Deformational Brachycephaly in Supine-sleeping Infants

Objectives: 

Medical dictionaries and anthropologic sources define brachycephaly as a cranial index (CI = width divided by length X 100%) greater than 81% (Fig 2). We examine the impact of supine sleeping on CI and compare orthotic treatment with repositioning.

Study Design: 

We compared the effect of repositioning versus helmet therapy on CI in 193 infants referred for abnormal head shape.

Results: 

Eighty percent of the infants had a pretreatment CI > 81%. Their initial mean CI at mean age 5.3 months was 89%, and after treatment, their mean CI was 87% (±2 SE = 0.9%) at mean age 9.0 months. For 92 infants with an initial CI at or above 90%, their initial mean CI of 96.1% was reduced to a mean of 91.9%.

Conclusions: 

Post-treatment CI was 86% to 88%, CI in neonates delivered by cesarean section was 80%, and CI in supine-sleeping Asian children was 85% to 91%, versus 78% to 83% for prone-sleeping American children. Repositioning was less effective than cranial orthotic therapy in correcting severe brachycephaly (Fig 3). We recommend varying the head position when putting infants to sleep.