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Traditional cranial molding is an ancient practice prevalent in Ghana. In this work, we aimed at assessing mothers'/caregivers' perspective and their knowledge on potential harm of cranial molding on neonates.Two hundred and one (201) nursing mothers with babies aged 1-12 months were sampled in a cross-sectional study using questionnaires. We assessed the mothers'/caregivers' reasons for cranial molding, their perceived benefits of this practice, and their knowledge about the potential harm this practice pose to babies.Sixty four percent (64%) of mothers confirmed they practice cranial molding on their babies either on their own or through the assistance of a caretaker. However, 72% of all mothers/caregivers did not know this practice has the potential to harm the baby in any way. Mothers'/caregivers' reasons for this practice included the following: to achieve a more "beautiful" head shape, hasten the healing of the fontanelle, and limit head growth. There was a significant association between the mothers'/caregivers' level of education and the practice of cranial molding (p value0.05). However, there was no association between head symmetry and cranial molding (p value0.05).Majority of mothers/caregivers were actively engaged in cranial molding on neonates but remain ignorant about the potential harm this practice could have on their babies. Mothers/caregivers therefore need to be educated about the potential harm posed by traditional cranial molding on neonates.

OBJECTIVES -The purpose of this study was to investigate the changes in skull shape on sonography after cranial molding helmet therapy in infants with deformational plagiocephaly. METHODS -Twenty-six infants who were treated with cranial molding helmet therapy were recruited. Caliper and sonographic measurements were performed. The lateral length of the affected and unaffected sides of the skull and cranial vault asymmetry index were measured with calipers. The occipital angle, defined as the angle between lines projected along the lambdoid sutures of the skull, was calculated by sonography. The occipital angle difference and occipital angle ratio were also measured. All caliper and sonographic measurements were performed in each infant twice before and twice after treatment. RESULTS -The study group included 12 male and 14 female infants with a mean age ± SD of 6.2 ± 3.5 months. The mean treatment duration was 6.0 ± 2.5 months. The difference in lateral length before and after helmet therapy was significantly greater on the affected skull than the unaffected skull (16.7 ± 12.7 versus 9.0 ± 13.4 mm; P < .01). The difference in the occipital angle before and after helmet therapy was significantly greater on the affected skull than the unaffected skull (-5.7° ± 7.3° versus 4.2° ± 7.9°; P < .01). The cranial vault asymmetry index and occipital angle ratio were significantly reduced after helmet therapy (cranial vault asymmetry index, 9.3% ± 2.3% versus 3.5% ± 3.0%; occipital angle ratio, 1.07 ± 0.05 versus 1.01 ± 0.01; P < .05). CONCLUSIONS -These results suggest that occipital angle measurements using sonography, combined with cephalometry, could provide a better understanding of the therapeutic effects of cranial molding helmet therapy in infants with deformational plagiocephaly.

Recent guidelines issued jointly by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine for assessing labor progress differ substantially from those described initially by Friedman, which have guided clinical practice for decades. The guidelines are based on results obtained from new and untested methods of analyzing patterns of cervical dilatation and fetal descent. Before these new guidelines are adopted into clinical practice, the results obtained by these unconventional analytic approaches should be validated and shown to be superior, or at least equivalent, to currently accepted standards. The new guidelines indicate the patterns of labor originally described by Friedman are incorrect and, further, are inapplicable to modern obstetric practice. We contend that the original descriptions of normal and abnormal labor progress, which were based on direct clinical observations, accurately describe progress in dilatation and descent, and that the differences reported more recently are likely attributable to patient selection and the potential inaccuracy of very high-order polynomial curve-fitting methods. The clinical evaluation of labor is a process of serially estimating the likelihood of a safe vaginal delivery. Because many factors contribute to that likelihood, such as cranial molding, head position and attitude, and the bony architecture and capacity of the pelvis, graphic labor patterns should never be used in isolation. The new guidelines are based heavily on unvalidated notions of labor progress and ignore clinical parameters that should remain cornerstones of intrapartum decision-making.

Objective To investigate the clinical effectiveness of and parents’ perspectives on cranial-molding orthotic treatment. Methods Medical charts were reviewed for 82 infants treated for plagiocephaly with cranial-molding orthoses in our clinic from April 2012 to July 2016 retrospectively. Infants who were clinically diagnosed with positional plagiocephaly and had a Cranial Vault Asymmetry Index (CVAI) of more than 3.5% were included. Pre- and post-treatment CVAI was obtained by three-dimensional head-surface laser scan. Parents’ perceptions of good outcome (satisfaction) were evaluated with the Goal Attainment Scale (GAS). The GAS score assessed how much the parent felt that his or her initial goal for correcting the skull asymmetry was achieved after the treatment. Results The compliance with cranial-molding orthoses was 90.2% (74 of 82 infants). There were 53 infants (65% of the 82 infants) who had adverse events with the cranial-molding orthoses during the study. Heat rash was found in 29 cases (35.4%) and was the most common adverse event. The mean GAS T-score was 51.9±10.2. A GAS T-score of 0 or more was identified for 71.6% of parents. The GAS T-score was significantly related to the age (p

Standardized lateral cephalograms of eleven skulls with artificial cranial deformations from Eastern Europe and twenty normal skulls from the same population were made, digitized and imported into the AutoCAD 2005 computer program. The x- and y-coordinates of defined measuring points were determined and angle measurements were made. The form difference of the skulls was tested with the Euclidean Distance Matrix Analysis (EDMA) and the difference of the angle measurements were compared statistically using the non-parametric Mann-Whitney test. All deformed skulls belonged to the tabular fronto-occipital type of deformation. The results of the EDMA and the angle measurements indicated significant differences for the neurocranium and the facial cranium in height between the normal and the deformed skulls, but not in the cranial length. It can be concluded that in Eastern Europe one method of cranial molding was used. The deformation of the neurocranium also affected the development of the facial cranium regarding facial height. This may indicate a dependency of the developmental fields of the neurocranium and facial cranium.

Background Management of positional plagiocephaly by wearing a cranial molding helmet has become a matter of growing medical interest. Some research studies reported that starting helmet therapy early (age 5 to 6 months) is important and leads to a significantly better outcome in a shorter treatment time. The aim of the present study was to evaluate the effectiveness of cranial remodeling treatment with wearing helmet for older infants (≥18 months). Methods We conducted a retrospective study of 27 infants with positional plagiocephaly without synostosis, who were started from 2008 to 2012. Every child underwent a computerized tomography (CT) before starting helmet therapy to exclude synostosis of the cranial sutures and had CT performed once again after satisfactory completion of therapy. Anthropometric measurements were taken on using spreading calipers in every child. The treatment effect was compared using cranial vault asymmetry (CVA) and the cranial vault asymmetry index (CVAI), which were obtained from diagonal measurements before and after therapy. Results The discrepancy of CVA and CVAI of all the patients significantly decreased after cranial molding helmet treatment in older infants (≥18 months) 7.6 mm from 15.6 mm to 8 mm and 4.51% from 9.42% to 4.91%. Six patients had confirmed successful outcome, and all subjects were good compliance patients. The treatment lasted an average of 16.4 months, was well tolerated, and had no complication. Additionally, the rate of the successful treatment (final CVA ≤5 mm) significantly decreased when the wearing time per was shorter. Conclusion This study showed that treatment by cranial remodeling orthosis was effective if the patient could wear the helmet longer and treatment duration was somewhat longer than in younger patients, well tolerated in older infants and had no morbidity. This therapeutic option is available and indicated in these older infants before other cranial remodeling surgery.

The growing number of infants with deformational plagiocephaly (DP) has raised clinical questions about which children, at what age, and how molding helmet therapy (MHT) should be performed especially in Japan. A total of 1,011 Japanese pediatric head deformity infants had undergone MHT after being diagnosed with non-synostotic DP. Three ratios of left to right comparison (anterior, posterior, and overall) were created and analyzed comparing age of starting treatment, helmet wearing period, and severity of skull deformity before with after MHT. The averages of head symmetry ratios after treatment in all groups (for the occipital region) showed apparent improvement; t(930) = −60.86, p = 0.000. (t(932) = −57.8, p = 0.000.) In the “severe” deformation group, the earlier the treatment was started, the higher symmetry ratio recovery was obtained. Treatment was especially effective when started in 4-month-old infants. In contrast to the “severe” group, the “mild” deformation group showed that MHT was most effective if treatment started before 6 months of age. Again, the earlier the treatment was started, the higher symmetry ratio was achieved, but compared to the “severe” group, it had a modest effect when treatment was started in infants older than 8 months. This is the first large-scale molding helmet study reporting the method and efficacy in Japanese infants. It demonstrated that despite the structural and physiological differences from infants of other races, molding helmet therapy is effective in Asian-born infants, provided that intervention timing and recognition conditions are met.

An assistive device (AD) was used to treat 122 infants with moderate-to-severe positional plagiocephaly. Clinical evaluations indicate that the AD provided the most benefit when applied to 2- to 8-month-old children. Our results suggest that the AD may join molding helmets and physical therapy as a treatment for moderate-to-severe positional plagiocephaly in infants under the age of 1 year.

Asymmetrical headshape in infants has increased markedly since the 1992 recommendation of the American Academy of Pediatrics to reduce the risk of sudden infant death syndrome by avoiding the prone sleeping position. Cranial molding correlated to restrictive intrauterine environment, birth trauma, torticollis, positioning, lack of full bone mineralization, neurological deficits, and any combination of the above. Nursing interventions to prevent cranial molding include alternative mattress surfaces and repositioning. The research strongly supports repositioning of infants to improve cranial vault symmetry.

Summary Deformational plagiocephaly (DP) is a multifactorial non-synostotic cranial deformity with a reported incidence as high as 1 in 7 infants in North America. Treatment options have focused on non-operative interventions including head repositioning and the use of an orthotic helmet device. Previous studies have used linear and two dimensional outcome measures to assess changes in cranial symmetry after helmet therapy. Our objective was to demonstrate improvement in head shape after treatment with a cranial molding helmet by using Root Mean Square (RMS), a measure unique to 3D photogrammetry, which takes into account both changes in volume and shape over time. Three dimensional photographs were obtained before and after molding helmet treatment in 40 infants (4–10 months old) with deformational plagiocephaly. Anatomical reference planes and measurements were recorded using the 3dMD Vultus ® analysis software. RMS was used to quantify symmetry by superimposing left and right quadrants and calculating the mean value of aggregate distances between surfaces. Over 95% of the patients demonstrated an improvement in symmetry with helmet therapy. Furthermore, when the sample of infants was divided into two treatment subgroups, a statistically significant correlation was found between the age at the beginning of treatment and the change in the RMS value. When helmet therapy was started before 7 months of age a greater improvement in symmetry was seen. This work represents application of the technique of RMS analysis to demonstrate the efficacy of treatment of deformational plagiocephaly with a cranial molding helmet.

In nonhuman anthropoids, the anteroposterior (AP) diameters of the fetus are greater than the transverse (TR) diameters and the AP diameters of the pelvic planes are greater than the TR diameters: during labor, therefore, the fetus moves through the birth canal without changing position or orientation. In modern humans, the fetal head at term is encephalized and the fetal chest is flattened. The maternal pelvic inlet is flattened in an AP direction, the sacral promontory and the ischial spines are prominent. As a result, AP TR at the midpelvis and outlet. In addition, the birth canal presents a marked sacral curvature in the AP direction. The human fetus successfully negotiates the birth canal because the three crucial fetal adaptations: (1) spheroidicity of the presenting part of the fetal head, which allows it to “roll” in the pelvis; (2) mobility of the head and chest in all directions; and (3) a capacity for cranial molding, which adapts fetal head dimensions to pelvic dimensions. The result is that the human fetal head and chest can perform multiple rotational movements in order to always present the greatest fetal diameters to the greatest pelvic diameters. Monkeys show a limited degree of encephalization and suffer from narrow TR pelvic diameters without any possibility of fetal adaptations as shown by humans. Apes also show some encephalization but, because of wider TR diameters in the pelvis, they achieve an easy delivery with no need of fetal adaptations.

Introduction: Minimally invasive endoscopic techniques for the treatment of sagittal craniosynostosis have been shown to achieve excellent long-term outcomes. The objective assessment of calvarial reconfiguration centers on serial measurement of cephalic index. Limited objective information is present in the literature about changes in the cephalic index over the course of postoperative helmet therapy. Our primary objective in this retrospective case series is to quantify this change in cephalic index, with secondary objectives intending to show that the rate of cephalic normalization decreases further from surgery irrespective of other variables. Methods: We analyzed data from 7 cases of primary sagittal craniosynostosis treated with endoscopic wide vertex craniectomy and biparietal wedge osteotomies performed at our institution between 2012-2013 in infants aged 3-6 months. Each patient’s cephalic index was quantified using preand postoperative STAR scanning over the course of up to one year. We compared changes in cephalic index one week after surgery to the rate of change further from the operation using ttest analysis. Results: Although patient compliance with STAR Scan was not consistent, (range of 36 STAR Scans per patient) the immediate postoperative difference from surgery to first (1 week) STAR Scan was significant. In comparison to the total change, 33% of cephalic index normalization occurred during this one week period versus the rest of the year (average change of 0.0436). In fact, 4 months after surgery little to no change in cephalic index occurred. At the conclusion of the study, all patients noted normalization of cephalic index (range of 0.76-0.81). Conclusions: The majority of improvement in cephalic index occurs most rapidly after initial surgical intervention, consistent with observations at other institutions. This change is noticeably visible on the operating room table, and quantifiable at initial STAR scan. Change occurs throughout helmet therapy, but at a slower rate of change further from surgical inter

The objective of this study was o determine the efficacy of a newly developed pneumatic orthotic cranial molding helmet for correcting positional plagiocephaly. The design was retrospective and the setting was a tertiary care center. Subjects were all patients in whom positional plagiocephaly has been diagnosed and who have been fitted by the Orthotics and Prosthetics Department for the helmet. Diagonal cranial lengths and widths were measured at each visit. Analysis included the calculation of the ratio change in oblique diameters compared with time, patient's age, and head circumference. Seventy-five patients met inclusion criteria (50 boys, 25 girls). Patients with pneumatic orthotic cranial molding helmet therapy had significantly improved outcomes as compared with pretreatment measurements (P < or = 0.0001). The helmet did not limit cranial growth as evidenced by significant normalization of the oblique measurement ratio when compared with increasing cranial circumference and age (P = 0.0003, P < or = 0.0001, respectively). The pneumatic orthotic cranial molding helmet successfully corrects positional plagiocephaly and does not hinder cranial growth.

Infant positional plagiocephaly, a cranial molding deformity expressed by asymmetrical head shape, is on the rise. The increase correlates with the recommendation by the American Academy of Pediatrics that infants be placed on their backs to sleep to reduce the risk of sudden infant death syndrome. The majority of misshapen heads develop because infants are placed to sleep in the same supine position, without head rotation. Infant molding deformities will generally improve with repositioning and cranial growth, but permanent deformation can occur, especially without early treatment. This article informs pediatric practitioners about positional plagiocephaly, offers preventative and treatment interventions, and reviews treatment options.

Our research indicates that infant head molding, the application of pressure or bindings to cranial bones to alter their shapes, is prevalent among various Caribbean, Latino, European, African American, Asian, and Native American groups. The data emerged during a cross-cultural anthropological study of child care practices. The documentation of the practice of intentional infant cranial molding, specifically during the first year after birth, has far-reaching implications, particularly for those medical personnel assessing children with dysmorphic crania suggestive of idiopathic craniosynostosis and craniostenosis.

Summary Congenital craniotabes, or cranial osteoporosis, is studied in relation to certain etiologically important factors in intracranial birth trauma, such as cranial molding and duration of labor. This study, supplementing an carlier investigation, now comprises 1,425 nonselected, apparently full-term newborn infants in Los Angeles and Mexico City, and the corresponding maternal obstetrical histories. It confirms the relationship of congenital craniotabes to cranial molding and separated cranial sutures as observed in the neonatal period, and rules out any relationship to the type of delivery and duration of labor. No published reports were foundconcerning the relationship of congenital craniotabes to any of these factors with the exception of separated cranial sutures. This study provides the basis for anew approach to the problem of intracranial birth trauma, namely, investigating it in relation to cranial ostoporosis in the full-term infant, and thus supports a broader clinical concept of congenital craniotabes.

A study was conducted to compare the perceived attractiveness of preterm infants with postnatal cranial molding to that of preterm and full‐term infants without this deformation. Forty‐two subjects who viewed photographs of infants selected preterm infants with postnatal cranial molding as the least attractive group of infants. Researchers have hypothesized that infant appearance is an antecedent to bonding and attachment. Nurses should implement measures such as the use of waterbed mattresses, which have been found to minimize the molding process, and include discussion of this measure when teaching parents about their preterm infants so that they are aware of causes and prevention of cranial molding. If an infant has developed postnatal cranial molding, the parents may require counseling to assist them in resolving their feelings about the discrepancy in the appearance of the infant and what they had anticipated prenatally.