title: Deformational plagiocephaly and orthotic treatment: indications and limitations.
abstract: OBJECTIVE
  As the incidence of deformational plagiocephaly (DP) has risen, so has the demand on clinicians to make appropriate treatment recommendations. While knowledge of risk factors and natural history continue to evolve, there is uncertainty and controversy regarding intervention approaches. The purpose of this report is to review current treatment approaches for DP, in particular the use of orthotic helmets.
  
  
  METHODS
  A narrative literature review was conducted to summarize current evidence supporting preventative measures and re-positional and orthotic interventions.
  
  
  RESULTS
  When started early at under 2 months of age, positional efforts and 'tummy time' can be effective in preventing and improving DP, but these strategies need to be better promoted to caregivers. The timing, severity and parental concerns as indicators for orthotic treatment are reviewed. Limitations discussed include high cost, lower level of evidence and poor understanding of long-term outcomes and caregiving implications.
  
  
  CONCLUSIONS
  For optimal outcome, current evidence supports use of repositioning in young infants and start of orthotic helmet treatment for infants with significant DP at 4-6 months. Further research is needed to better understand the parameters for use (stratified by age and severity), long-term outcomes and natural history and the impact on caregiving, as well as the cultural significance of head shape.
authors.affiliation: Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada. pmortenson@cw.bc.ca
authors.forename: Patricia
authors.initials: P
authors.lastname: Mortenson
authors.forename: Paul
authors.initials: P
authors.lastname: Steinbok
authors.forename: David
authors.initials: D
authors.lastname: Smith
mesh_terms: D002508:Cephalometry / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D009989:Orthotic Devices; D049068:Plagiocephaly, Nonsynostotic / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome