Positional skull deformation in infants: heading towards evidence-based practice

The shape of a young infant’s skull can deform as a result of prolonged external forces. The prevalence of positional skull deformation increased dramatically during the last decades. The primary aim of this dissertation was to provide a stronger evidence base for the treatment of skull deformation. A second aim was a better understanding of the decision for treatment by parents and preferences for treatment of professionals. Both aims were met in the HEADS (HElmet therapy Assessment in Deformed Skulls) study. The HEADS study started as a cohort study for infants aged two to four months with positional preference and/ or skull deformation who started pediatric physical therapy. After follow-up at the age of five months, the study continued as an RCT into the effects and costs of helmet therapy. In parallel with the RCT, a non-randomized controlled trial (nRCT) was carried out. Firstly, the dissertation described that infants presenting with skull deformation at baseline and infants who start therapy at an older age (>3 months) were more likely to respond poorly to pediatric physical therapy. Next, based on the equal effectiveness of helmet therapy compared with the natural course, the high prevalence of side effects and the high costs of treatment, the use of helmet therapy is being discouraged as a standard treatment for healthy infants with moderate or severe skull deformation. Secondly, it was found that the parents’ decision to start helmet therapy for their five month-old with skull deformation was mostly influenced by the expected additional value of helmet therapy compared to the natural course of skull deformation and their (dis)satisfaction with their infant’s appearance. In a study into different prescription rates of helmet therapy in the Netherlands and New Zealand, differences in beliefs and attitudes with regard to consequences of helmet therapy and the natural course of skull deformation were found between healthcare professionals in both countries. Outcomes presented in this dissertation should lead to evidence-based decision-making by parents and professionals regarding treatment for infants with skull deformation, more efficient health care, less infants with persistent skull deformation and less concerned parents