Comparison of perceptions and treatment practices between neurosurgeons and plastic surgeons for infants with deformational plagiocephaly

Clinical article

Restricted access


Deformational plagiocephaly (DP) is the leading cause of head shape abnormalities in infants. Treatment options include conservative measures and cranial molding. Pediatric neurosurgeons and craniofacial plastic surgeons have yet to agree on an ideal therapy, and no definable standards exist for initiating treatment with helmets. Furthermore, there may be differences between specialties in their perceptions of DP severity and need for helmet therapy.


Requests to participate in a web-based questionnaire were sent to diplomates of the American Board of Pediatric Neurological Surgery and US and Canadian members of the Pediatric Joint Section of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons and the American Cleft Palate–Craniofacial Association. Questions focused on educational background; practice setting; volume of DP patients; preferences for evaluation, treatment, follow-up; and incentives or deterrents to treat with helmet therapy. Six examples of varying degrees of DP were presented to delineate treatment preferences.


Requests were sent to 302 neurosurgeons and 470 plastic surgeons, and responses were received from 71 neurosurgeons (24%) and 64 plastic surgeons (14%). The following responses represented the greatest variations between specialties: 1) 8% of neurosurgeons and 26% of plastic surgeons strongly agreed with the statement that helmet therapy is more beneficial than conservative therapy (p < 0.01); and 2) 25% of neurosurgeons and 58% of plastic surgeons would treat moderate to severe DP with helmets (p < 0.01).


Survey responses suggest that neurosurgeons are less likely to prescribe helmet therapy for DP than plastic surgeons. Parents of children with DP are faced with a costly treatment decision that may be influenced more strongly by referral and physician bias than medical evidence.

Abbreviation used in this paper: DP = deformational plagiocephaly.

Article Information

Address correspondence to: Amy Lee, M.D., Washington University School of Medicine, Department of Neurosurgery, Campus Box 8057, 660 South Euclid Avenue, St. Louis, Missouri 63110. email:

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Bar graph showing the training and practice backgrounds of respondents. A+P = academic and private; NS = neurosurgeon; PS = plastic surgeon.

  • View in gallery

    Box and whiskers plots showing the 25th and 75th percentiles (box) and range (whiskers) of the percentage of patients that actually receive helmet therapy by specialty.

  • View in gallery

    Bar graph showing responses to the statement: “Helmet therapy is more beneficial than conservative management for deformational plagiocephaly.”

  • View in gallery

    Overhead-view computer-generated images of varying degrees of DP (mild, moderate, severe) and bar graphs showing physicians' responses to being asked whether they would treat these infants with a helmet. Avg = average.



American Academy of Pediatrics AAP Task Force on Infant Positioning and SIDS: Positioning and SIDS. Pediatrics 89:6 Pt 1112011261992


Argenta LCDavid LRWilson JABell WO: An increase in infant cranial deformity with supine sleeping position. J Craniofac Surg 7:5111996


Biemer PPLyberg LE: Introduction to Survey Quality Hoboken, NJJohn Wiley & Sons2003


Bruner TWDavid LRGage HDArgenta LC: Objective outcome analysis of soft shell helmet therapy in the treatment of deformational plagiocephaly. J Craniofac Surg 15:6436502004


de Leeuw Ede Heer WTrends in household survey nonresponse: a longitudinal and international comparison. Groves RMDillman DAEltinge JL: Survey Nonresponse New YorkJohn Wiley & Sons2002. 4154


Graham JM JrGomez MHalberg AEarl DLKreutzman JTCui J: Management of deformational plagiocephaly: repositioning versus orthotic therapy. J Pediatr 146:2582622005


Kane AAMitchell LECraven KPMarsh JL: Observations on a recent increase in plagiocephaly without synostosis. Pediatrics 97:8778851996


Kordestani RKPatel SBard DEGurwitch RPanchal J: Neurodevelopmental delays in children with deformational plagiocephaly. Plast Reconstr Surg 117:2072202006


Loveday BPde Chalain TB: Active counterpositioning or orthotic device to treat positional plagiocephaly?. J Craniofac Surg 12:3083132001


Steinbok PLam DSingh SMortenson PASinghal A: Longterm outcome of infants with positional occipital plagiocephaly. Childs Nerv Syst 23:127512832007




All Time Past Year Past 30 Days
Abstract Views 48 48 21
Full Text Views 73 73 4
PDF Downloads 105 105 4
EPUB Downloads 0 0 0


Google Scholar