Pediatrics Cranial Deformities

What are ways that increase cranial deformation postnatally?

Back to sleep campaign, decreased tummy time, bottle feeding on same arm, CMT

What are ways that increase the risk of cranial deformity before birth?

Uterine constraints

What are generalized risk factors for cranial deformation?

male, first born, traumatic delivery, low birth weight, old mother

What are quanititative measures for craial demormaties?

Calipers, digital photographic techniques, 3D digital imaging

What is deformational plagiocephaly quantified by?

Transcranial diagonal difference, oblique cranial length ration, and cranial vault asymmetry index

What is brachycephaly?

Head is as wide as it is long

How can you quantify deformational brachycephaly?

Cephalic or cranial index,

What is the cut-off for deformational plagiocephaly?

3-10 is mild, 10-12 is moderate, over 12 is severe

What is the cut-off value for deformational brachycephaly?

82-90% is mild, 90-100% is moderate, over 100% is severe

What is cranial synostosis?

Premature closure of one or more sutures

How can cranial synostosis affect development?

Can restrict brain growth and increase overall ICP

When would you refer for a crainal orthosis?

After 4 months old with no improvement from standard therapy

How long does a baby need to wear a cranial orthosis?

20-23.5 hours per day for 2-7 months

What are first interventions to try to fix a cranial deformity?

Educate parent, prone positioning, limiting time in containers, sidelying play, supervised upright play

Key characteristics of stage one plagiocephaly

limited to posterior skull

Key characteristics of stage two plagiocephaly

Displacement of lateral ear forward or downward

Key characteristics of stage three plagiocephaly

Ipsilateral frontal bone protrusion

Key characteristics of stage four plagiocephaly

Ipsilateral facial asymmetry

Key characteristics of stage five plagiocephaly

Temporal buldging or abnormal vertical growth of skull

Key characteristics of brachycephaly stage 1

Deformity limited to posterior skull

Key characteristics of brachycephaly stage 2

Adds widening to posterior skull

Key characteristics of brachycephaly stage 3

Same as type 4 plagiocephaly