Background: Despite much interest in positional (deformational) plagiocephaly, the natural history is unclear. The purpose of this study was to determine cosmetic and developmental outcomes at a minimum of 5 years of age in children diagnosed in infancy with positional plagiocephaly (PP) and the impact of cranial orthotic use.
Methods: A questionnaire survey was sent to parents of children diagnosed with PP in infancy and now aged more than 5 years. A retrospective review of the child's clinic chart was performed of consenting families, and prospective follow-up was done when families agreed to return for assessment.
Results: Of 278 eligible children with plagiocephaly, questionnaires were completed by 65 parents, and 27 brought their child for assessment. Participants and nonparticipants were similar. Cranial orthoses were used in 18 of 65 children. Parents perceived the cosmetic appearance of their child as "very abnormal" in 2, "mildly abnormal" in 25, and "normal" in 38. Residual asymmetry was noted by parents in 58%, but only 21% were concerned about appearance. In the last year, 7.7% of children commented about asymmetry of head, and 4.6% were teased occasionally. Thirty-three percent had received learning assistance, and 14% were in a special class. Long-term outcomes, as perceived by the parent or child, were no different between children with and without orthosis use.
Conclusions: The results allow better counselling of parents about outcome of infants with PP, reducing anxiety, and allowing more rational selection of management modality.