title: Guidelines: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Management of Patients With Positional Plagiocephaly: The Role of Repositioning.
abstract: BACKGROUND
  Plagiocephaly, involving positional deformity of the calvarium in infants, is one of the most common reasons for pediatric neurosurgical consultation.
  
  
  OBJECTIVE
  To answer the question: "what is the evidence for the effectiveness of repositioning for positional plagiocephaly?" Treatment recommendations are provided based on the available evidence.
  
  
  METHODS
  The National Library of Medicine MEDLINE database and the Cochrane Library were queried using MeSH headings and key words relevant to repositioning as a means to treat plagiocephaly and brachycephaly. Abstracts were reviewed to identify which studies met the inclusion criteria. An evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III).
  
  
  RESULTS
  There were 3 randomized trials (Class I), 1 prospective cohort study (Class II), and 6 retrospective cohort studies (Class III). Repositioning education was found to be equal to a repositioning device and inferior to a physical therapy program. Five of the 7 cohort studies comparing repositioning with a helmet reported helmets to be better and take less time.
  
  
  CONCLUSIONS
  Within the limits of this systematic review, repositioning education is effective in affording some degree of correction in virtually all infants with positional plagiocephaly or brachycephaly. Most studies suggest that a molding helmet corrects asymmetry more rapidly and to a greater degree than repositioning education. In a Class I study, repositioning education was as effective as repositioning education in conjunction with a repositioning wrap/device. Another Class I study demonstrated that a bedding pillow was superior to physical therapy for some infants. However, in keeping with the American Academy of Pediatrics' warning against the use of soft positioning pillows in the sleeping environment, the Task Force recommends physical therapy over any positioning device. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_3.
authors.affiliation: *Semmes-Murphey Neurologic & Spine Institute; Department of Neurosurgery, University of Tennessee Health Science Center; Le Bonheur Children's Hospital, Memphis, Tennessee; ‡University of Tennessee Health Science Center, Memphis, Tennessee; §Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon; ¶Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; ‖Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida; #Division of Neurosurgery, University of Vermont Medical Center, Burlington, Vermont; **St. Louis Cleft-Craniofacial Center, SSM Health Cardinal Glennon Children's Hospital at Saint Louis University, Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, Missouri; ‡‡Department of Neurosurgery, Palmetto Health University of South Carolina Medical Group, Columbia, South Carolina; §§Guidelines Department, Congress of Neurological Surgeons, Schaumburg, Illinois; ¶¶Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois; ‖‖Advocate Children's Hospital, Oak Lawn, Illinois; ##Department of Pediatric Neurological Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; ***Department of Surgery, Division of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; ‡‡‡Goryeb Children's Hospital of Atlantic Health Systems, Morristown, New Jersey; §§§Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana.
authors.forename: Paul
authors.initials: P
authors.lastname: Klimo
authors.forename: Patrick Ryan
authors.initials: PR
authors.lastname: Lingo
authors.forename: Lissa C
authors.initials: LC
authors.lastname: Baird
authors.forename: David F
authors.initials: DF
authors.lastname: Bauer
authors.forename: Alexandra
authors.initials: A
authors.lastname: Beier
authors.forename: Susan
authors.initials: S
authors.lastname: Durham
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Lin
authors.forename: Catherine
authors.initials: C
authors.lastname: McClung-Smith
authors.forename: Laura
authors.initials: L
authors.lastname: Mitchell
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Nikas
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Tamber
authors.forename: Rachana
authors.initials: R
authors.lastname: Tyagi
authors.forename: Catherine
authors.initials: C
authors.lastname: Mazzola
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Flannery
mesh_terms: D006801:Humans; D007223:Infant; D019317:Evidence-Based Medicine; D009493:Neurosurgery / Q000458:organization & administration; D056888:Patient Positioning; D049068:Plagiocephaly, Nonsynostotic / Q000628:therapy; D012890:Sleep