation will correct once the infants sit up for obvious reasons is incorrect. The deformity was caused due to excessive pressure to a segment of the infant skull but normally presents itself across the full head. Removing the pressure of the entire skull will have no corrective impact and expecting spontaneous correction nonsensical.
An infant that can sit up has attained a developmental milestone that will never have him poisoned in a single position long enough to attain correction. Again, when considering the global nature of the deformation, expecting and that contact on a very small surface area on the back of the head to correct all aspect of the deformation just not feasible.
Classifying cranial deformity as a cosmetic issue is oversimplified and not evidence-based
When left untreated, moderate to severe deformity may lead to significant cosmetic and functional and psychological consequences.
Infants with head deformities attempt to compensate for the head’s abnormal orientation in space, which can result in ocular and vestibular impairment.
Skull deformities are well known for inducing an inferiority complex in childhood and associated issues later on in life.
It’s incorrect to presume the window of opportunity and correction is up to 12 or even 16 months of age
Early recognition and treatment within this small window of opportunity are paramount. In the “severe” deformation group, the earlier the cranial orthotic treatment is started, the higher the symmetry ratio recovery obtained.
Treatment is especially effective when started in four-month-old infants. The “mild” deformation group shows that cranial orthotic remoulding is most effective if treatment started before six months of age.
It’s a misconception that when you start early more than one cranial orthotic will be needed
The advantages of starting young in severe cases, as early as four months, far out ways the possibility that a second orthotic will be required. It is very infrequent that a second cranial orthotic is required, and due to the amazing plasticity of such a young infant amazing results achieved with a single orthotic.
It is a totally incorrect assumption that orthotic management is not evidence-based, with few strong supportive studies
This is just not true, in fact when you review the research the effectiveness and indication for cranial orthotic management are irrefutable. Cranial deformity and craniofacial misalignment can affect health outcomes related to growth and development and oral health.
It’s a total misconception that the deformity is only on the back of the head, and probably will be covered with hair
Look at the imaging of a plagiocephaly presentation, the deformation of one element leads to compensatory deformation and displacement of all other connected elements.
This can include facial deformation, mandibular asymmetry, abnormal eye placement, external ear misalignment, orbital asymmetry, strabismus and other ocular problems.
As adults, social issues as a result of the visible deformity are compounded by difficulties in wearing glasses, hairstyle problems, temporomandibular joint asymmetries and teeth alignment problems.
In tandem, it’s a misconception that the cranial orthotics only corrects the back part of the deformation
Cranial remoulding orthoses don’t only correct the posterior (occipital) flatness but when fitted and managed correctly have a direct effect on frontal, parietal, sphenoid, temporal, and one of the occipital bones of the neurocranium. Indirectly, it affects the entire facial alignment in the viscerocranium due to the direct transfer of forces through the neurocranial structures.
Throughout the orthotic treatment program measurable changes in the cranial base, cranial vault, orbitotragial depth, and cephalic index are documented. By returning the cranial and facial bones to a normal alignment, long-term dysfunction to hearing, vision, and mandibular mechanics could likely be avoided.
It’s a misconception that cranial orthotics are not well tolerated and unsafe to wear
The vast majority of infants have very few problems tolerating the orthotic. As can be expected, specialized care and proper fitting ensure comfort and compliance.
Numerous studies documented the safety and efficacy of cranial remoulding orthosis for positional plagiocephaly and other positional cranial deformities. It’s important to ensure the provider is correctly licensed and experienced. Please note that a physiotherapist is not licensed to fit cranial orthotics.
We often hear that cranial orthotics management is not approved by insurance companies
In the event, protocols are adhered to, early repositioning attempted and chronological referenced anthropometric measurements indicate, most insurance companies consider cranial remodelling orthotics as medically necessary for the treatment of moderate to severe positional head deformities. Eligibility is determined by what the policy category is and each person’s limitation. This factor should never deter referral for care and needs to be mitigated on a case-by-case basis.