DEFORMATIONAL BRACHYCEPHALY IN SUPINE-SLEEPING INFANTS

GRAHAM, JOHN M. JR MD, SCD
KREUTZMAN, JEANNIE CPNP, MSN
EARL, DAWN CPNP, MSN
HALBERG, ANDY BS
SAMAYOA, CARLOS MPH
GUO, XIUQING PHD

Medical Genetics Institute, Ahmanson Department of Pediatrics, Steven Spielberg Pediatric Research Center, Burns and Allen Research Institute, Cedars-Sinai Medical Center and Department of Pediatrics, University of California, Los Angeles, California.

Reprint requests: Dr John M. Graham, Jr, Clinical Genetics and Dysmorphology, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, #1001, Los Angeles, CA 90048.

Supported by SHARE's Childhood Disability Center, the Steven Spielberg Pediatric Research Center, the Cedars-Sinai Burns and Allen Research Institute, the Skeletal Dysplasias NIH/NICHD Program Project Grant (HD22657-11), and the Medical Genetics NIH/NIGMS Training Program Grant (GM08243).

See related article, p 258.

Submitted for publication Feb 2, 2004; revision received Aug 24, 2004; accepted Oct 4, 2004.

Journal of Pediatrics 146(2):p 253-257, February 2005.

Objectives

Medical dictionaries and anthropologic sources define brachycephaly as a cranial index (CI = width divided by length × 100%) greater than 81%. 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. We recommend varying the head position when putting infants to sleep.