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Warning: If you are a parent worried about your child´s head shape, this document will serve you as a guide to ROUGHLY assess your baby´s condition. It should never be used BY ITSELF to issue a diagnostic without accounting for other factors that might affect your particular child´s skull development.

This document is intended to be used by healthcare professionals who understand all factors involved in newborn cranial growth.

How to measure Brachycephaly and Scaphocephaly:

1-

Although Braquicephaly and Scaphocephaly are of diferent origin, both afect the relationship between width and length of the skull. To assess the degree of deformity, we need to measure length (A-P) and width (S-D) with the craneometer.

2-

Measure the distance AP. Point A is placed between the eyebrows and slightly above them. Point P, is the furthest away point at the back of the heado. Point A corresponds to Nasio and P corresponds to Lineum.

3-

Now, measure the distance SD as the widest point of the skull, parallel to the face. Usually those points are slightly above and behind the ears.

4-

Calculate Craneal Index (CI) with the following formula:


5-

Although standard CI varies slightly from male to female and amongst races we can safely consider 78% as a general average.

What we are interested is how much our patient deviates from the standard CI. we call this Deformation Index (DI). We calculate this as follows:

Brachycephaly
(CI bigger than 78%)
DI(%)=CI-78
Scaphocephaly
(CI smaller than 78%)
DI(%)=78-CI

The issue we need to address is this:

HOW MUCH DEFORMITY (DI) CAN WE CORRECT FOR A GIVEN BABY?


With the previous question in mind we have developed the following curve as a guidance for parents and doctors to know whether a baby needs an orthotic device or positioning techniques are sufficient to correct the brachycephaly.

It is based on the remaining cranial growth that a baby has before 2 years of age. Head will continue to grow in size after 2 years of age but the shape is fixed once the fontanelles are closed and that usually happens at 2 years of age.

The curve represents the maximum head deformity that we can correct by positioning and prevention techniques. Those include counter positioning, head counter positioning, Mimos Pillow, Tummy time, cot counterpositioning and baby carriage.

Please understand this is just a general guideline based on average skull growth. Certain babies ability to recover might vary substantially from this curve. For example the closing of the fontanelles hapens in average at 2 years of age but in some babies this might happen as early as 12 months and others as late as 30 months.

This graph is intended as an extra diagnose tool for specialists who understand cranial growth and development. DON'T USE IT TO ISSUE A DIAGNOSTIC JUST BY ITSELF.

Examples of how to read this graph:

- A baby of 1 month old with a DI=18% is usually considered a severe case and is given in many instances advice to use an orthotic device. At 1 month old there is sufficient craneal growth left to correct this with positioning techniques.

- A baby of 3 months old with a DI=14% is on the limit of recovery. We have to be extremely strict with positioning and monitor the deformity very closely. If we don't manage to keep the deformity under the curve in the following months we should use an orthotic band.

- A baby of 12 months and DI=6% is above the curve, meaning that without corrective helmet he won't recover completely. A 12 months old baby can recover DI=2% which will left behind DI=4% untreated. Having this piece of information parents can decide whether they want a corrective helmet or not.

Premature babies: Please use Adjusted age, not Chronological age. Count as if the baby was born on the exact due date.