Deformational plagiocephaly has been defined as asymmetry of the skull resulting from abnormal forces acting on an intrinsically normal, developing cranium. Further distinction of the asymmetry is typically referred to as mild, moderate, or severe. These terms have commonplace acceptance in the clinical setting, although little discussion can be found within the literature. Numerous articles refer to orthotic treatment of children with severe involvement. However, few attempts have been made to define this distinction. The lack of consistent interpretation has delayed outcome studies.Moss first distinguished patients into two groups: mild-moderate and moderate-severe. This distinction was made from the differences in length of the cranial vault. A length of 12 mm or less is mild-moderate asymmetry. Lengths more than 12 mm are considered moderate-severe. This does not reflect a proportion of asymmetry relative to the child's head circumference. A difference of 12 mm in a 3-month-old infant represents more asymmetry than the same difference in a child who is 11 months old.
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