Background : Although helmet treatment is still controversially discussed, the efficiency is evident. The outcome depends significantly on an optimal entrance age of 4–6 months of life. But often parents and affected children are seen by various medical therapists prior to the first consultation at a specialist. We investigated the pathways to treatment to detect how much delay exists.
Methods : Parents and caregivers of 218 children with positional plagiocephaly were interviewed by telephone. 122 of the infants underwent a helmet therapy. The questionnaire inquired which persons were involved at what time in the recognition and treatment of the deformity and what kind of treatment was applied prior to the first consultation at our department. Descriptive and statistical analysis was performed.
Results : The first recognition of the deformity happened in more than 77% until the 4th month of age, mostly by the parents (61%). 99% of the parents reported the problem to the paediatrician with a mean latency of 0.41 months. Diagnosis was established after 1.9 months (SD 2.1). It took in mean 3.1 months (SD 2.1) for non-helmet infants and 3.5 months (SD 2.2) for helmet infants to consult our department. 69% of the infants in the group without helmet therapy and 80% in the helmet group received both positioning and physiotherapy or osteopathy. Children who underwent physio- or osteopathy came significantly later ( p = 0.023).
Conclusion : Although watch and wait strategy and physiotherapy are accepted and approved methods a delayed referral to a specialist might be problematic for infants in need for a helmet. Missing the optimal entrance age may potentially deteriorate the outcome. An immediate referral to a specialist and if necessary a simultaneous application of different treatments (physiotherapy, helmet) should be preferred to a step by step approach.
Key words : positional plagiocephaly; helmet therapy