Clinical Bottom Line: Parents are provided with a multitude of information regarding the risk and prevention of sudden infant death syndrome (SIDS). The “Back to Sleep” campaign has had a substantial effect in decreasing the incidence of SIDS. Although the research is showing a correlation between the “Back to Sleep” campaign and an increased incidence of plagiocephaly and motor development delay, the intention of the program continues to be significantly worthwhile. These effects in comparison to SIDS are relatively minor however, can easily be prevented with awareness and education. Through an extensive literature review we found that there is a consistent positive correlation between supine sleeping and slight motor delay however all the studies show that these delays are no longer significant by the time the infant is upright and walking. More recent studies address the impact of prone awake time amongst supine sleepers and are showing a decrease in motor delay amongst infants who are given more opportunities to spend time in prone while awake.
We also found reports of a positive correlation between supine sleeping and the increased incidence of positional plagiocephaly. Studies are showing that there are no significant differences between the two main treatment options, repositioning or orthotic helmets, for positional plagiocephaly. Rather age seems to be the determining factor for treatment outcomes regardless of the technique used. In general, infants treated before the age of six months are shown to get the maximum benefit. After the age of six months orthotic helmets are shown to be more effective than repositioning. Orthotic helmets and repositioning therapy are both effective in reducing plagiocephaly. However, orthotic helmets tend to be a quicker treatment option but they are more restrictive and often rejected due to the stigma attached. Repositioning requires a lot of parental involvement, however is cost free and can be implemented into everyday activities.
For our clinical scenario we would encourage the mother to give her four month old opportunities to spend awake, supervised time in the prone position to prevent further delays. In regards to the plagiocephaly, we would discuss the benefits and drawbacks of both treatment options allowing her to decide what is more appropriate for her family’s lifestyle. To express our own recommendations, we would suggest a sufficient trial period of 2 months of repositioning starting right away at age 4 months, with a back up option of an orthotic helmet if the results are not adequate.
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