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J Pediatr. 2013 Jun;162(6):1216-21, 1221.e1. doi: 10.1016/j.jpeds.2012.11.076. Epub 2013 Jan 11.

A prospective randomized trial on preventative methods for positional head deformity: physiotherapy versus a positioning pillow.

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Department of Cranio-Maxillofacial Surgery, University Hospital Giessen, Giessen, Germany.



To evaluate the impact of stretching exercises versus available bedding pillows on positional head deformities.


Fifty children aged 5 months or younger with positional head deformity were included in this prospective clinical trial (n=20 plagiocephaly, n=10 brachycephaly, n=20 combination). A random distribution was performed for treatment with the bedding pillow alone (n=25) or with stretching exercises (n=25) for 6 weeks. Anthropometric caliper measurements were done before and after that interval. Cranial vault asymmetry index (CVAI) and cranial index (CI) were calculated and analyzed using a descriptive statistical general linear model.


ΔCVAI in the stretching group was 2.09% for plagiocephaly and 2.34% for combined head deformities. Using the bedding pillow, ΔCVAI was 3.01% in plagiocephal children and 2.86% for combined head deformity. The ΔCI in the stretching group was 0.94% for isolated brachycephal children and 2.24% for combined head deformity. ΔCI in the pillow group was 3.63% for brachycephaly and 3.23% in children with combined head deformities, respectively.


Bedding pillows and stretching exercises both resulted in improvements in positional cranial deformation. For children with combined plagiocephaly and brachycephaly, improvement in cranial asymmetry was slightly greater when using bedding pillows versus stretching.

[Indexed for MEDLINE]

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