Management of Congenital Brachycephaly

Diagnosis and Assessment

• Clinical examination is the primary method for diagnosing brachycephaly, with imaging rarely necessary except in equivocal cases 3, 4
• Brachycephaly is characterized by flattening of the entire occipital region, resulting in a foreshortened head in the anterior-posterior dimension 1
• In cases where clinical examination is unclear, three-dimensional surface imaging or stereophotogrammetry is recommended for assessment 4
• CT scans should only be used when x-rays or ultrasound are non-diagnostic, to definitively rule out craniosynostosis 5

Treatment Algorithm

First-Line Interventions

• Repositioning therapy is effective for mild cases of brachycephaly, but parent education on proper positioning techniques is essential 1, 2
• Physical therapy is superior to repositioning alone based on randomized controlled trials, and is particularly effective for mild to moderate deformity 1, 2, 6
• The American Academy of Pediatrics warns against soft positioning devices in the sleeping environment, and they are not recommended 2

Common Pitfalls

• Failing to distinguish between positional brachycephaly and synostotic brachycephaly (which requires surgical intervention) 1
• Relying solely on repositioning for moderate to severe cases, which is less effective than combined approaches or helmet therapy 2