Comparative analysis of goal attainment for helmet therapy versus conservative management for positional plagiocephaly in infants.

Background: Positional plagiocephaly (PP) is a common cranial asymmetry of infancy. Its treatment options include conservative management and helmet therapy. However, the efficacy of each, particularly at achieving a normal cranial shape, remains uncertain.

Purpose: This study aimed to compare the efficacy of conservative management and helmet therapy for PP.

Methods: We retrospectively analyzed 199 infants with PP treated in 2015-2024. A total of 72 patients with a minimum treatment duration of 90 days and minimum plagiocephaly severity level of 2 (Children's Healthcare Atlanta Plagiocephaly Severity Scale) were included. Of them, 36 received conservative management and 36 received helmet therapy. Each infant underwent three-dimensional surface scanning of the cranium (StarScanner).

Results: The mean±standard deviation age at treatment initiation was 31.9±6.6 weeks in the helmet group versus 21.0±5.7 weeks in the conservative management group (P<0.001). The average treatment duration was 21.9 (interquartile range [IQR], 15.3-31.4) weeks vs. 20.6 (IQR, 14.1-26.6) weeks (P=0.171), respectively. The monthly correction speed of the cranial vault asymmetry index (CVAI) was comparable between groups (0.66±2.09 vs. 0.64±0.55, P=0.964). Plagiocephaly degree was reduced to level 1 in 9 of 36 patients (25%) who received helmet therapy versus 4 of 36 patients (11%) in the conservative management group (P=0.220), whereas a reduction in severity level was observed in 24 of 36 (67%) versus 15 of 36 (42%), respectively (P=0.058). In the helmet group, an earlier treatment initiation was significantly associated with a greater severity level reduction (r=-0.480, P=0.003). A longer treatment duration showed a trend toward a greater reduction in CVAI (r=0.331, P=0.052). In the conservative management group, both earlier treatment initiation (r=-0.537, P<0.001) and longer treatment duration (r=0.381, P=0.022) correlated significantly with improved outcomes.

Conclusion: Conservative management and helmet therapy reduced cranial asymmetry with no significant difference in correction speed. An early treatment initiation was the strongest predictor of improvement, while a longer treatment duration was associated with better outcomes. A trend toward a greater reduction in severity level was observed with helmet therapy, suggesting its potential benefits in more severe cases.