Cranial

In cases that are identified very early on or when the child is predisposed to have positional cranial flattening (premature birth, multiple birth, in NICU for a period of time at/after birth), Boston Orthotics & Prosthetics advocates repositioning techniques including: 

The Perfect Noggin: the most ergonomic and clinically effective sleep surface available to maintain a natural head shape in infants.

If repositioning is unsuccessful, Boston O&P offers excellent an effective treatment option:

The Boston Band: a lightweight, plastic and foam orthosis made from a cast impression or a 3D scan of the infant’s head.

In this example. the left coronal suture is prematurely fused and therefore no more growth can occur from this suture line. This shows a slightly posterior plagiocephaly on the left side however in true positional plagiocephaly you would also see a left anterior bossing (pushing forward all on the same side). In this case, the anterior bossing in only on the child's right side. This is fairly obvious and indicates something other than positional deformity. Reports vary, but this is thought to be seen in only one in 3,500 live births.

In this example, the right lambdoidal suture prematurely fuses. You see the posterior flattening that would seem to indicate right plagiocephaly, however upon further review you notice a couple things conflicting with that diagnosis:

1. The anterior bossing is on the forehead while the right is actually sunken back.

2. The right ear may actually be shifted posteriorly also. Remember, in true positional plagiocephaly, that forward shift is all on the same side. The means the right ear and right forehead would be shifted forward if it was positional plagiocephaly. Again, reports vary, but this configuration is thought to occur in only one in 100,000 live births

Sagittal synostosis (shown) and metopic synostosis are also potential forms of synostosis, however obviously do not in any way mimic deformational plagiocephaly. They are the most common forms of prematurely closed cranial sutures, occurring in one in 2,000 live births and one in 2,500-3,500 live births respectively. 

Please understand that we are in no way discouraging use of specialists, however we are saying that in many cases, a pediatrician with proper training can make the diagnosis of positional cranial deformity versus synostosis and refer the patient directly to an orthotist if a cranial remolding orthosis is warranted. This process obviously saves time and money. If there is any doubt whatsoever or co-morbidities present, please contact a specialist immediately.