Early identification of cranial deformation during the first 3 months is critical for effective treatment to promote the development of a symmetric and proportional head shape in young infants. Repositioning efforts can have a significant and positive effect on the overall head shape if started early enough and performed with diligence by the caregivers. When treated early, mild deformations respond favorably to changes in supported positioning during playing, feeding, and sleeping. Improvements to moderate and severe deformations might not be as significant, and further cranial remolding with a custom orthosis could be indicated. Insurance companies require anthropometric measurements and letters of medical necessity to document degrees of severity in determining the basis for coverage. Unfortunately, no standard of clinical care exists for the evaluation and treatment of these infants, and such a void in the medical literature leaves many infants without the possibility of effective treatment during the critical window of opportunity presented in the first year of life. Criteria for the clinical differentiation of synostotic and deformational plagiocephaly are also necessary to distinguish surgical cases from those that can be managed with more conservative efforts such as therapy and/or orthotic treatment programs.
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