Effect of Pediatric Physical Therapy on Deformational Plagiocephaly in Children With Positional Preference: A Randomized Controlled Trial

OBJECTIVE: To study the effect of pediatric physical therapy on positional preference and deformational plagiocephaly.

DESIGN: Randomized controlled trial.

SETTING: Bernhoven Hospital, Veghel, the Netherlands.

PARTICIPANTS: Of 380 infants referred to the examiners at age 7 weeks, 68 (17.9%) met criteria for positional preference, and 65 (17.1%) were enrolled and followed up at ages 6 and 12 months.

INTERVENTION: Infants with positional preference were randomly assigned to receive either physical therapy (n = 33) or usual care (n = 32).

MAIN OUTCOME MEASURES: The primary outcome was severe deformational plagiocephaly assessed by plagiocephalometry. The secondary outcomes were positional preference, motor development, and cervical passive range of motion.

RESULTS: Both groups were comparable at baseline. In the intervention group, the risk for severe deformational plagiocephaly was reduced by 46% at age 6 months (relative risk, 0.54; 95% confidence interval, 0.30-0.98) and 57% at age 12 months (0.43; 0.22-0.85). The numbers of infants with positional preference needed to treat were 3.85 and 3.13 at ages 6 and 12 months, respectively. No infant demonstrated positional preference at follow-up. Motor development was not significantly different between the intervention and usual care groups. Cervical passive range of motion was within the normal range at baseline and at follow-up. When infants were aged 6 months, parents in the intervention group demonstrated significantly more symmetry and less left orientation in nursing, positioning, and handling.

CONCLUSION: A 4-month standardized pediatric physical therapy program to treat positional preference significantly reduced the prevalence of severe deformational plagiocephaly compared with usual care.

CLINICAL TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN84132771.