THE BACK TO SLEEP CAMPAIGN AND DEFORMATIONAL PLAGIOCEPHALY - IS THERECAUSE FOR CONCERN

In April 1992, the American Academy of Pediatrics recommended back or side sleeping for healthy new-borns to reduce the risk of sudden infan t death syndrome. Subsequently, the US Public Health Service organized a health care coalition to promote a ''Back to Sleep Campaign'' to ad vocate back or side sleeping for infants. Since 1992, our craniofacial anomalies center has witnessed a marked increase in the incidence of infants with deformational changes of the cranium and face. The purpos e of this project was to study the etiologies of deformational plagioc ephaly and possible correlation with infant head position. We reviewed 52 consecutive patients presenting with deformational plagiocephaly f rom January 1992 to December 1994. A diagnosis of deformational plagio cephaly was determined by (1) history (date when head shape change was first noted), (2) clinical examination (occipital flattening, contral ateral forehead flattening, lowering of the eyebrow, and ear shearing) , and (3) skull. radiographs (patent cranial sutures). All infants had medical photography to document baseline craniofacial morphology and any follow-up changes after nonsurgical therapy. Cranial asymmetry was first noted after birth at a mean time of 3.5 months. All infants wer e initially positioned on their back/side. In 52 patients, 61% had rig ht-sided flattening of the occiput (vs 39% left-sided). All infants ha d flattening of the occiput, contralateral brow lowering or inferior d isplacement of the brow, contralateral forehead flattening, and poster oinferior displacement of the ear. All skull radiographs demonstrated patent sutures. Follow-up of patients ranged from 3 to 22 months with a mean of 10.5 months. Follow-up clinical examination and photography demonstrated significant improvement of cranial form in all patients w ith recommended frequent head turning (73%), helmet molding (23%), and surgery (4%). Our unit has seen an increase in the number of infants with deformational plagiocephaly over the last three years. All of the affected infants in this study had been managed according to the offi cially recommended protocol of back/side positioning. These findings s uggest a possible relationship between this type of infant positioning and the development of a deformational plagiocephaly. However, crania l asymmetry in this group of patients decreased significantly with non surgical therapy. We have not recommended cranial vault remodeling sur gery for the mild and moderate types of this deformity. However, if th ere is evidence of increasing asymmetry of deformational plagiocephali c infants during follow-up and evidence of severe variants of these de formities, surgical correction of the cranial vault is recommended.