title: Deformational plagiocephaly and craniosynostosis: trends in diagnosis and treatment after the "back to sleep" campaign.
abstract: BACKGROUND
  In 1992, the American Academy of Pediatrics discouraged prone sleeping positions because of its association with sudden infant death syndrome. After this was an increased incidence of deformational plagiocephaly (DP).
  
  
  METHODS
  A retrospective review was completed for patients with DP and craniosynostosis seen by plastic surgeons at a tertiary medical center during a 19-year period. Two groups of patients were evaluated before (1988-1995) and after (1996-2007) implementation of the "Back to Sleep" campaign.
  
  
  RESULTS
  Of the 5169 patients, those with craniosynostosis (n = 279) had a mean age at initial evaluation before and after 1996 of 12.4 versus 5.6 months (P = 0.0008). There was a trend of decreasing age at initial evaluation and first surgery after 1996. For patients with DP (n = 4890), the mean age at initial evaluation before and after 1996 was 11.5 versus 6.0 months (P = 0.10). There was a trend of decreasing age at initial evaluation and DP correction after 1996. The majority of patients had right-sided DP (50.2%), followed by left-sided (24.7%) and bilateral (18.9%). There was no significant difference in DP correction rate (67% versus 87%) or the mean age that DP was corrected (12.8 versus 11.8 mo) before and after 1996. Compared with 1996 to 1999, there was a 214% and 390% increase in DP referrals from 2000 to 2003 and 2004 to 2007. For craniosynostosis, there was a 27% and 129% increase in referrals.
  
  
  CONCLUSIONS
  The increasing incidence of DP since the Back to Sleep campaign is concerning, but a positive outcome is that patients are being referred and treated at a younger age.
authors.affiliation: From the Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Leslie G
authors.initials: LG
authors.lastname: Branch
authors.forename: Kendra
authors.initials: K
authors.lastname: Kesty
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Krebs
authors.forename: Lindsey
authors.initials: L
authors.lastname: Wright
authors.forename: Stephanie
authors.initials: S
authors.lastname: Leger
authors.forename: Lisa R
authors.initials: LR
authors.lastname: David
mesh_terms: D000168:Acrocephalosyndactylia / Q000453:epidemiology; D017668:Age of Onset; D015897:Comorbidity; D003398:Craniosynostoses / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology; D008297:Male; D010031:Otitis / Q000453:epidemiology; D049068:Plagiocephaly, Nonsynostotic / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D016684:Prone Position; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013398:Sudden Infant Death / Q000517:prevention & control; D014481:United States / Q000453:epidemiology