Study: Physical therapy improves positional preference-related skull deformation

October 1, 2008

Study: A standardized physical therapy program may significantly reduce the prevalence of deformational plagiocephaly.

A study conducted in the Netherlands demonstrated that a standardized pediatric physical therapy program significantly reduces the prevalence of severe skull deformation (deformational plagiocephaly) in children with side preferences.

Investigators divided 68 7-week-olds found to have positional preference into two groups. In the intervention group, infants received a maximum of eight sessions of pediatric physical therapy between ages 7 weeks and 6 months. These sessions initially were weekly, then every two or three weeks in the second and third month. The physical therapy regimen consisted of exercises to reduce positional preference and to stimulate motor development. It also offered parental counseling about counterposition, handling, nursing, and the cause of positional preference. Parents also received a leaflet describing basic preventive measures. They were encouraged to offer their infant earlier, more frequent, and longer periods of "tummy time." In the control group, parents received the leaflet about preventive care, but no further education or instructions.

The number of infants with severe deformational plagiocephaly decreased significantly in the intervention group, from 18 of 33 (55%) at age 7 weeks to 10 (30%) at age 6 months. By comparison, the 32-infant control group had a decrease from 20 (63%) to 18 (56%). At age 12 months, the number of infants with severe deformational plagiocephaly in the intervention group decreased further to eight (24%) and remained unchanged in the control group. Data analysis showed that three to four children with positional preference must be treated to avoid one child's having severe deformational plagiocephaly between 7 and 12 months of age (van Vlimmeren LA et al: Arch Pediatr Adolesc Med 2008;162:712).

In this randomized, controlled trial the authors show the efficacy of a physical therapy regimen in decreasing deformational plagiocephaly in children with a side preference. These findings are important, as they may reduce the need for more invasive therapies, including molding helmet therapy or surgery, later on.

DR. BURKE, section editor for Journal Club, is chairman of the department of pediatrics at Saint Agnes Hospital, Baltimore. He is a contributing editor for Contemporary Pediatrics. He has nothing to disclose in regard to affiliations with, or financial interests in, any organization that may have an interest in any part of this article.